The relationship between C-reactive protein to lymphocyte ratio and the prevalence of myocardial infarction in US adults: A cross-sectional study

Comparison of the clinical value of inflammatory blood biomarkers in relation to disease severity and survival in chronic heart failure

BACKGROUND

Chronic heart failure (CHF) is a leading cause of hospitalization among the elderly in developed nations. CHF involves myocardial dysfunction and systemic disturbances, leading to high morbidity and mortality, particularly in the elderly. The New York Heart Association (NYHA) classification is the primary tool for stratifies severity of heart failure by patient-reported symptoms. Inflammation plays a key role in CHF progression, and identifying reliable inflammatory biomarkers is crucial for assessing disease severity and predicting outcomes.

AIMS

This study aimed to evaluate the diagnostic and predictive value of 27 different inflammatory blood biomarkers in differentiating patients with varying disease severity based on the NYHA classification and to assess their prognostic significance in CHF.

METHODS

A group of 154 CHF patients (mean age: 72.1 ± 13.5 years) was retrospectively analyzed. Inflammatory blood biomarkers were correlated with NYHA classification, left ventricular ejection fraction (LVEF), pulmonary artery systolic pressure (PASP), NT-proBNP and patient survival.

RESULTS

Of 27 biomarkers, lymphocyte-to-CRP ratio (LCR), CRP-to-lymphocyte ratio (CLR) and CRP-to-albumin ratio (CAR) demonstrated highest diagnostic accuracy for distinguishing between NYHA classification (AUC > 0.700). Five biomarkers: CLR, CAR, LCR, CRP-to-hemoglobin ratio (CHR) and neutrophil-to-CRP ratio (NCR) correlates with NYHA, LVEF%, PASP, and NT-proBNP. CAR, CHR and platelet-to-CRP ratio (PCR) were identified as independent factors affecting patient survival.

CONCLUSIONS

Selected blood inflammatory biomarkers, including CAR, CLR, LCR, CHR, and PCR, which are based on CRP, are valuable for predicting disease severity and survival in CHF, offering potential for enhanced clinical management.

Association between C-reactive protein to lymphocyte ratio and gallstones: a cross-sectional study

BACKGROUND

Inflammation plays a key role in the development of gallstones, and the C-reactive protein to lymphocyte ratio (CLR) has been introduced as a promising biomarker for evaluating inflammatory processes. Nonetheless, its correlation with gallstone prevalence remains ambiguous. This study aims to evaluate the potential link between CLR levels and gallstone prevalence.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey, covering the periods from March 2017 to 2020 and 2021 to 2023. Multivariate logistic regression was employed to examine the association between CLR and gallstone prevalence. Furthermore, smoothed curve fitting, subgroup analysis, and interaction testing were performed to provide a comprehensive evaluation. We also employed receiver operating characteristic (ROC) curves to determine the predictive ability of the index for gallstones.

RESULTS

Among the 13,386 participants included in this study, 1,444 were diagnosed with gallstones. In a fully adjusted model, a small but statistically significant positive association between CLR and the prevalence of gallstones was observed (odds ratio [OR] = 1.07, 95% CI: 1.01-1.12). Compared to individuals in the lowest tertile of CLR (T1), those in the middle tertile (T2) showed a non-significant increase in gallstone prevalence (OR = 1.10, 95% CI: 0.94-1.29), while the highest tertile (T3) exhibited a statistically significant elevation (OR = 1.20, 95% CI: 1.03-1.41). Smoothed curve fitting further confirmed this positive relationship. Bonferroni-corrected subgroup analysis demonstrated a statistically significant association between CLR and gallstones in the "Married/Living with Partner" subgroup (P < 0.0015), while no significant associations were observed in the other subgroups. Additionally, Bonferroni-corrected interaction tests indicated no significant interactions between CLR and gallstones across all subgroups (P for interaction > 0.0038).

