Neutrophil-lymphocyte ratio: A prognostic tool in patients with in-hospital cardiac arrest

Patel, Vishal; Vendittelli, Philip; Garg, Rajat; Szpunar, Susan; LaLonde, Thomas; Lee, John; Rosman, Howard; Mehta, Rajendra H.; Othman, Hussein

doi:10.5492/wjccm.v8.i2.9

Cited by 13 publications

(10 citation statements)

References 30 publications

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“…Recent data suggest that the response of neutrophils to hypoxia could be an early and critical mediator of ischemic reperfusion injury [5]. This is consistent with previous studies reporting substantial mortality and neurologic morbidity in resuscitated cardiac arrest patients with an elevated number of blood neutrophils in relation to other leukocyte counts [6,7,8]. The mechanisms by which neutrophils may contribute to post-resuscitative brain damage have, however, not yet been elucidated.…”

Section: Introductionsupporting

confidence: 76%

“…This study investigated whether early plasma NET formation is associated with poor neurologic 30 day function following successful out-of-hospital resuscitation. The study was built on previous data suggesting a possible role of neutrophils in the development of post-resuscitative organ damage and was driven by the hypothesis that excessive NET release upon ischemic reperfusion may contribute to cerebral micro-circulatory compromise and thus neurologic disability in cardiac arrest survivors [5,6,7,8].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies reported increased mortality and neurologic morbidity in resuscitated cardiac arrest patients presenting with markers of neutrophil inflammation or elevated neutrophil counts in proportion to other leucocytes [6,7,8,26,27,28]. However, it has not been investigated whether these findings simply reflect stress response or whether neutrophils might be causally involved in the progression of organ injury following successful resuscitation.…”

Section: Discussionmentioning

confidence: 99%

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Increased Citrullinated Histone H3 Levels in the Early Post-Resuscitative Period Are Associated with Poor Neurologic Function in Cardiac Arrest Survivors—A Prospective Observational Study

Mauracher

Buchtele

Schörgenhofer

et al. 2019

JCM

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The exact contribution of neutrophils to post-resuscitative brain damage is unknown. We aimed to investigate whether neutrophil extracellular trap (NET) formation in the early phase after return of spontaneous circulation (ROSC) may be associated with poor 30 day neurologic function in cardiac arrest survivors. This study prospectively included adult (≥18 years) out-of-hospital cardiac arrest (OHCA) survivors with cardiac origin, who were subjected to targeted temperature management. Plasma levels of specific (citrullinated histone H3, H3Cit) and putative (cell-free DNA (cfDNA) and nucleosomes) biomarkers of NET formation were assessed at 0 and 12 h after admission. The primary outcome was neurologic function on day 30 after admission, which was assessed using the five-point cerebral performance category (CPC) score, classifying patients into good (CPC 1–2) or poor (CPC 3–5) neurologic function. The main variable of interest was the effect of H3Cit level quintiles at 12 h on 30 day neurologic function, assessed by logistic regression. The first quintile was used as a baseline reference. Results are given as crude odds ratio (OR) with 95% confidence interval (95% CI). Sixty-two patients (79% male, median age: 57 years) were enrolled. The odds of poor neurologic function increased linearly, with 0 h levels of cfNDA (crude OR 1.8, 95% CI: 1.2–2.7, p = 0.007) and nucleosomes (crude OR 1.7, 95% CI: 1.0–2.2, p = 0.049), as well as with 12 h levels of cfDNA (crude OR 1.6, 95% CI: 1.1–2.4, p = 0.024), nucleosomes (crude OR 1.7, 95% CI: 1.1–2.5, p = 0.020), and H3Cit (crude OR 1.6, 95% CI: 1.1–2.3, p = 0.029). Patients in the fourth (7.9, 95% CI: 1.1–56, p = 0.039) and fifth (9.0, 95% CI: 1.3–63, p = 0.027) H3Cit quintile had significantly higher odds of poor 30 day neurologic function compared to patients in the first quintile. Increased plasma levels of H3Cit, 12 h after admission, are associated with poor 30 day neurologic function in adult OHCA survivors, which may suggest a contribution of NET formation to post-resuscitative brain damage and therefore provide a therapeutic target in the future.

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Section: Introductionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Increased Citrullinated Histone H3 Levels in the Early Post-Resuscitative Period Are Associated with Poor Neurologic Function in Cardiac Arrest Survivors—A Prospective Observational Study

Mauracher

Buchtele

Schörgenhofer

et al. 2019

JCM

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“…For example, neutrophil lymphocyte ratio, a marker of systemic inflammation, was previously reported to be associated with mortality independently from epinephrine application [60]. Another study showed that neutrophil lymphocyte ratio in survivors was 4.9 (range 0.6-46.5) compared with 8.9 (0.28-96) in non-survivors (P = 0.001) [61]. Blood concentrations of C-reactive protein steadily increased in the several days after ROSC in CA patients and there was a much pronounced higher CRP levels in the patients with system infection [62].…”

Section: Discussionmentioning

confidence: 96%

High plasma levels of pro-inflammatory factors interleukin-17 and interleukin-23 are associated with poor outcome of cardiac-arrest patients: a single center experience

