Change in lymphocyte to neutrophil ratio predicts acute rejection after heart transplantation

Choi, Dong Hyun; Kobayashi, Yuhei; Nishi, Takeshi; Luikart, Helen; Dimbil, S.; Kobashigawa, Jon A.; Khush, Kiran K.; Fearon, William F.

doi:10.1016/j.ijcard.2017.10.060

Cited by 22 publications

(17 citation statements)

References 18 publications

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“…The lymphocyte/neutrophil ratio correlated negatively with age (a), the SOFA score (b), and the APACHE II score (c) but positively with the PaO 2 /FiO 2 ratio (D) in ARDS patients The area under the curve (AUC) was 0.721 (95% CI 0.656 to 0.784) for the lymphocyte/neutrophil ratio, 0.625 (95% CI 0.554 to 0.692) for the PaO 2 / FiO 2 ratio, 0.593 (95% CI 0.521 to 0.661) for the BMI, 0.592 (95% CI 0.520 to 0.660) for the lymphocyte count, 0.723 (95% CI 0.656 to 0.784) for the lymphocyte/neutrophil ratio combined with the lymphocyte count and 0.719 (95% CI 0.651 to 0.780) for the lymphocyte/neutrophil ratio in combined with the PaO 2 /FiO 2 ratio. The AUC was 0.369 (95% CI 0.292 to 0.446) for age, 0.425 (95% CI 0.345 to 0.505) for the APACHE II score, and 0.355 (95% CI 0.278 to 0.433) for the SOFA score (not shown) During the past decade, there have been a few investigations addressing the potential function of the lymphocyte/neutrophil ratio, which remains a useful test for the diagnosis of tuberculous pleuritis [19] and acts as an early biomarker for predicting acute rejection after heart transplantation [20]. Previous studies have focused on the poor prognosis of patients with severe lymphopenia from the first day of ICU admission [21].…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for ARDS: clinical, physiological and atypical immunodeficiency

Song

Liu

et al. 2020

BMC Pulm Med

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Background: Risk factors affecting the prognosis of acute respiratory distress syndrome (ARDS) in adults were investigated. The aim was to identify new predictors for ARDS patient prognosis, including those with clinical, pathophysiological, and atypical immunodeficiency. Methods: ARDS patients were retrospectively included. The patients were grouped and analysed according to different oxygenation index grades and prognosis, and factors influencing prognosis and survival were examined. Adolescent patients, patients with typical immunodeficiency and patients who died within 24 h after being diagnosed with ARDS were excluded. The predictive value for mortality was determined by Cox proportional hazard analysis. Results: In total, 201 patients who fulfilled the Berlin definition of ARDS were included. The severity of critical illness on the day of enrolment, as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) II score (P = 0.016), Sequential Organ Failure Assessment (SOFA) score (P = 0.027), and PaO 2 /FiO 2 (P = 0.000), worsened from mild to severe ARDS cases. Compared with survivors, non-survivors were significantly older and had higher APACHE II and SOFA scores. Moreover, significantly lower lymphocyte/neutrophil ratios and leukocyte counts were found among non-survivors than survivors (P = 0.008, P = 0.012). A moderate positive correlation between the lymphocyte/ neutrophil and PaO 2 /FiO 2 ratios (P = 0.023) was observed. In predicting 100-day survival in patients with ARDS, the area under the curve (AUC) for the lymphocyte/neutrophil ratio was significantly higher than those for the PaO 2 / FiO 2 ratio alone, body mass index (BMI) alone, and the lymphocyte count alone (P = 0.0062, 0.0001, and 0.0154). Age (per log 10 years), BMI < 24, SOFA score, leukocyte count, and the lymphocyte/neutrophil ratio were independent predictors of 28-day mortality in ARDS patients. Additionally, ARDS patients with a lymphocyte/ neutrophil ratio < 0.0537 had increased 28-day mortality rates (P = 0.0283). Old age affected both 28-day and 100day mortality rates (P = 0.0064,0.0057).

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Section: Discussionmentioning

confidence: 99%

Prognostic factors for ARDS: clinical, physiological and atypical immunodeficiency

Song

Liu

et al. 2020

BMC Pulm Med

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“…However, when evaluating lymphocyte to neutrophil ratio (LNR) variability in time, at baseline, 3, 6 and 12 months after heart transplantation in a cohort of 74 patients, decreasing LNR was correlated with acute rejection [49]. Lower LNR during the first three months of follow-up was an independent predictor of clinically overt acute graft rejection [49]. In other words, higher NLR would be associated with acute rejection after heart transplantation.…”

