Association of Inflammatory Markers with Mortality in Patients Hospitalized with Non-massive Pulmonary Embolism

Duman, Dildar; Sonkaya, Esin; Yıldırım, Elif; Gıdık, Erman; Tanülkü, Uğurcan; Saltürk, Cüneyt; Karakurt, Zühal

doi:10.5152/turkthoracj.2021.190076

Cited by 12 publications

(19 citation statements)

References 20 publications

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“…The relationship of NLR and PE prognosis has been previously reported [ 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. However, previous studies were limited by relatively small sample sizes and broad exclusion criteria, preventing generalization.…”

Section: Discussionmentioning

confidence: 95%

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The Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Patients Hospitalized with Acute Pulmonary Embolism

Efros

Halevi

Meisel

et al. 2021

JCM

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Early risk stratification is essential for determining the appropriate therapeutic management approach of pulmonary embolism (PE). This study aimed to evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients hospitalized with acute pulmonary embolism by investigating its association with mortality in a large-scale population diagnosed and hospitalized with acute PE. We retrieved all consecutive patients hospitalized in an internal medicine department or an intensive care unit in a tertiary medical center from December 2007 to April 2021 with a discharge diagnosis of pulmonary embolism. A total of 2068 patients were included. Patients with above-median NLR (i.e., 5.12) had a higher 30-day mortality risk (adjusted odds ratio (aOR), 2.82; 95% confidence interval (CI) 2.14–3.70) and higher one-year mortality risk (aOR, 2.51; 95% CI 2.04–3.08). Similar trends were demonstrated in a sub-analysis of patients without cancer and hemodynamically stable (i.e., systolic blood pressure over 90 mmHg). Furthermore, the median hospital length of stay in patients with an elevated NLR was higher, and so was the in-hospital mortality rate. Elevated NLR in acute PE is associated with a worse short-term and long-term prognosis and with a longer duration of hospitalization.

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Section: Discussionmentioning

confidence: 95%

“…In recent years, the NLR has also been proposed to have a prognostic role in acute PE [ 12 , 17 ]. However, previous research investigating NLR in acute PE has been limited to relatively small cohorts and restrictive inclusion criteria [ 18 , 19 , 20 , 21 , 22 , 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

The Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Patients Hospitalized with Acute Pulmonary Embolism

Efros

Halevi

Meisel

et al. 2021

JCM

View full text Add to dashboard Cite

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“…Duman et al also identified there was no significant difference in PLR levels between dead and surviving subgroups in 828 PE patients (p=0.13) and that PLR was not an independent risk factor for death (p>0.05). 21 Ertem et al found that PLR was also not significantly associated with death in 294 patients with APE (p=0.241). 24 Liu et al also revealed that PLR was not an independent predictor of 30-day mortality in patients with PAPE (p=0.193).…”

Section: Plr and Vtementioning

confidence: 97%

“…Duman et al found that an NLR above 6.1 increased mortality at 30 days by 13.8-fold in a cohort of 828 PE patients. 21 NLR over 3.25 was an independent risk factor for 6-month mortality (HR=2.77, 95% CI: 1.48–5.18, p=0.001) and NLR over 3.14 was an independent risk factor for 1-year mortality (HR=2.20, 95% CI: 1.32–3.66, p=0.003). Karataş et al followed 203 patients with APE for a mean of 20 months and 34 patients (17%) died during the follow-up period.…”

Section: Nlr and Vtementioning

confidence: 98%

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Diagnostic and Prognostic Value of Immune/Inflammation Biomarkers for Venous Thromboembolism: Is It Reliable for Clinical Practice?

Xue¹,

Ma²,

Jia³

et al. 2021

JIR

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Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), has been an important cause of sudden in-hospital death. Studies have shown that the immune/inflammatory response plays an important role in the pathogenesis of vascular disease, with representative markers in the blood including the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), systemic immune/inflammatory index (SII), etc. However, there is a variety of immune/inflammatory indicators. Moreover, most previous studies have been single-center investigations involving one or two indicators, with varying nature of cases, number of cases and study objectives, thereby making it difficult to reach consensus conclusions with good clinical guidelines. This article reviews the clinical value of immunoinflammatory indicators for VTE based on previous studies, including the diagnostic and prognostic capabilities. In conclusion, NLR provides promising predictive capability for the onset and prognosis of VTE and deserves extensive application in clinical practice. PLR also has certain diagnostic and prognostic value, but further studies are warranted to identify its reliability and stability. Monocytes, eosinophils and platelet-related indicators show some clinical association with VTE, although the predictive capabilities are mediocre. SII is of promising potential value for VTE and deserves further investigations. This review will provide new clues and valuable clinical guidance for the diagnosis and therapy of VTE.

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The prognostic value of blood cellular indices in pulmonary embolism

Siddiqui,

Tafur,

Hussain

et al. 2024

American J Hematol

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Prognostication in acute pulmonary embolism (PE) requires reliable markers. While cellular indices such as neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and systemic immune‐inflammation index (SII) appear promising, their utility in PE prognostication needs further exploration. We utilized data from the RIETE registry and the Loyola University Medical Center (LUMC) to assess the prognostic value of NLR, PLR, and SII in acute PE, using logistic regression models. The primary outcome was 30‐day all‐cause mortality. We compared their prognostic value versus the simplified Pulmonary Embolism Severity Index (sPESI) alone. We included 10 085 patients from RIETE and 700 from the LUMC. Thirty‐day mortality rates were 4.6% and 8.3%, respectively. On multivariable analysis, an elevated NLR (>7.0) was associated with increased mortality (adjusted odds ratio [aOR]: 3.46; 95% CI: 2.60–4.60), outperforming the PLR > 220 (aOR: 2.36; 95% CI: 1.77–3.13), and SII > 1600 (aOR: 2.52; 95% CI: 1.90–3.33). The c‐statistic for NLR in patients with low‐risk PE was 0.78 (95% CI: 0.69–0.86). Respective numbers were 0.66 (95% CI: 0.63–0.69) and 0.68 (95% CI: 0.59–0.76) for intermediate‐risk and high‐risk patients. These findings were mirrored in the LUMC cohort. Among 9810 normotensive patients in RIETE, those scoring 0 points in sPESI and with an NLR ≤ 7.0 (35% of the population) displayed superior sensitivity (97.1%; 95% CI: 95.5–98.7) and negative predictive value (99.7%; 95% CI: 99.5–99.8) than sPESI alone (87.1%; 95% CI: 83.9–90.3, and 98.7%; 95% CI: 98.4–99.1, respectively) for 30‐day mortality. The NLR is a significant prognostic marker for 30‐day mortality in PE patients, especially useful to identify patients with very low‐risk PE.

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Association of Inflammatory Markers with Mortality in Patients Hospitalized with Non-massive Pulmonary Embolism

Cited by 12 publications

References 20 publications

The Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Patients Hospitalized with Acute Pulmonary Embolism

The Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Patients Hospitalized with Acute Pulmonary Embolism

Diagnostic and Prognostic Value of Immune/Inflammation Biomarkers for Venous Thromboembolism: Is It Reliable for Clinical Practice?

The prognostic value of blood cellular indices in pulmonary embolism

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