The Impact of Neutrophil-to-Lymphocyte Ratio on Short- and Long-Term Prognosis Following Elective Infrarenal EVAR

BACKGROUND

Neutrophil-to-lymphocyte ratio (NLR) is a readily available parameter, associated with long-term outcomes in cardiovascular conditions. This study aims to analyze the predictors of NLR and its impact on prognosis and disease-specific outcomes following endovascular aneurysm repair (EVAR).

METHODS

Single-center retrospective cohort study. Consecutive patients who underwent elective EVAR (2011-2023) were considered. Primary outcome is short-term major adverse events (MAE) and long-term mortality. Secondary outcomes were freedom-from EVAR failure, aortic reintervention, and NLR predictors. Multivariable logistic regression analyses were performed for binary outcomes. Survival outcomes were analyzed through Kaplan-Meier and Cox regression analyses.

RESULTS

Overall, 434 patients were included. A 2.4 NLR cutoff was a fair discriminator for long-term-mortality (area under the curve, 0.62), and groups were dichotomized according to this premise. Increasing age (adjusted odds ratio [aOR]: 1.06; 1.03-1.09, per 1-year increase) and a pulmonary comorbidity (aOR: 1.91; 1.24-2.96) associated to NLR ≥ 2.4. No significant association between comorbidity burden and NLR was observed. MAE occurred more often if NLR ≥ 2.4 (6.2 vs. 11.6% high-NLR, P = 0.049; NLR ≥ 2.4 aOR: 2.10; 1.01-4.36). At 8-years follow-up, survival estimates favored NLR < 2.4 (55.7% vs. 33.7% high-NLR, P < 0.001, NLR ≥ 2.4 adjusted hazard ratio [aHR]: 1.07; 1.05-1.98), without differences in freedom-from EVAR failure (70.6 vs. 68.2% high-NLR, P = 0.27, NLR ≥ 2.4 aHR: 1.26; 0.82-1.94). Conversely, NLR ≥ 2.4 associated with lower freedom from aortic reinterventions (80.0% vs. 70.2% high-NLR, P = 0.01, NLR ≥ 2.4 aHR: 1.80; 1.08-3.01).

CONCLUSION

NLR appears as a prognostic marker with reduced impact of comorbidity burden. Following EVAR, it independently predicts MAE and mortality. Over time, elevated NLR appears associated with increased aortic reinterventions, although rates and mode of failure seem similar across groups.

Role of the Systemic Immune-Inflammation Index and Systemic Immune-Response Index in the Prediction of Adverse Outcomes in Pregnant Women With Antiphospholipid Syndrome

PROBLEM

This study aims to evaluate the role of the systemic immune-inflammation index (SII) and the systemic immune-response index (SIRI) in predicting adverse perinatal outcomes (APO) in pregnant women with antiphospholipid syndrome (APS).

METHODS

This is a retrospective case-control study at the tertiary center, between January 2015 and January 2023. The study included APS cases and a low-risk control group. Pregnant women with APS (n = 52) and controls (n = 104) were compared between SII and SIRI values taken in the first trimester (1) and the last month before birth (2). It was examined whether these indexes predicted APO in cases with APS.

RESULTS

In the APS group, SII and SIRI values taken in the first trimester (1) and in the last month before birth (2) were significantly lower than in the control group (p = 0.015, p = 0.023, p = 0.001, p = 0.001, respectively). The small for gestational age (SGA) rate was 30.8% and the stillbirth rate was 11.5% in the APS group (p = 0.017, p = 0.001). The optimum cutoff values for SGA were 584.97 (75% sensitivity, 77.8% specificity), 688.50 (62.5% sensitivity, 62.9% specificity), and 1.02 (56.3% sensitivity, 77.8% specificity) for SII 1, SII 2, and SIRI 1, respectively. The optimum cutoff value for stillbirth was 1.23 for SIRI 2 (83.3% sensitivity, 89.1% specificity, p = 0.004).

CONCLUSION

Pregnant women with APS had decreased blood indices in the first trimester and the last month before birth compared to the control group. In cases with APS, these indices can predict APOs like SGA and stillbirth.

Association of NLR with all-cause and cardiovascular mortality in adults with coronary heart disease: 1999-2018 NHANES data analysis

