Neutrophil-Lymphocyte Ratio and Red Blood Cell Distribution Width in Patients with Atrial Fibrillation and Rheumatic Valve Disease

Clinical value of NT-proBNP, MPO, and NLR combined with echocardiography in prediction of malignant arrhythmia in elderly patients with valvular heart disease

OBJECTIVE

We aimed to probe the clinical value of N-terminus pro-brain natriuretic peptide (NT-proBNP), myeloperoxidase (MPO), and neutrophil lymphocyte ratio (NLR) combined with echocardiography in the prediction of malignant arrhythmias (MA) in elderly patients with valvular heart disease (VHD).

METHODS

MPO, NT-proBNP, and NLR were detected in blood samples. After 1 year of follow-up, receiver operating characteristic curves were analyzed to determine the clinical value of NT-proBNP, MPO, NLR, and echocardiography for predicting MA in patients with VHD.

RESULTS

MPO, NT-proBNP, and NLR were higher in the VHD group. MPO, NT-proBNP, and NLR were higher with severe cardiac dysfunction. MPO, NT-proBNP, NLR, and LVESV in the MA group were higher. NT-proBNP was an independent factor influencing the occurrence of MA in elderly patients with VHD. The AUC for predicting MA in elderly patients with VHD using NT-proBNP, MPO, NLR, and echocardiography were 0.782 (sensitivity 61.50%, specificity 94.60%, 95% CI 0.630-0.934), 0.759 (sensitivity 69.20%, specificity 81.10%, 95% CI 0.579-0.938), 0.736 (sensitivity 76.90%, specificity 64.90%, 95% CI 0.562-0.910), and 0.782 (sensitivity 76.90%, specificity 75.70%, 95% CI 0.646-0.918), respectively. The AUC for the combined prediction using NT-proBNP, MPO, NLR, and echocardiography was 0.913 (sensitivity 76.90%, specificity 94.60%, 95% CI 0.820-1.000), higher than that of each parameter alone (P < 0.05).

CONCLUSION

The combination of NT-proBNP, MPO, NLR, and echocardiography has a predictive value in detecting MA in elderly VHD patients.

Clinical significance of blood cell ratios in healthy and sick Leishmania infantum-seropositive dogs

BACKGROUND

The accuracy of blood cell ratios (BCRs) as cost-effective and easily accessible diagnostic and prognostic markers of inflammatory conditions has been investigated in veterinary medicine in recent years.

METHODS

Neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), and platelet-to-lymphocyte (PLR) ratios were studied in 195 dogs clinically evaluated and tested for anti-Leishmania infantum (Li) antibodies (Li-seronegative (Li-), n = 10; Li-seropositive clinically healthy (Li+healthy), n = 100; Li-seropositive with clinical and/or clinicopathological abnormalities (Li+sick), n = 85). The Li+sick dogs were classified in LeishVet stages IIa/IIb (Li+IIa/IIb) (n = 66) and III/IV (Li+III/IV) (n = 19). BCR relationships with LeishVet clinical stage, antibody levels, and serum protein electrophoretic fraction concentrations were investigated.

RESULTS

Higher NLR values were found in Li+, Li+healthy, and Li+IIa/IIb sick dogs compared to Li- dogs (P < 0.001). Higher NLR and MLR were found in Li+sick (NLR, P < 0.001; MLR, P = 0.034) and Li+III/IV dogs (NLR, P < 0.001; MLR, P = 0.005) compared to Li- dogs, and in Li+III/IV dogs (NLR, P = 0.002; MLR, P < 0.001) compared to Li+healthy. All three BCRs were higher in Li+sick (NLR, MLR, P < 0.001; PLR, P = 0.023) and Li+IIa/IIb dogs (NLR P < 0.001; MLR P = 0.001; PLR, P = 0.012) compared to Li+healthy dogs. The BCRs failed to distinguish dogs with moderate (Li+IIa/IIb) and severe or very severe disease (Li+III/IV). BCRs demonstrated weak positive correlations with serum globulin fractions and antibody levels, and weak negative correlations with serum albumin level were found. Li+sick dogs presenting hypoalbuminemia showed higher MLR ratios (P = 0.001) than those with normal albumin values.

CONCLUSIONS

This study shows that BCR measures provide useful information for differentiating antibody-positive healthy and sick dogs at diagnosis. Dogs with hypoalbuminemia showed higher MLR values despite monocytosis being very rare.

Enhancing the evaluation of acute ischemic stroke risk in individuals with non-valvular atrial fibrillation by including laboratory indicators

To investigate the clinical significance of the CHA2DS2-VASc-60 score, lipoprotein (a) [Lp(a)], red blood cell distribution width (RDW), and their combined effect in patients with non-valvular atrial fibrillation (NVAF) who experience acute ischemic stroke (AIS). This retrospective analysis was conducted on the clinical data of hospitalized patients with NVAF at the Third Affiliated Hospital of Anhui Medical University between April 1, 2020, and April 1, 2023. Based on the diagnosis of acute ischemic stroke (AIS), the patients were divided into two groups: the AIS group (150 cases of NVAF patients with comorbid AIS) and the non-AIS group (163 cases of NVAF patients without AIS). We performed CHA2DS2-VASc-60 scoring for all patients and collected their laboratory indicators and echocardiographic indicators during hospitalization. The study comprised 313 individuals with NVAF in total. There is a statistically significant difference (P < 0.05) in the comparison of CHA2DS2-VASc-60 score (5.68 ± 1.12 vs. 3.67 ± 1.47), Lp(a) [23.98 (13.28, 42.22) vs. 14.32 (7.96, 21.91)] and RDW (13.67 ± 1.25 vs. 12.94 ± 0.76) between NVAF patients with and without concomitant AIS. The results of the Spearman correlation analysis demonstrate a positive association between Lp(a) and RDW levels and both the CHA2DS2-VASc score and the CHA2DS2-VASc-60 score in patients with NVAF. Multivariate logistic regression analysis revealed that CHA2DS2-VASc-60 score [OR = 6.549, 95% CI: 4.110-10.433, P < 0.05], Lp(a) [OR = 1.023, 95% CI: 1.005-1.041, P < 0.05], and RDW [OR = 1.644, 95% CI: 1.071-2.525, P < 0.05] were independent risk factors for AIS in patients with non-valvular atrial fibrillation (NVAF). The receiver operator characteristic (ROC) curves showed that the area under the curve of CHA2DS2-VASc-60 score, Lp(a), RDW, and CHA2DS2-VASc-60 score combined with Lp(a) and RDW predicted that NVAF patients with AIS were 0.881 [95% CI: 0.804-0.906], 0.685 [95% CI: 0.626-0.744], 0.695 [95% CI: 0.637-0.754], and 0.906 [95% CI: 0.845-0.921], respectively. The CHA2DS2-VASc-60 score, Lp(a), and RDW were significantly increased in NVAF patients with AIS, which were independent risk factors for NVAF patients with AIS. The combination of the three has a high predictive capacity for NVAF patients with AIS.