CONCLUSION

Higher CLR was associated with higher gallstone prevalence. However, additional large-scale prospective studies are required to further investigate the role of CLR in the prevalence of gallstones.

The role of C-reactive protein to lymphocyte ratio in NAFLD and mortality among NAFLD patients

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is recognized as the predominant chronic liver disorder globally. Inflammation is integral to the onset and progression of NAFLD. The C-reactive protein to lymphocyte ratio (CLR), a novel inflammatory marker, has yet to be explored in the context of NAFLD.

METHOD

This investigation encompassed 4371 individuals from the National Health and Nutrition Examination Survey (NHANES) conducted between 2015-2018. Weighted logistic regression was employed to examine the correlation between CLR and NAFLD. Weighted Cox proportional hazards models were utilized to evaluate the association between CLR and all-cause and Cardiovascular disease (CVD) mortality in patients with NAFLD. Restricted cubic spline (RCS) curves were employed to assess the dose-response relationship. Threshold effect analysis was used to determine the existence of an inflection point.

RESULT

After adjusting for all included covariates in Model 3, a positive correlation between lnCLR and NAFLD was identified (OR = 1.45, 95% CI = 1.16-1.81, P = 0.010). However, no significant association was observed between it and all-cause as well as CVD mortality among patients with NAFLD. The RCS curve illustrated a nonlinear association between CLR and NAFLD (P-nonlinear < 0.0001). Threshold effect analysis determined that the inflection point occurs at CLR = 1.667.

CONCLUSION

CLR exhibited a nonlinear positive association with NAFLD. Higher CLR levels may increase the risk of NAFLD. However, CLR does not affect all-cause and CVD mortality in patients with NAFLD.

Association between cardiometabolic index and myocardial Infarction: based on NHANES database

BACKGROUND

The cardiometabolic index (CMI) combines abdominal obesity and abnormal blood lipid indices, representing a good predictive indicator of risk in cardiovascular diseases (CVDs). However, the association between CMI and myocardial infarction (MI) is not clear.

OBJECTIVE

The present project was designed to explore the linkage between CMI and MI.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were employed in this project, with CMI as the independent variable and MI as the dependent variable. Weighted logistic regression was applied in the association analysis between CMI and MI. Restricted cubic spline (RCS), subgroup analysis, and interaction tests were employed to elucidate the non-linear relationship and stability of CMI and MI's link. Moreover, to verify the robustness of the results, sensitivity analysis was conducted, with the MI status of subjects taking lipid-lowering drugs as the outcome variable.

RESULTS

A total of 13,923 participants were gathered in this project, with 605 cases of MI, accounting for 3.5%. In the weighted logistic regression model, a positive linkage was observed between CMI and the risk of MI (OR: 1.41, 95% CI: 1.18-1.68, p < 0.001). The RCS curves indicated a linear relationship between CMI and MI (P-non-linear = 0.146). Subgroup analysis manifested that CMI was positively linked with MI risk in males, individuals with BMI > 30kg/m2, and alcohol drinkers (p < 0.05). In addition, the interaction results demonstrated that there was no heterogeneity in the association between CMI and MI risk in the subgroups (p > 0.05). The sensitivity analysis showed that after adjusting for all confounding factors in the model, there was still a significant positive correlation (p < 0.01) between CMI and MI in the population taking lipid-lowering drugs.

CONCLUSION

There is a significant positive linkage of CMI with MI risk, which is particularly significant in males, those with a BMI greater than 30 kg/m2, and those who have drinking habits. Even after considering the impact of lipid-lowering drug therapy, the positive correlation between CMI and MI remains robust, supporting CMI as a promising tool for assessing MI risk and guiding clinical prevention. Further research is required to probe into the application of CMI in different populations and its role in the prevention of CVDs.

The relationship between C-reactive protein to lymphocyte ratio and the prevalence of chronic kidney disease in US adults: a cross-sectional study

Objective

The C-reactive protein/Lymphocyte Ratio (CLR) is a novel biomarker whose role in the development of chronic kidney disease (CKD) is not well understood. This study aimed to investigate the correlation between CLR and the prevalence of CKD.