Section: Heart Transplantationmentioning

confidence: 99%

The neutrophil to lymphocyte ratio in heart failure: a comprehensive review

Delcea

Buzea

Dan

2019

Romanian Journal of Internal Medicine

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Introduction. Heart failure (HF) and systemic inflammation are interdependent processes that continuously potentiate each other. Distinct pathophysiological pathways are activated, resulting in increased neutrophil count and reduced lymphocyte numbers, making the neutrophil to lymphocyte ratio (NLR) a potential indirect marker of severity. We conducted this comprehensive review to characterize the role of NLR in HF. Methods. We searched the PubMed (MEDLINE) database using the key words “neutrophil”, “lymphocyte”, “heart failure”, “cardiomyopathy”, “implantable cardioverter defibrillator”, “cardiac resynchronization therapy” and “heart transplant”. Results. We identified 241 publications. 31 were selected for this review, including 12,107 patients. NLR was correlated to HF severity expressed by clinical, biological, and imaging parameters, as well as to short and long-term prognosis. Most studies reported its survival predictive value. Elevated NLR (>2.1–7.6) was an independent predictor of in-hospital mortality [adjusted HR 1.13 (95% CI 1.01–1.27) – 2.8 (95% CI 1.43–5.53)] as well as long-term all-cause mortality [adjusted HR 1.43 (95% CI 1.1–1.85) – 2.403 (95% CI 1.076–5.704)]. Higher NLR levels also predicted poor functional capacity [NLR > 2.26/2.74, HR 3.93 (95% CI 1.02–15.12) / 3.085 (95% CI 1.52–6.26)], hospital readmissions [NLR > 2.9/7.6, HR 1.46 (95% CI 1.10–1.93) / 3.46 (95% CI 2.11–5.68)] cardiac resynchronization therapy efficacy [NLR > 3.45/unit increase, HR 12.22 (95% CI 2.16–69.05) / 1.51 (95% CI 1.01–2.24)] and appropriate implantable cardioverter defibrillator shocks (NLR > 2.93), as well as mortality after left ventricular assist device implantation [NLR > 4.4 / quartiles, HR 1.67 (95% CI 1.03–2.70) / 1.22 (95% CI 1.01–1.47)] or heart transplant (NLR > 2.41, HR 3.403 (95% CI 1.04–11.14)]. Conclusion. Increased NLR in HF patients can be a valuable auxiliary biomarker of severity, and most of all, of poor prognosis.

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“…6 The neutrophil-to-lymphocyte ratio (NLR) therefore represents the balance between inflammation and immune regulation. It has been shown to predict mortality and major adverse cardiac events in acute coronary syndromes, 7 degenerative aortic stenosis, 8 acute rejection after heart transplantation, 9 and acute myocardial infarction.…”

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confidence: 99%

The neutrophil-to-lymphocyte ratio and mean platelet volume can be associated with severity of valvular involvement in patients with acute rheumatic carditis

Çelik¹,

Çelik²

2018

CVJA

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Objectives: The aim of the study was to investigate the association between the severity of acute rheumatic carditis (ARC) and the neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV). Methods: Paediatric patients diagnosed with ARC between 2010 and 2016 and age-and gender-matched controls were retrospectively analysed. At the time of diagnosis, we reviewed the demographic features obtained: echocardiographic data, complete blood count reports, acute-phase reactants, including C-reactive protein, and erythrocyte sedimentation rate values. The patient group was further divided into two subgroups according to the degree of valvular regurgitation, which included those with severe and those with mild-tomoderate valvular regurgitation. Results: The number of cases with ARC and age-and gendermatched controls were 120 and 50, respectively. The mean age of the patients was 12.25 ± 2.89 (range: 7-18) years. NLR, MPV, anti-streptolysin-O, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), haemoglobin level, and white blood cell (WBC) and neutrophil count were significantly higher in patients with acute carditis compared with the controls (p < 0.001). NLR was found to have a significantly positive correlation with CRP (r = 0.177, p = 0.001), ESR (r = 0.81, p = 0.03) and WBC count (r = 0.47, p = 0.001). Moreover, we found a positive correlation between NLR and severity of valvular regurgitation (r = 0.34, p < 0.001), and a negative correlation between MPV and severity of valvular regurgitation (r =-0.38, p < 0.05) in our patients. In multiple linear regression analysis, severe valvular regurgitation was associated with NLR (0.51; 95% CI: 0.32-0.68; p = 0.006) and MPV (-0.78; 95% CI:-0.72 to-0.98; p = 0.008). Conclusion: NLR and MPV are novel inflammatory markers and simple, rapid and easily accessible prognostic parameters that can be associated with severity of valvular involvement in patients with ARC.

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Change in lymphocyte to neutrophil ratio predicts acute rejection after heart transplantation

Abstract: The results of this study suggest that ΔLNR over the first 3months after heart transplantation is a strong and independent predictor of acute rejection after heart transplantation. ΔLNR can be used as an early biomarker for predicting of acute rejection after heart transplantation.

Cited by 22 publications

References 18 publications

Prognostic factors for ARDS: clinical, physiological and atypical immunodeficiency

Prognostic factors for ARDS: clinical, physiological and atypical immunodeficiency

The neutrophil to lymphocyte ratio in heart failure: a comprehensive review

The neutrophil-to-lymphocyte ratio and mean platelet volume can be associated with severity of valvular involvement in patients with acute rheumatic carditis

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