The neutrophil-to-lymphocyte ratio (NLR) is an important inflammatory marker. However, the relationship between NLR and the prognosis of patients with coronary heart disease (CHD) remains unclear. The purpose of this study is to explore the relationship between NLR and all-cause mortality and cardiovascular mortality in CHD patients. This study analyzed data from 1625 CHD patients who participated in the National Health and Nutrition Examination Survey from 1999 to 2018. Multivariate Cox regression analysis was used to explore the relationship between mortality risk and NLR. The optimal NLR cutoff value related to survival outcomes was determined using the maximum selected rank method. Restricted cubic spline analysis was performed to investigate the correlation between NLR and mortality risk in CHD patients. Moreover, subgroup analyses were conducted to assess the relationship between NLR and all-cause and cardiovascular mortality in different populations. Additionally, time-dependent receiver operating characteristic curves were used to evaluate the accuracy of NLR in predicting survival outcomes. During a median follow-up of 88 months, a total of 475 patients experienced all-cause mortality, and 278 patients experienced cardiovascular mortality. After adjusting for confounding factors, compared with CHD patients with higher NLR, those with lower NLR had a 43% reduced risk of all-cause mortality (hazard ratio: 0.57, 95% CI: 0.41-0.8) and a 51% reduced risk of cardiovascular mortality (hazard ratio: 0.49, 95% CI: 0.3-0.78). Kaplan-Meier analysis showed that the survival rate in the high NLR group was significantly lower in terms of all-cause and cardiovascular mortality rates than in the low NLR group (P < .0001). The results of the restricted cubic spline analysis indicated a nonlinear relationship between NLR and all-cause mortality as well as cardiovascular mortality in CHD patients. In addition, receiver operating characteristic analysis showed that the area under the curve for all-cause mortality at 3 years, 5 years, and 10 years were 0.596, 0.591, and 0.604, while the area under the curve for cardiovascular mortality were 0.623, 0.617, and 0.623, in CHD patients. Elevated NLR is associated with increased risk of cardiovascular and all-cause mortality in CHD patients, and NLR can independently predict the prognosis of CHD patients.

Development and validation of a novel nomogram model predicting the unfavorable outcome based on NAR and collaterals status for patients with AIS

INTRODUCTION

Stroke is a leading cause of disability and mortality globally. This study aimed to develop a prognostic nomogram based on neutrophil-to-albumin ratio (NAR) and collateral status in acute ischemic stroke (AIS) patients with anterior large vessel occlusion (LVO).

MATERIAL & METHOD

590 AIS patients with LVO assessed for regional leptomeningeal collateral (rLMC) were retrospectively enrolled, and randomly divided into a training set (n = 414) and a testing set (n = 176). Unfavorable functional outcome was defined as a modified Rankin scale (mRS) score of 3 to 6 at 3 months. We assessed the accuracy and clinical utility of the nomogram using calibration plots, area under the curve (AUC), decision curve analysis (DCA), net reclassification index (NRI), and integrated discrimination improvement (IDI).

RESULTS

Both NAR and rLMC were independently associated with unfavorable outcome at 3 months (OR=8.96, p=0.0341; OR=0.89, p=0.0002, respectively). The developed nomogram (akaike information criterion (AIC)=398.77), which included NAR, rLMC and other factors, showed good performance (the AUC for the development and validation cohorts was 0.848 and 0.840 respectively) and improved the predictive value compared to a model without NAR and rLMC, according to an overall NRI of 3.27% (p=0.2401), overall IDI of 3.27% (p=0.2414), and a higher AUC (0.848 vs 0.831).

CONCLUSIONS

NAR can serve as an independent predictor in AIS patients with anterior LVO, and the nomogram incorporating NAR and rLMC is reliable in predicting unfavorable outcome. Further studies with larger sample sizes are needed to validate and extend these findings.

Elucidating the Relationship between Neutrophil-Lymphocyte Ratio and Plaque Composition in Patients with Drug-Eluting Stent Restenosis by Virtual Histology-Intravascular Ultrasound

(1) Background: In-stent Restenosis (ISR) is a major factor influencing the prognosis and revascularization of target lesions. The plaque composition is unclear; therefore, it is critical to investigate ISR composition to identify clinical intervention markers. (2) Methods: This study was conducted on 36 patients with drug-eluting stent restenosis. The patients were classified into a Low Neutrophil-Lymphocyte Ratio (L-NLR) and High Neutrophil-Lymphocyte Ratio (H-NLR) according to the median NLR level of 36 patients. Discrepancies in the current information such as baseline data, biochemical examination, cardiac ultrasound data, etc., were examined to identify the underlying risk factors, and a multifactorial linear regression analysis of plaque properties was conducted. (3) Results: NLR = 2.64 was utilized to classify 18 patients into the L-NLR group and 18 patients into the H-NLR group. There were statistically significant differences in age, a pre-percutaneous coronary intervention (PCI) SYNTAX II score, a C-reactive protein (CRP), interleukin (IL)-6, plaque loading, a fibro-lipid tissue area, calcified nubs, and virtual histology-thin fibrous cap atherosclerotic (VH-TCFA). The significant impacts of variations in age, neutrophil-lymphocyte ratio (NLR) levels, and IL-6 levels on the plaque stress and percentage of the fibro-lipid tissue in virtual histology-intravascular ultrasound (VH-IVUS) were identified through multifactorial linear regression. (4) Conclusions: The high NLR group demonstrated increased myocardial injury severity, consistent with higher SYNTAX II scores, a higher plaque burden, and higher proportions of vulnerable components. NLR proved to be a risk factor for both the plaque load and the proportion of the fibro-lipid tissue in ISR.

