|
1
|
Abe H, Miyazaki T, Tomaru M, Nobushima Y, Ajima T, Hirabayashi K, Ishiwata S, Kakihara M, Maki M, Shimai R, Aikawa T, Isogai H, Ozaki D, Yasuda Y, Odagiri F, Takamura K, Hiki M, Iwata H, Yokoyama K, Tokano T, Minamino T. Poor Nutritional Status during Recovery from Acute Myocardial Infarction in Patients without an Early Nutritional Intervention Predicts a Poor Prognosis: A Single-Center Retrospective Study. Nutrients 2023; 15:4748. [PMID: 38004141 PMCID: PMC10674636 DOI: 10.3390/nu15224748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Whether malnutrition during the early phase of recovery from acute myocardial infarction (AMI) could be a predictor of mortality or morbidity has not been ascertained. We examined 289 AMI patients. All-cause mortality and composite endpoints (all-cause mortality, nonfatal stroke, nonfatal acute coronary syndrome, and hospitalization for acute decompensated heart failure) during the follow-up duration (median 39 months) were evaluated. There were 108 (37.8%) malnourished patients with GNRIs of less than 98 on arrival; however, malnourished patients significantly decreased to 91 (31.4%) during the convalescence period (p < 0.01). The incidence rates of mortality and primary composite endpoints were significantly higher in the malnourished group than in the well-nourished group both on arrival and during the convalescence period (All p < 0.05). Nutrition guidance significantly improved GNRI in a group of patients who were undernourished (94.7 vs. 91.0, p < 0.01). Malnourished patients on admission who received nutritional guidance showed similar all-cause mortality with well-nourished patients, whereas malnourished patients without receiving nutritional guidance demonstrated significantly worse compared to the others (p = 0.03). The assessment of GNRI during the convalescence period is a useful risk predictor for patients with AMI. Nutritional guidance may improve the prognoses of patients with poor nutritional status.
Collapse
Affiliation(s)
- Hiroshi Abe
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Tetsuro Miyazaki
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Masato Tomaru
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Yuka Nobushima
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Tomohi Ajima
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Koji Hirabayashi
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Sayaki Ishiwata
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Midori Kakihara
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Masaaki Maki
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Ryosuke Shimai
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Tadao Aikawa
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Hiroyuki Isogai
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Dai Ozaki
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Yuki Yasuda
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Fuminori Odagiri
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Kazuhisa Takamura
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (M.H.); (H.I.); (T.M.)
| | - Hiroshi Iwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (M.H.); (H.I.); (T.M.)
| | - Ken Yokoyama
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Takashi Tokano
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Chiba, Urayasu-shi 279-0021, Japan; (H.A.); (M.T.); (Y.N.); (T.A.); (K.H.); (S.I.); (M.K.); (M.M.); (R.S.); (T.A.); (H.I.); (D.O.); (Y.Y.); (F.O.); (K.T.); (K.Y.); (T.T.)
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (M.H.); (H.I.); (T.M.)
- Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, 1-7-1 Otemachi, Chiyoda-ku, Tokyo 100-0004, Japan
| |
Collapse
|
|
2
|
Tudurachi BS, Anghel L, Tudurachi A, Sascău RA, Stătescu C. Assessment of Inflammatory Hematological Ratios (NLR, PLR, MLR, LMR and Monocyte/HDL-Cholesterol Ratio) in Acute Myocardial Infarction and Particularities in Young Patients. Int J Mol Sci 2023; 24:14378. [PMID: 37762680 PMCID: PMC10531986 DOI: 10.3390/ijms241814378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Cardiovascular disease, particularly coronary artery disease (CAD), remains a predominant cause of mortality globally. Factors such as atherosclerosis and inflammation play significant roles in the pathogenesis of CAD. The nexus between inflammation and CAD is underscored by the role of immune cells, such as neutrophils, lymphocytes, monocytes, and macrophages. These cells orchestrate the inflammatory process, a core component in the initiation and progression of atherosclerosis. The activation of these pathways and the subsequent lipid, fibrous element, and calcification accumulation can result in vessel narrowing. Hematological parameters derived from routine blood tests offer insights into the underlying inflammatory state. Recent studies have highlighted the potential of inflammatory hematological ratios, such as the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio and lymphocyte/monocyte ratio. These parameters are not only accessible and cost-effective but also mirror the degree of systemic inflammation. Several studies have indicated a correlation between these markers and the severity, prognosis, and presence of CAD. Despite the burgeoning interest in the relationship between inflammatory markers and CAD, there remains a paucity of data exploring these parameters in young patients with acute myocardial infarction. Such data could offer valuable insights into the unique pathophysiology of early-onset CAD and improve risk assessment and predictive strategies.
