Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Important Indicators for Predicting in-Hospital Death in Elderly AMI Patients

Abstract

To investigate the role of neutrophil-to-lymphocyte ratio(NLR) and platelet-to-lymphocyte(PLR) in predicting the risk of inhospital 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 inhospital 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.

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“…A study by Bhat et al demonstrated that a higher NLR is associated with increased mortality among patients with congestive heart failure [ 30 ]. Our study’s findings are consistent with those of these previous studies, indicating an elevated NLR’s association with increased CVD risk [ 29 , 30 ]. Furthermore, a study by Chen et al suggested that NLR and PLR can predict in-hospital mortality risk in elderly patients with acute myocardial infarction, with NLR showing better predictive ability than PLR [ 29 ].…”

“…Our study’s findings are consistent with those of these previous studies, indicating an elevated NLR’s association with increased CVD risk [ 29 , 30 ]. Furthermore, a study by Chen et al suggested that NLR and PLR can predict in-hospital mortality risk in elderly patients with acute myocardial infarction, with NLR showing better predictive ability than PLR [ 29 ]. Similarly, our study found that NLR remained significantly associated with an increased risk of CVD even after adjusting for several factors, whereas PLR lost its significance after these adjustments.…”

“…These studies also suggested PLR as a potential inflammatory marker and predictor of CVD risk [ 26 , 27 ]. However, similar to our results, some previous studies reported the loss of significance in the association between PLR and CVD risk after adjusting for multiple factors [ 26 , 28 , 29 ], highlighting the importance of considering various factors when using PLR as a risk indicator for CVD assessment.…”

“…Previous research has demonstrated associations between an increased risk of CVD and various inflammatory markers, including WBC count, neutrophil count, NLR, and PLR [ 26 , 28 , 29 , 33 ]. However, it’s essential to consider that the strength of the association between these inflammatory markers and the actual risk of CVD may diminish after adjustments for variables such as age, gender, smoking, and other factors.…”

“…It’s important to note that the associations between WBC, neutrophil count, PLR, NLR, and CVD risk can be influenced by various factors. While these blood cell counts and ratios provide valuable insights into inflammation and potential CVD risk [ 26 , 29 , 30 , 32 ] they are not specific or direct markers of CVD. Multiple factors can influence these blood cell counts and ratios, and their associations with CVD risk may vary depending on the study population, design, and adjustments made for confounding factors [ 34 ].…”