The value of neutrophil-to-lymphocyte ratio in predicting severity of coronary involvement and long-term outcome of percutaneous coronary intervention in patients with acute coronary syndrome: a systematic review and meta-analysis

BACKGROUND

The value of counting inflammatory cells and especially their counting ratio in predicting adverse clinical outcomes in patients with acute coronary syndrome (ACS) undergoing revascularization has been shown, but the results of studies have been very diverse and paradoxical. The aim of the current study was to systematically review the studies that investigated the role of increased neutrophil-to-lymphocyte ratio (NLR) in predicting long-term clinical outcomes in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

METHODS

Data abstraction was independently performed by both un-blinded reviewers on deeply assessing Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane Central Register of Controlled Trials and using the relevant keywords. The risk of bias for each study was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions and the QUADAS-2 tool. Statistical analysis was performed using the Stata software. Overall, 14 articles published between 2010 and 2021 were eligible for the final analysis.

RESULTS

A total of 20,846 ACS patients undergoing PCI were included. Higher values of NLR were associated with higher numbers of involved coronaries (RR: 1.175, 95%CI 1.021-1.353, P = 0.024). Increasing the value of NLR was associated with a 3.4 times increase in long-term death (RR: 3.424, 95%CI 2.325-5.025, P = 0.001). Similarly, higher values of NLR were significantly associated with a higher likelihood of long-term MACE (RR: 2.604, 95%CI 1.736-3.906, P = 0.001).

CONCLUSIONS

NLR has a high value in predicting both the severity of coronary artery involvement and long-term adverse clinical outcomes following the PCI procedure.

Association of systemic inflammatory markers with postoperative arrhythmias in esophageal cancer: a propensity score matching

BACKGROUND

The severity and prognosis of an array of inflammatory diseases have been predicted using systemic inflammatory indices, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio (LMR), derived neutrophil-to-lymphocyte ratio (dNLR), and systemic immune inflammation index (SII). The purpose of this study was to examine the association between systemic inflammatory markers and postoperative arrhythmias (PA) in esophageal cancer patients.

METHODS

In the study, laboratory-related parameters were gathered and examined in 278 patients (non-PA = 221, PA = 57). Fit separate propensity score matching (PSM) within subgroup strata (surgery approaches); match within strata, and aggregate for main analysis. Finally, we established a 1:1(57:57) model. The ability of inflammatory makers on the first post-esophagectomy day to distinguish PA from postoperative non-arrhythmia (non-PA) by receiver operating characteristic (ROC) analysis.

RESULTS

On the first post-esophagectomy day, there was a greater difference between PA and non-PA in terms of white blood cell (WBC) and neutrophil (NE), Neutrophil percentage (NE%), NLR, dNLR, LMR, and SII. After PSM, the following variables were substantially different between non-PA and PA: NE%, NLR, dNLR, and SII. It was found that WBC, NE, NE%, NLR, dNLR, LMR, and SII had the area under the curve (AUC) that was higher than 0.500 in ROC analysis, with NLR and SII having the highest AUC (AUC = 0.661). The indicators were subjected to binary logistic regression analysis, which increased the indicators' predictive ability (AUC = 0.707, sensitivity = 0.877).

CONCLUSION

On the first post-esophagectomy day, systemic inflammatory indicators were significantly correlated with both PA and non-PA, and high SII and NLR are reliable markers of PA.

Neutrophil-to-albumin Ratio as a Prognostic Factor in Patients with Acute Ischemic Stroke

BACKGROUND

Neutrophil-To-Albumin Ratio (NAR) is a novel inflammatory biomarker. However, the potential prognostic value of NAR in acute ischemic stroke (AIS) remains unclear. This study aimed to evaluate whether NAR levels correlated with the 3-month modified Rankin scale (mRS) in patients with AIS.

METHODS

AIS patients were included in this retrospective study. NAR was calculated as the ratio of absolute neutrophil count to serum albumin level. Logistic regression analyses were used to investigate the effect of NAR on 3-month mRS of AIS. The predictive values of NAR, albumin level, and neutrophil count were compared utilizing receiver operating characteristic (ROC) curves. Moreover, subgroup analyses and interaction tests were conducted to evaluate the consistency of NAR's effect on AIS prognosis.

RESULTS

Of the 780 patients included, 403 (51.67%) had a poor clinical outcome (mRS 3-6) at 3 months. NAR was independently correlated to 3-month poor functional outcome after adjusting for confounders (Odds ratios (OR), 9.34; 95% confidence intervals (CI), 1.09 to 80.13; p =0.0417). Subgroup analysis showed a relative effect consistent with the overall population results, and no statistical interactions were found in the subgroups (all p for interaction > 0.05). The ROC curve showed that the prognosis-related cutoff value for NAR was 0.123, with corresponding specificity and sensitivity of 53.55% and 63.94%, respectively. When comparing the predictive power, NAR (0.590; 95%CI 0.549-0.630) exhibited the highest area under the curve (AUC) of ROC compared to neutrophils (0.584; 95%CI 0.543-0.624) and albumin (0.540; 95%CI 0.500-0.581).