Collapse
Affiliation(s)
- Bogdan-Sorin Tudurachi
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (B.-S.T.); (R.A.S.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania;
| | - Larisa Anghel
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (B.-S.T.); (R.A.S.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania;
| | - Andreea Tudurachi
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania;
| | - Radu Andy Sascău
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (B.-S.T.); (R.A.S.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania;
| | - Cristian Stătescu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (B.-S.T.); (R.A.S.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania;
| |
Collapse
|
|
3
|
Shimizu S, Hanai T, Egashira Y, Sato Y, Sekiya K, Nishida S, Ishihara M, Ishihara T, Asada R, Kobayashi R, Suzuki A. Controlling nutritional status score during hospitalization as a predictor of clinical outcome in patients with aneurysmal subarachnoid hemorrhage. Sci Rep 2023; 13:12758. [PMID: 37550344 PMCID: PMC10406813 DOI: 10.1038/s41598-023-39938-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/02/2023] [Indexed: 08/09/2023] Open
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a serious condition with high mortality and a high permanent disability rate. In this study, we examined the association of clinical outcome with the Controlling Nutritional Status (CONUT) score during hospitalization in aSAH patients. A single-center, retrospective observational study was conducted at Gifu University Hospital. Patients transported to the emergency room for aSAH and diagnosed with World Federation of Neurosurgical Societies (WFNS) grade III and IV aSAH between April 2004 and March 2021 were enrolled. A logistic regression model was constructed to evaluate the association of the CONUT score with a modified Rankin scale (mRS) ≥ 3 and delayed cerebral ischemia (DCI). 127 patients diagnosed with WFNS grade III and IV aSAH were analyzed. CONUT score was significantly associated with mRS ≥ 3 during hospitalization. The score obtained by subtracting the CONUT score at admission from the maximum CONUT score was significantly associated with mRS ≥ 3 at discharge. Moreover, the score obtained by subtracting the CONUT score at admission from the maximum CONUT score during the first 14 days was significantly associated with DCI within 14 days from admission. These findings indicate that CONUT score during hospitalization may be a useful daily marker for predicting poor outcomes in aSAH patients.
Collapse
Affiliation(s)
- Shinya Shimizu
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Tatsunori Hanai
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Yusuke Egashira
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yukina Sato
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Kumiko Sekiya
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Shohei Nishida
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masashi Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan
| | - Ryuta Asada
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan
| | - Ryo Kobayashi
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
- Laboratory of Advanced Medical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
- Laboratory of Advanced Medical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan.
| |
Collapse
|
|
4
|
Chen Y, Chen S, Han Y, Xu Q, Zhao X. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Important Indicators for Predicting in-Hospital Death in Elderly AMI Patients. J Inflamm Res 2023; 16:2051-2061. [PMID: 37215380 PMCID: PMC10198281 DOI: 10.2147/jir.s411086] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/06/2023] [Indexed: 05/24/2023] Open
Abstract
Aim To investigate the role of neutrophil-to-lymphocyte ratio(NLR) and platelet-to-lymphocyte(PLR) in predicting the risk of in-hospital mortality in elderly acute myocardial infarction(AMI) patients. Methods This study was a single-center, retrospective and observational study. From December 2015 to December 2021, a total of 1550 elderly patients (age ≥ 60 years) with AMI with complete clinical history data were enrolled in the Second Hospital of Dalian Medical University. Routine blood tests were performed on admission, and NLR and PLR were calculated based on neutrophil, platelet, and lymphocyte counts. Outcome was defined as all-cause mortality during hospitalization. Cox regression and restricted spline cubic(RCS) models were used to evaluate the association of NLR and in-hospital mortality risk and the association of PLR with in-hospital mortality risk, respectively. Results (1) A total of 132 (8.5%) patients died during hospitalization. From the results of blood routine, the white blood cell, neutrophil, NLR and PLR in the death group were higher than those in the non-death group, while the lymphocyte was lower than that in the non-death group, and the difference was statistically significant (P < 0.05). (2) The results of receiver operating characteristic(ROC) curves analysis showed that the predictive ability of NLR (AUC = 0.790) for in-hospital death was better than that of PLR (AUC = 0.637). (3) Multivariate Cox proportional regression hazard models showed that high NLR was associated with the risk of in-hospital mortality in elderly AMI patients (HR = 3.091, 95% CI 2.097-4.557, P < 0.001), while high PLR was not. (4) RCS models showed a nonlinear dose-response relationship between NLR and in-hospital death (P for nonlinear = 0.0007). Conclusion High NLR (> 6.69) is associated with the risk of in-hospital mortality in elderly patients with AMI and can be an independent predictor of poor short-term prognosis in elderly patients with AMI.