Methods

This cross-sectional study included participants from the US National Health and Nutrition Examination Survey conducted between 1999 and 2010. Multivariate regression analyses and subgroup analyses were performed, controlling for socio-demographic variables, lifestyle behaviors, chronic diseases associated with kidney disease, and biochemical markers of bone metabolism. The associations between CLR and CKD prevalence, as well as indicators of renal damage, were explored. Non-linear relationships were analyzed using weighted restricted cubic splines. The predictive ability of CLR for CKD was assessed by the receiver operating characteristic curve and the area under the curve was calculated. Subgroup and sensitivity analyses were conducted to validate the robustness of the model.

Results

A total of 13,862 respondents were included, comprising 2,449 CKD patients and 11,413 non-CKD patients. Weighted logistic regression modeling revealed a positive correlation between CLR levels and CKD prevalence (Odds ratio [OR] = 1.54, 95% Confidence interval [CI] = 1.30 to 1.83, P < 0.001). Additionally, CLR levels were negatively correlated with the glomerular filtration rate, a marker of renal injury, and positively correlated with the urinary albumin/creatinine ratio. The receiver operating characteristic curve demonstrated that the area under the curve for CLR in predicting CKD was 0.653 (95% CI, 0.641-0.665). The optimal cutoff value was 0.856, with a sensitivity of 0.703, specificity of 0.526, positive predictive value of 0.874, and negative predictive value of 0.275. The robustness of the model was confirmed through subgroup and sensitivity analyses.

Conclusion

Analysis of a large cross-sectional dataset demonstrated a positive correlation between CLR levels and CKD prevalence, suggesting that CLR may serve as a novel marker for the development and treatment of CKD.

Inflammation and nutritional status in relation to mortality risk from cardio-cerebrovascular events: evidence from NHANES

Objective

Inflammation and nutritional status are closely associated with the mortality risk of survivors of cardio-cerebrovascular events. This study aims to evaluate the relationship between inflammation and nutritional indices and mortality among, identifying the most predictive indices.

Methods

This study included cohort data of the survivors of major adverse cardiovascular and cerebrovascular events (MACCE) from the National Health and Nutrition Examination Survey (NHANES) in 1999-2010. MACCE is defined as a composite of myocardial infarction, heart failure and stroke, and at least one of the three events occurs. The main outcomes were all-cause mortality and cardiovascular mortality. Kaplan-Meier analysis and receiver operating characteristic curves were used to compare the correlation between seven inflammatory nutritional indices (such as Advanced Lung Cancer Inflammation Index, ALI) and mortality among the survivors. A multivariable-adjusted Cox regression and restricted cubic splines analysis identified the most predictive index, with the optimal number of nodes determined by the Akaike information criterion. Subgroup and sensitivity analyses were conducted to assess model stability.

Results

A total of 2,045 MACCE survivors were included. The higher levels of ALI and serum albumin were significantly associated with lower risks of all-cause and cardiovascular mortality among these individuals. Increases in C-reactive protein to Lymphocyte Ratio, Neutrophil to Serum Albumin Ratio, Neutrophil-to-Lymphocyte Ratio, Systemic Immune-Inflammation Index (SII), and C-reactive protein were similarly correlated with higher mortality risk. ALI outperformed other indices, displaying a distinct L-shaped nonlinear relationship with both all-cause and cardiovascular mortality among MACCE survivors, with an inflection point at 90 indicating the lowest risk. To the left of this inflection, each unit increase in ALI was associated with a 1.3% decrease in all-cause and cardiovascular mortality risk among MACCE patients. To the right, the risk might increase by 0.2%, although the change was not statistically significant. Subgroup analyses and sensitivity analyses showed that the association between ALI and risk of mortality remained stable in most MACCE survivor populations.