CONCLUSION

There is a positive relationship between NAR levels and 3-month poor functional outcomes in AIS patients, supporting the potential of NAR as a readily available and economic serum biomarker for the early identification of AIS prognosis. Further studies are required to validate the prognostic value and clinical utility of the NAR.

Multimodal data-driven prognostic model for predicting new-onset ST-elevation myocardial infarction following emergency percutaneous coronary intervention

OBJECTIVES

We developed a nomogram model derived from inflammatory indices, clinical data, and imaging data to predict in-hospital major adverse cardiac and cerebrovascular events (MACCEs) following emergency percutaneous coronary intervention (PCI) in patients with new-onset ST-elevation myocardial infarction (STEMI).

METHODS

Patients with new-onset STEMI admitted between June 2020 and November 2022 were retrospectively reviewed. Data pertaining to coronary angiograms, clinical data, biochemical indices, and in-hospital clinical outcomes were derived from electronic medical records. Lasso regression model was employed to screen risk factors and construct a prediction model.

RESULTS

Overall, 547 patients with new-onset STEMI who underwent PCI were included and assigned to the training cohort (n = 384) and independent verification cohort (n = 163). Six clinical features (age, diabetes mellitus, current smoking, hyperuricemia, neutrophil-to-lymphocyte ratio, and Gensini score) were selected by LASSO regression to construct a nomogram to predict the risk of in-hospital MACCEs. The area-under-the-curve (AUC) values for in-hospital MACCEs risk in the training and independent verification cohorts were 0.921 (95% CI 0.881-0.961) and 0.898 (95% CI 0.821-0.976), respectively. It was adequately calibrated in both training cohort and independent verification cohorts, and predictions were correlated with actual outcomes. Decision curve analysis demonstrated that the nomogram was capable of predicting in-hospital MACCEs with good clinical benefit.

CONCLUSIONS

Our prediction nomogram based on multi-modal data (inflammatory indices, clinical and imaging data) reliably predicted in-hospital MACCEs in new-onset STEMI patients with emergency PCI. This prediction nomogram can enable individualized treatment strategies.

Mean platelet volume, platelet count, and neutrophil/lymphocyte ratio in drug-naïve patients with schizophrenia: a cross-sectional study

Introduction

Mean platelet volume (MPV), platelet count, and neutrophil/lymphocyte ratio (NLR) have been proposed to be biomarkers of the chronic inflammatory process in schizophrenia and indicative of increased cardiovascular risk.

Objective

To describe MPV, total platelet count (PLT), and NLR between healthy controls and patients with schizophrenia to determine the correlation between these parameters and the duration of untreated psychosis (DUP).

Methods

In a retrospective cross-sectional study, we included 175 patients with schizophrenia who had never received psychiatric treatment, and who had undergone blood biometry and blood chemistry within 24 h of admission. Laboratory studies were determined by the impedance method on Coulter ac-T 5 diff hematological equipment.

Results

Mean platelet volume levels in patients with schizophrenia were higher than in healthy controls but not statistically significant. The receiver operating characteristic curve for this parameter shows that the optimal cutoff point of agreement was 8.95 fL, with sensitivity and specificity for schizophrenia of 52% and 67%, respectively, and the area under the curve (AUC) was 0.580 (p = 0.079). DUP had no significant correlation with the blood parameters analyzed.

Conclusion

The results partially support the hypothesis that MPV, platelet count, and NLR is related to schizophrenia, and further research is needed to establish whether there is an underlying chronic inflammatory process.

Outcome and Risk Factors of Restenosis Post Percutaneous Transluminal Angioplasty at Juxta-Anastomotic of Wrist Autogenous Radial-Cephalic Arteriovenous Fistulas: A Retrospective Cohort Study

BACKGROUND

This retrospective cohort study was to determine the factors related to restenosis post percutaneous transluminal angioplasty (PTA) at juxta-anastomotic of wrist radial-cephalic arteriovenous fistulas (RC-AVFs).

METHODS

We conducted a retrospective study of patients who underwent their first PTA for juxta-anastomotic stenosis at RC-AVF from January 1, 2016, to December 31, 2020. Patient and stenotic lesion characteristics and PTA procedure factors were included in the analysis. The primary and assisted primary patency post PTA of RC-AVFs were evaluated using the Kaplan-Meier analysis and log-rank test. A Cox proportional hazard model was used to identify factors associated with restenosis post PTA. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of the risk factors for restenosis post PTA.