Collapse
Affiliation(s)
- Yan Chen
- Department of Cardiology, the Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Shengyue Chen
- Department of Cardiology, the Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Yuanyuan Han
- Department of Cardiology, the Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Qing Xu
- Department of Cardiology, the Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Xin Zhao
- Department of Cardiology, the Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| |
Collapse
|
|
5
|
Huang L, He R, Sun X, Lv J, Chen S. Association of Controlling Nutritional Status Score With Adverse Outcomes in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis. Angiology 2023; 74:149-158. [PMID: 35491724 DOI: 10.1177/00033197221094409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This systematic review and meta-analysis sought to examine the association between the controlling nutritional status (CONUT) score and adverse outcomes in patients with coronary artery disease (CAD). PubMed and Embase databases were searched for eligible studies from their inceptions to December 12, 2021 to identify studies investigating the association of the CONUT score with major adverse cardiovascular events (MACEs) and all-cause mortality in CAD patients. Twelve studies (36,198 CAD) patients satisfied the criteria. Comparison of the high with low CONUT score, the pooled multivariate adjusted risk ratios (RR) was 1.78 (95% confidence intervals [CI] 1.36-2.32) for MACEs and 1.45 (95% CI 1.27-1.66) for all-cause mortality, respectively. When compared with patients with normal nutrition, malnourished (defined by the CONUT score ≥2) patients conferred a 52% increased risk of MACEs. Additionally, per point CONUT score increment was associated with 15% and 11% higher risk of MACEs and all-cause mortality, respectively. Higher CONUT score independently predicts the MACEs all-cause mortality in CAD patients. Estimation of nutritional status using the CONUT score could be helpful for improving risk classification of CAD.
Collapse
Affiliation(s)
- Lijun Huang
- Department of Cardiac and Vascular Surgery, 584020Zhejiang Hospital, Hangzhou, China
| | - Renliang He
- Department of Cardiac and Vascular Surgery, 584020Zhejiang Hospital, Hangzhou, China
| | - Xiajun Sun
- Department of Gastroenterology, 584020Zhejiang Hospital, Hangzhou, China
| | - Jing Lv
- Department of General Practice, 584020Zhejiang Hospital, Hangzhou, China
| | - Shaoxi Chen
- Department of Cardiac and Vascular Surgery, 584020Zhejiang Hospital, Hangzhou, China
| |
Collapse
|
|
6
|
Ji Z, Liu G, Guo J, Zhang R, Su Y, Carvalho A, Qu Y, Zuo W, Yao Y, Lin J, Ma G. The Neutrophil-to-Lymphocyte Ratio Is an Important Indicator Predicting In-Hospital Death in AMI Patients. Front Cardiovasc Med 2021; 8:706852. [PMID: 34616780 PMCID: PMC8488114 DOI: 10.3389/fcvm.2021.706852] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022] Open
Abstract
Objective: To explore the role of neutrophil-to-lymphocyte ratio (NLR) in predicting the short-term prognosis of NSTEMI and STEMI. Methods: This study was a single-center, retrospective and observational study. 2618 patients including 1289 NSTMI and 1329 STEMI patients were enrolled from June 2013 to February 2018 in Zhongda Hospital, Southeast University. The demographic information, clinical characteristics, medical history, laboratory examination, treatment, and outcome of individuals at admission and during hospitalization were extracted from the electronic medical record system. Outcome was defined as the all-cause death during hospitalization. Results: (1) In the NSTEMI group, the ability of NLR in predicting in-hospital death (AUC = 0.746) was higher than the neutrophil-monocyte ratio (NMR) (AUC = 0.654), the platelet-lymphocyte ratio (PLR) (AUC = 0.603) and the lymphocyte-monocyte ratio (LMR) (AUC = 0.685), and also higher than AST (AUC = 0.621), CK (AUC = 0.595), LDH (AUC = 0.653) and TnI (AUC = 0.594). The AUC of NLR in the STEMI group was only 0.621. (2) The optimal cut-off value of NLR in NSTEMI group was 5.509 (Youden index = 0.447, sensitivity = 77.01%, specificity = 67.72%). After adjusting variables including age, sex, diabetes history, smoking history, LDL-C and Cr, the logistic regression showed that the patients with NLR>5.509 had higher hazard risk of death (HR4.356; 95%CI 2.552-7.435; P < 0.001) than the patients with NLR ≤ 5.509. (3) Stratification analysis showed that the in-hospital mortality of patients with NLR > 5.509 was 14.611-fold higher than those with NLR ≤ 5.509 in patients aged <76, much higher than the ratio in patients aged ≥ 76. For patients with creatinine levels ≤ 71, the in-hospital death risk in high NLR group was 10.065-fold higher than in low NLR group (95%CI 1.761-57.514, P = 0.009), while the HR was only 4.117 in patients with creatinine levels > 71. The HR in patients with or without diabetes were 6.586 and 3.375, respectively. The HR in smoking or no smoking patients were 6.646 and 4.145, respectively. The HR in patients with LDL-C ≥ 2.06 or <2.06 were 5.526 and 2.967 respectively. Conclusion: Compared to NMR, PLR, and LMR, NLR had the best ability in predicting in-hospital death after NSTEMI. Age, creatinine, LDL-C, diabetes and smoking history were all important factors affecting the predictive efficiency in NSTEMI. NLR had the limited predictive ability in STEMI.
Collapse
Affiliation(s)
- Zhenjun Ji
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Guiren Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Jiaqi Guo
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Rui Zhang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yamin Su
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Abdlay Carvalho
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yangyang Qu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Wenjie Zuo
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yuyu Yao
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jie Lin
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Department of Cardiology, Jiangsu Taizhou People's Hospital, The Fifth Affiliated Hospital of Nantong University, Taizhou, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| |
Collapse
|