Conclusion

Routine and dynamic monitoring of ALI is helpful for clinicians to assess the mortality risk among MACCE survivors. Anti-inflammatory therapies and appropriate nutritional support are crucial for reducing mortality in these individuals.

Significance of inflammation-related markers and histopathological features in mitral valve regurgitation

The lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-neutrophil ratio (PNR), C-reactive protein (CRP)-to-lymphocyte ratio (CLR) and fibrinogen-to-albumin ratio (FAR) are well-known indicators of the systemic inflammatory response (SIR). Less is known about the association of SIR with the echocardiographic parameters and the histopathological (HP) aspects of the mitral valve in patients who have undergone cardiac surgery to repair or replace the mitral valve. Information on serum parameters, transesophageal echocardiography findings, and HP results was obtained from 166 patients who had undergone cardiac surgery to address mitral valve regurgitation. Among these patients, 30 were diagnosed with mitral valve prolapse, with 15 cases showing mitral valve flail or chordae rupture. The possible association between SIR, echocardiographic aspects of mitral valve flail and the HP aspect was checked. Fibrosis, hyalinization and myxoid degeneration of the valve were scored under microscope. Hyalinization of the mitral valve had a significant positive association with LMR and PLR (p=0.041 and p=0.03, respectively) and with NLR (p=0.093). A higher fibrosis degree was present in the valves without flail compared with those with flail (p=0.000). The monocyte average values of the group without flail were statistically significantly higher than those in the flail group (p=0.029). An increase of one unit in the value of monocytes was found to decrease the chances of flail [odds ratio (OR) 0.017, p=0.068, significant at p<0.1 level]. SIR parameters can be used to appraise inflammation status in mitral valve disease and to establish the risk of chordae rupture/flail in the case of mitral valve prolapse.

Lymphocyte to C-reactive protein ratio is associated with in-hospital cardiac death in elderly patients with non-ST-segment elevation myocardial infarction

Background

Although percutaneous coronary intervention (PCI) is recommended by guidelines, data from the real world suggest that elderly non-ST-segment elevation myocardial infarction (NSTEMI) patients have a low rate of PCI and a high death rate. Lymphocyte to C-reactive protein ratio (LCR), a novel inflammatory marker, has been shown to be associated with prognosis in a variety of diseases. However, the relationship between LCR and in-hospital cardiac death in elderly NSTEMI patients is unclear. The aim of this study was to investigate the effect of LCR on in-hospital cardiac death in elderly NSTEMI patients without PCI therapy.

Methods

This was a single-center retrospective observational study, consecutively enrolled elderly (≥75 years) patients diagnosed with NSTEMI and without PCI from February 2019 to February 2024. LCR was defined as lymphocyte count to C-reactive protein ratio. The endpoint of observation was in-hospital cardiac death. The predictive efficacy of the old and new models was evaluated by the net reclassification index (NRI) and the integrated discriminant improvement index (IDI).

Results

A total of 506 patients were enrolled in this study, and in-hospital cardiac death occurred in 54 patients (10.7%). Univariate logistic regression analysis showed that left ventricular ejection fraction, LCR, Killip ≥2, and N-terminal B-type natriuretic peptide proteins (NT-proBNP) were associated with the occurrence of in-hospital cardiac death. After adjusting for potential confounders, the results showed that NT-proBNP (OR = 1.695, 95% CI: 1.238-2.322) and LCR (OR = 0.262, 95% CI: 0.072-0.959) were independent risk factors for in-hospital cardiac death. After the addition of LCR to NT-proBNP, the predictive ability of the new model for in-hospital cardiac death was significantly improved (NRI = 0.278, P = 0.030; IDI = 0.017, P < 0.001).

Conclusion

Lower LCR is an independent risk factor for in-hospital cardiac death in elderly NSTEMI patients without PCI, and integrating LCR improves the prediction of in-hospital cardiac death occurrence.