RESULTS

A total of 65 patients with a mean age of 59.09 ± 14.94 years were enrolled in the study. The mean RC-AVF age was 9.2 (4.9, 35.05) months, and the median time of intervention for stenosis was 10.8 (4.05, 41.35) months after AVF creation. The primary patency rates following the first PTA at 3, 6, 12, and 24 months were 93.9, 84.6, 63.1, and 55.4%, respectively. The assisted primary patency rates at 3, 6, 12, and 24 months were 95.4, 90.8, 87.7, and 84.6%, respectively. Cox proportional hazard regression analysis revealed the maximum balloon diameter >5 mm had a lower postoperative restenosis rate compared with the maximum balloon diameter ≤5 mm (hazard ratio = 0.422; 95% confidence interval [CI]: 0.201-0.884; P = 0.022). ROC curve analysis showed that the area under the curve of the maximum balloon diameter during PTA was 0.624 (95% CI, 0.486-0.762). The best critical value for the maximum balloon diameter was 6 mm, the sensitivity was 64.5%, and the specificity was 61.8%.

CONCLUSIONS

For the first PTA at juxta-anastomotic of wrist RC-AVFs without thrombosis and complete occlusion, the use of a balloon with a maximum diameter of ≤5 mm is a risk factor to the occurrence of restenosis within 12 months post PTA. The result may help in tailoring surveillance programs in patients with RC-AVF stenosis.

Prognostic significance of neutrophil count on in-hospital mortality in patients with acute type A aortic dissection

Backgrounds

The goal of this study was to assess the impact of neutrophil count, in patients with acute type A aortic dissection (ATAAD).

Methods

This study retrospectively collected data from patients between September 2017 and June 2021. Youden's index was used to determine the optimal cut-off value for the neutrophil count and patients were divided into two subgroups. A restricted cubic spline (RCS) was used to model the relationship between variables and in-hospital mortality. The least absolute shrinkage and selection operator (LASSO) method and multivariate logistic regression analyses were used to investigate the independent prognostic factors for in-hospital mortality in patients with ATAAD.

Results

A total of 467 patients were enrolled in this study. In-hospital mortality was 7.28%. The group with elevated neutrophil counts had significantly higher mortality than the group with decreased neutrophil counts (10.8% vs. 3.2%, P = 0.02). This data shows that elevated neutrophil count was significantly associated with in-hospital mortality (OR 3.07, 95% CI 1.22-7.62, P = 0.02).

Conclusions

Neutrophil count is an independent risk factor for in-hospital mortality in patients with ATAAD. It is an effective inflammatory index, which can be individualized for patients.

Prognostic Impact of Multiple Lymphocyte-Based Inflammatory Indices in Acute Coronary Syndrome Patients

Background

The aim of this study was to evaluate the prognostic values of five lymphocyte-based inflammatory indices (platelet-lymphocyte ratio [PLR], neutrophil-lymphocyte ratio [NLR], monocyte-lymphocyte ratio [MLR], systemic immune inflammation index [SII], and system inflammation response index [SIRI]) in patients with acute coronary syndrome (ACS).

Methods

A total of 1,701 ACS patients who underwent percutaneous coronary intervention (PCI) were included in this study and followed up for major adverse cardiovascular events (MACE) including all-cause death, non-fatal ischemic stroke, and non-fatal myocardial infarction. The five indices were stratified by the optimal cutoff value for comparison. The association between each of the lymphocyte-based inflammatory indices and MACE was assessed by the Cox proportional hazards regression analysis.

Results

During the median follow-up of 30 months, 107 (6.3%) MACE were identified. The multivariate COX analysis showed that all five indices were independent predictors of MACE, and SIRI seemingly performed best (Hazard ratio [HR]: 3.847; 95% confidence interval [CI]: [2.623–5.641]; p < 0.001; C-statistic: 0.794 [0.731–0.856]). The addition of NLR, MLR, SII, or SIRI to the Global Registry of Acute Coronary Events (GRACE) risk score, especially SIRI (C-statistic: 0.699 [0.646–0.753], p < 0.001; net reclassification improvement [NRI]: 0.311 [0.209–0.407], p < 0.001; integrated discrimination improvement [IDI]: 0.024 [0.010–0.046], p < 0.001), outperformed the GRACE risk score alone in the risk predictive performance.

Conclusion

Lymphocyte-based inflammatory indices were significantly and independently associated with MACE in ACS patients who underwent PCI. SIRI seemed to be better than the other four indices in predicting MACE, and the combination of SIRI with the GRACE risk score could predict MACE more accurately.

THE PROGNOSTIC UTILITY OF LEUKOCYTE AND PLATELET COUNTS FOR RISK ASSESSMENT OF IN-HOSPITAL COMPLICATIONS IN PATIENTS WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

OBJECTIVE

The aim: We have aimed to develop method of risk assessment in patients with acute STEMI using blood cells count useful in everyday clinical practice.

PATIENTS AND METHODS

Materials and methods: 317 STEMI patients admitted to ICCU starting at 01/2014 to 06/2020 were included in this study. Data were evaluated partially retrospectively (n=214), 1st group) and prospectively, applying new risk-assessment tool in 103 patients 2nd group). Study groups did not differ in terms of all clinical characteristics.