Zhuang

Chen

Zhou

et al. 2020

BMC Cardiovasc Disord

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Background: Systemic inflammation is an important feature of post-cardiac arrest syndrome (PCAS). This study was designed to determine whether the plasma concentrations of some circulating pro-inflammatory cytokines , IL-22, IL-23 and IL-33) are of value in predicting the outcome of patients after return of spontaneous circulation (ROSC) during the post-cardiac arrest period. Methods: This was a prospective observational clinical study. In total, 21 patients (survivors, n = 10; non-survivors, n = 11) who experienced cardiac arrest and successful ROSC with expected survival of at least 7 days were consecutively enrolled from January 2016 to December 2017. Of the 21 enrolled patients, ten survived were designated "survivors". The other eleven patients died between 2 days and 1 months post ROSC. Venous blood was drawn at three time-points: baseline (< 1 h post ROSC), 2 days post ROSC and 7 days post ROSC. Plasma IL-8, IL-22, IL-23 and IL-33 were determined using commercial enzyme-linked immunosorbent assays. Results: Plasma creatinine levels, but aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, were elevated in non-survivors compared with survivors. Plasma levels of IL-17, IL-22, IL-23 and IL-33 of the 21 total patients did not change at 2 or 7 days post ROSC compared to baseline. In survivors, the plasma levels of IL-17 and IL-23 at 2 or 7 days post ROSC were lower than baseline. In non-survivors, plasma levels of IL-17 increased compared with baseline. Receiver operating characteristic curve analysis showed that the plasma levels of IL-17 and IL-23 at 2 or 7 days post ROSC were able to predict the mortality of PCAS patients, and positively correlated with Acute Physiology and Chronic Health Evaluation (APACHE)-II score and time to ROSC.Conclusion: These results provide the first evidence that the elevated plasma IL-17 and IL-23 levels are associated with poor outcome in PCAS patients. The role of IL-17/IL-23 axis post ROSC is worth paying attention to in PCAS patients.Trial registration: Clinicaltrial.gov NCT02297776, 2014-11-21.

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“…The neutrophil-to-lymphocyte ratio (NLR) has been associated with survival in multiple subtypes of malignancies, 27,28) and a higher ratio is associated with poorer cardiovascular outcomes. 29) An elevated neutrophil count is associated with elevated levels of vascular endothelial growth factor (VEGF), 30) which is a primary promotor of angiogenesis, 31) but it is not believed to play a role in arteriogenesis, the proposed mechanism by which collateral arteries mature.…”

Section: Discussionmentioning

confidence: 99%

Predictors and Prognostic Implications of Well-Matured Coronary Collateral Circulation in Patients with a Chronic Total Occlusion (CTO)

et al. 2020

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The predictors and prognostic implications of well-matured collaterals in those with a chronic total occlusion (CTO) are unknown. We sought to identify the determinants of collateral maturation and to determine its effects on procedural outcomes and prognosis. Patients presenting for CTO percutaneous coronary intervention (PCI) between April 2010 and July 2019 were included. Patients with a previous coronary artery bypass (CABG) to the CTO and those with only bridging collaterals were excluded. The degree of collateral maturation was determined by the Rentrop grading classification. Demographic, biochemical, and anatomical factors and procedural and longer-term outcomes were identified. A total of 212 patients were included in the study. Patients with well-matured collaterals were more likely to be females (29.7% versus 15.2% versus 0%, P < 0.005 for Rentrop grade 3, 2, and 0 or 1, respectively), less likely to have chronic kidney disease (CKD) (8.8% versus 4.5% versus 19.2%, P < 0.05) and less likely to have had a prior CABG (15.6% versus 18.7% versus 19.2%). Patients with well-matured collaterals had lower neutrophil-to-leukocyte ratio (NLR) (2.8 versus 4.0 versus 5.7, P < 0.0001). Patients with well-matured collaterals were more likely to have procedural success (90.5% versus 62.5% versus 34.6%, P < 0.0001). The degree of collateral maturation was not associated with longer-term mortality. Improved collateral maturation was associated with female sex and lower rates of CKD and CABG and a lower NLR. Those with well-matured collaterals had a significantly higher rate of procedural success but not improved prognosis.

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Neutrophil-lymphocyte ratio: A prognostic tool in patients with in-hospital cardiac arrest

Cited by 13 publications

References 30 publications

Increased Citrullinated Histone H3 Levels in the Early Post-Resuscitative Period Are Associated with Poor Neurologic Function in Cardiac Arrest Survivors—A Prospective Observational Study

Increased Citrullinated Histone H3 Levels in the Early Post-Resuscitative Period Are Associated with Poor Neurologic Function in Cardiac Arrest Survivors—A Prospective Observational Study

High plasma levels of pro-inflammatory factors interleukin-17 and interleukin-23 are associated with poor outcome of cardiac-arrest patients: a single center experience

Predictors and Prognostic Implications of Well-Matured Coronary Collateral Circulation in Patients with a Chronic Total Occlusion (CTO)

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