RESULTS

Results: To evaluate criteria of severity of in-hospital complication we have created in-hospital complication index (HCI), composed according to number of adverse events per patient. Based on correlation analyses we have composed complex WBC-platelets (WBC-PLT) index = ((GRA - MON) / LYM) · 10 + PDWc + P-LCR). In the 1st study group WBC-PLT index was associated with in-hospital complications' index and correlated with neutrophil-leukocytes ratio (NLR) (p<0,001 and p<0,0005 respectively). WBC-PLT index > 137 appeared to be mildly associated with increased risk of adverse in-hospital outcomes (with specificity of 78 % and low sensitivity of 64 %, AUC- 0,72). Further prospective study of WBC-PLT index measured on the first STEMI-day (group 2) revealed that this parameter was more informative regarding association with adverse in-hospital events whereas NLR had low accuracy in risk assessment.

CONCLUSION

Conclusions: WBC-PLT index assessed on the first STEMI day may be used as a tool for detection of patients at risk of adverse in-hospital events in the every-day clinical practice.

Pre-operative Neutrophil to Lymphocyte Ratio is Associated With 30 Day Death or Amputation After Revascularisation for Acute Limb Ischaemia

OBJECTIVE

Inflammation is an early feature of acute limb ischaemia (ALI), hence the potential prognostic significance of inflammatory biomarkers. This study aimed to assess the value of pre-operative inflammatory biomarkers, specifically the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR), for predicting an adverse outcome after revascularisation for ALI.

METHODS

All patients submitted to lower limb revascularisation for Rutherford IIa or IIb ALI at the authors' institution between 2009 and 2019 were screened retrospectively. Pre-operative NLR and PLR were analysed, along with other known prognostic factors. Primary outcome was the composite endpoint of 30 day death or amputation.

RESULTS

A total of 345 patients were included, 84 of whom suffered the primary outcome (24.3%). The median follow up was 23.1 months (3.1 - 52.2). Higher age (OR 1.05 per year increase, 95% CI 1.01 - 1.09), diabetes (OR 2.63, 95% CI 1.14 - 6.06), Rutherford grade IIb vs. IIa (OR 5.51, 95% CI 2.11 - 14.42), higher NLR (OR 1.28 per unit increase, 95% CI 1.12 - 1.47), and fasciotomy need (OR 3.44, 95% CI 1.14 - 10.34) were independently associated with 30 day death or amputation, whereas pre-operative statin or anticoagulant medication were associated with a risk reduction (OR 0.23, 95% CI 0.53 - 0.96 and OR 0.20, 95% CI 0.05 - 0.84, respectively). PLR did not show an independent effect on this population. Pre-operative NLR presented a good discriminative ability (AUC 0.86, 95% CI 0.82 - 0.90). A cut off NLR level ≥ 5.4 demonstrated a 90.5% sensitivity and 73.6% specificity for 30 day death or amputation. Kaplan-Meier analysis showed that patients with pre-operative NLR ≥ 5.4 had significantly lower 30 day, six month and one year amputation free survival when compared with those with NLR < 5.4 (64.8 ± 4.0%, 44.1 ± 4.1%, and 37.5 ± 4.1% vs. 98.5 ± 0.9%, 91.9 ± 2.0%, and 85.9 ± 2.5%, log rank p < .001).

CONCLUSION

In this study, higher pre-operative NLR was associated with 30 day death or amputation following intervention for Rutherford grade IIa or IIb ALI. NLR potentially stands as a simple, widely available and inexpensive biomarker that can refine decision making and possibly contribute to ALI morbidity and mortality reduction.

Thrombosis and thrombocytopenia in antiphospholipid syndrome: their association with mean platelet volume and hematological ratios

OBJECTIVE

To assess the mean platelet volume (MPV), platelet-to-lymphocyte ratio (PLR), the neutrophil-to-lymphocyte ratio (NLR) and the MPV-to-lymphocyte ratio, and to test them according to the clinical/serological status, shift through time and other comorbidities in APS.

METHODS

We included 96 primary APS patients according to the Sydney classification criteria and/or patients with thrombocytopenia and/or autoimmune hemolytic anemia who also fulfilled the serological criteria. We tested aCL, anti-β2GP-I and aPS/PT antibodies and LA. We first registered the MPV and the aforementioned ratios within at least 6 months after an event of thrombosis or thrombocytopenia/AIHA (baseline determination), and during thrombosis/thrombocytopenia/AIHA onset when available (acute event).

RESULTS

A lower baseline MPV and a higher PLR characterized the thrombotic group (n = 74). The AUC for baseline PLR was 0.82 (p < 0.001): SE of 69%, SP 91%, PPV 96%, NPV 74%, LR+ 13.67 and LR- 0.19. During the acute event, both variables increased. The thrombocytopenic group (n = 66) had a higher baseline MPV and a lower PLR, and during an acute event the PLR decreased more deeply. The AUC for MPV was 0.64 (p = 0.02): SE 44%, SP 92%, PPV 86%, NPV 40%, LR+ 3.3 and LR- 0.85. These findings were not related with the aPL antibody profile status, titers or comorbidities.

CONCLUSION

Basal MPV and PLR might help to identify APS patients according to their thrombotic or thrombocytopenic phenotype. These variables change during the acute events and might be the reflex of physiopathological or compensatory mechanisms in APS.

Changes in the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios before and after percutaneous coronary intervention and their impact on the prognosis of patients with acute coronary syndrome

OBJECTIVES

This study aimed to prospectively observe the changes in the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) before and after percutaneous coronary intervention (PCI) and their impact on the prognosis of patients with acute coronary syndrome (ACS).

METHODS

Blood samples from 205 patients with ACS were collected at admission and at 24h and 30 days post-PCI to observe changes in the complete blood count. The Cox multivariate regression model was used to analyze the factors influencing major adverse cardiac events (MACE) after PCI in patients with ACS. A receiver operating characteristic (ROC) curve was used to evaluate the predictive value of inflammation indicators for MACE after PCI.

RESULTS

Following PCI, NLR and PLR first increased postoperatively and then decreased within 30 days after PCI. Cox multivariate regression analysis showed that NLR and PLR at 24h post-PCI and acute ST-segment elevation myocardial infarction were independent influencing factors for the incidence of MACE after PCI. The ROC curve analysis showed that the NLR at 24h post-PCI was a better predictor of the incidence of MACE. The NLR at 24h post-PCI was significantly correlated with the number and length of implanted stents and operation duration.

CONCLUSIONS

After PCI, patients with ACS had an increased neutrophil proportion and NLR. The NLR at 24h post-PCI was a better predictor of the incidence of postoperative MACE.

Predictive efficacy of neutrophil-to-lymphocyte ratio for long-term prognosis in new onset acute coronary syndrome: a retrospective cohort study

BACKGROUND

Inflammation is involved in the pathogenesis and progression of coronary artery diseases (CADs), including acute coronary syndrome. The neutrophil-to-lymphocyte ratio (NLR) has been identified as a novel marker of the pro-inflammatory state. We aimed to evaluate the predictive efficacy of the NLR for the prognosis of patients with new-onset ACS.

METHODS

We retrospectively included consecutive patients with new-onset ACS treated with emergency coronary angiography. NLR was measured at baseline and analyzed by tertiles. The severity of coronary lesions was evaluated by the Gensini score. Correlations of NLR with the severity of CAD and the incidence of major adverse cardiovascular diseases (MACEs) during follow-up were determined.

RESULTS

Overall, 737 patients were included. The NLR was positively correlated with the severity of coronary lesions as assessed by Gensini score (P < 0.05). During the follow-up period (mean, 43.49 ± 23.97 months), 65 MACEs occurred. No significant association was detected between baseline NLR and the risk of MACEs during follow-up by either Kaplan-Meier or Cox regression analysis. Multivariable logistic regression analysis showed that a higher NLR was independently associated with coronary lesion severity as measured by the Gensini score (1st tertile vs. 3rd tertile hazard ratio [HR]: 0.527, P < 0.001, and 2nd tertile vs. 3rd tertile HR: 0.474, P = 0.025).

CONCLUSIONS

The NLR may be associated with coronary disease severity at baseline but is not associated with adverse outcomes in patients with new-onset ACS.

ETHICS APPROVAL NUMBER

2019XE0208.

The combination of neutrophil-to-lymphocyte ratio and platelet correlation parameters in predicting the no-reflow phenomenon after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

OBJECTIVE

To evaluate the predictive value of the neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), and platelet distribution width (PDW) for the no-reflow phenomenon in patients with ST-segment elevation myocardial infarction. Methods: Patients who underwent primary percutaneous coronary intervention from January 2017 to April 2019 were consecutively enrolled in this study and were split into the control and no-reflow groups. Logistic regression analysis was used to determine the independent predictors. Receiver operating characteristic curves were carried out to evaluate the predictive value. Results: A total of 455 patients were included and the incidence of the no-reflow was 19.6%. After the adjustment of confounding factors, logistic regression analyses showed that the NLR (odds ratio [OR] per unit increase: 1.107, 95% confidence interval [CI]: 1.044-1.172, p = .001), MPV (OR: 1.398, 95% CI: 1.010-1.937, p = .044), and PDW (OR: 1.392, 95% CI: 1.012-1.914, p = .042) were all independent predictors. In the prediction of the no-reflow, the NLR had the largest area under the curve of 0.650 (95% CI: 0.593-0.708) with 90% sensitivity and 36% specificity. The area under the curve of the combination of NLR + MPV was 0.676 and that of NLR + PDW was 0.654. Conclusions: The NLR, MPV and PDW are all associated with the no-reflow. However, there is no significant difference in the predictive value of these indicators. The combinations of NLR and platelet-associated parameters also do not show a better predictive value than NLR alone.

Mean platelet volume and coronary artery disease

PURPOSE OF REVIEW

To critically review the literature describing links between mean platelet volume (MPV) and cardiovascular disease (CVD). We will focus on coronary artery disease (CAD). The MPV is measured routinely as part of a routine blood count.

RECENT FINDINGS

There is accumulating evidence showing that the MPV may predict CVD, as well as outcomes in patients with CAD. There is also evidence linking MPV and comorbidities (e.g. diabetes mellitus and impaired glycaemic control) that are expected in patients with CAD. The effect on MPV of drugs commonly used to treat CAD has not been clarified, but there is some evidence that they may exert a beneficial effect on the MPV. More specifically, the MPV may predict the effect of antiplatelet drugs (e.g. clopidogrel). There is also evidence relating MPV to stroke, atrial fibrillation, coronary artery ectasia and periprocedural outcomes after percutaneous coronary intervention (PCI).

SUMMARY

Measuring the MPV may prove useful in CVD risk assessment in patients with established CAD or at risk of developing CAD. Overall, there is evidence pointing to the role of MPV as a contributor rather than simple marker of CVD.

Inflammatory and Hematological Indices as Simple, Practical Severity Predictors of Microdysfunction Following Coronary Intervention: A Systematic Review and Meta-Analysis

C-reactive protein (CRP) and high-sensitivity CRP (hsCRP), along with a series of hematological indices, platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV), platelet distribution width (PDW), and red blood cell distribution width (RDW), are regarded to be related to the incidence of no-reflow or slow flow. Clinical studies were retrieved from the electronic databases of PubMed, EMBASE, Google Scholar, Clinical Trials, and science direct from their inception to August 24, 2019. A total of 21 studies involving 7403 patients were included in the meta-analysis. Pooled analysis results revealed patients with higher hsCRP (odds ratio [OR] = 1.03, 95% confidence interval [CI], 1.01-1.05, P = .006), hsCRP (OR = 1.04, 95% CI: 1.0-1.08, P = .012), NLR (OR = 1.23, 95% CI: 1.11-1.37, P < .0001), PLR (OR = 1.13, 95% CI: 1.07-1.20, P < .0001), and MPV (OR = 2.13, 95% CI: 1.57-2.90, P < .0001) all exhibited significantly higher no-reflow incidence, but there was no significant association between no-reflow risk and RDW or PDW. Patients with higher CRP/hsCRP also performed higher rate of slow flow (OR = 1.06, 95% CI: 1.01-1.11, P = .018). Preangiographic CRP/hsCRP could independently predict no-reflow and slow flow. Moreover, some hematological indices are associated with no-flow.

The White Blood Cell Count to Mean Platelet Volume Ratio for the Prediction of Chronic Limb-Threatening Ischemia in Lower Extremity Artery Disease

Background: The white blood cell count to mean platelet volume ratio (WMR) is increasingly gaining importance as a promising prognostic marker in atherosclerotic disease, but data on lower extremity artery disease (LEAD) are not yet available. The principle aim of this study was to assess the association of the WMR with the occurrence of CLTI (chronic limb-threatening ischemia) as the most advanced stage of disease. Methods: This study was performed as a retrospective analysis on 2121 patients with a diagnosis of LEAD. Patients were admitted to the hospital for the reason of LEAD and received conservative or endovascular treatment. Blood sampling, in order to obtain the required values for this analysis, was implemented at admission. Statistical analysis was conducted by univariate regression in a first step and, in case of significance, by multivariate regression additionally. Results: Multivariate regression revealed an increased WMR (p < 0.001, OR (95%CI) 2.258 (1.460–3.492)), but also advanced age (p < 0.001, OR (95%CI) 1.050 (1.040–1.061)), increased CRP (p < 0.001, OR (95%CI) 1.010 (1.007–1.014)), and diabetes (p < 0.001, OR (95%CI) 2.386 (1.933–2.946)) as independent predictors for CLTI. Conclusions: The WMR presents an easily obtainable and cost-effective parameter to identify LEAD patients at high risk for CLTI.

Blood Cell Parameters and Predicting Coronary In-Stent Restenosis

Major advances in coronary interventional techniques and pharmacotherapy as well as the use of drug-eluting stents (DESs) have considerably reduced the risk of in-stent restenosis (ISR). However, ISR remains a major clinical challenge. Inflammation and platelet activation are important processes that underlie the pathophysiology of ISR. Parameters related to blood cells, entailing both cell count and morphology, are useful markers of the inflammatory response and platelet activation in clinical practice. Recent studies have highlighted several new combined or derived parameters related to blood cells that independently predict ISR after DES implantation. The neutrophil/lymphocyte ratio, an inflammatory marker, is regarded as a predictor of the risk of ISR and the stability of atherosclerotic plaques. The mean platelet volume, a widely used platelet activation parameter, has been shown to be a predictor of the risk of ISR and the efficacy of antiplatelet therapy. Other markers considered include the platelet/lymphocyte ratio, red blood cell distribution width, and platelet distribution width. This review provides an overview of these parameters that may help stratify the risk of coronary angiographic and clinical outcomes related to ISR.