Neutrophil-to-Lymphocyte Ratio for the Prediction of the Presence and Severity of Coronary Artery Disease

Abstract

We read with interest the study by Pan et al. 1 They report the sex-specific role of the neutrophil-to-lymphocyte ratio (NLR) in the presence and severity of coronary artery disease (CAD). These findings have implications, suggesting that sex-specific cut-offs for NLR could be warranted in clinical practice to stratify patients at increased risk. In low-resource settings, parameters that can be calculated from existing, routinely available hemogram variables are of great significance. The NLR is an effective, easily accessible, and inexpensive test, and this study further refines its utility in guiding clinical decisions. The NLR is also among several highly versatile laboratory parameters that have application in the diagnosis and prognostication of several pathological states. [2][3][4][5][6] We have previously demonstrated the utility of NLR in various disease conditions including CAD. [6][7][8][9][10][11] In our analysis of NLR as a predictor of CAD severity rather than the diagnosis of CAD, we found that it was a significant predictor among both sexes.The authors 1 also show that low-density lipoprotein (LDL) and total cholesterol were not significant predictors of the presence of CAD in their population, which is an uncommon finding when compared with reports from Western populations. Likewise, as more data on NLR from different ethnicities are collated, more light will be shed on the ethnicity and sex-specific complex mechanisms behind CAD.The authors describe NLR as an effective risk marker for CAD among males, when compared with non-CAD patients, and report no significant results for female patients. It is worth noting that on receiver operator characteristic (ROC) curve analysis, the area under the curve (AUC) value for NLR among males was .607, which although statistically significant, is quite low. In addition to the AUC, optimal cut-off values along with sensitivity and specificity could have been a valuable addition to the study, to allow more direct clinical application. While NLR may not be an excellent diagnostic marker for CAD vs non-CAD in this case, its role might lie in predicting the severity of CAD. The authors 1 have comprehensively assessed CAD severity using both the Gensini and SYNTAX scores. Although they have demonstrated significant correlation coefficients between NLR and CAD severity scores among males and females, multivariate regression analysis was not carried out to assess the role of NLR on CAD severity.

Neutrophile-to-Lymphocyte Ratio (NLR) Identifies Patients with Coronavirus Infectious Disease 2019 (COVID-19) at High Risk for Deterioration and Mortality—A Retrospective, Monocentric Cohort Study

“…Moreover, NLR appears to discriminate high versus low mortality risk in patients with COVID-19 [4,5]. However, as confirmed by our data provided here, these effects are strongly affected by age, gender, and comorbidities [8][9][10][11][12]. Of note, not only NLR at admission but also longitudinal NLR measurements might adjust the risk for mortality during hospitalization.…”

“…Another limitation is that we only performed adjustment for age, gender, arterial hypertension, diabetes mellitus, and obesity. Moreover, NLR and PLR are known to be affected by concomitant bacterial infections, administration of antibiotics, COVID-19-specific therapy, and the presence of additional chronic diseases [8][9][10][11][12]. The association between laboratory markers and outcome has to be considered with caution.…”

“…Both markers, however, are limited by the lack of specificity and are also found elevated in other chronic conditions such as hematological disorders, cardiovascular and neurodegenerative disease, and malignancy [8][9][10][11][12].…”

The predictive role of laboratory parameters in cardiovascular risk assessment in obese

“…[13] NLR has been investigated in various studies regarding coronary artery disease. [13–15] In one study, significant but not very high AUC values (.607) were reported. [15] However, in our study, the NLR ratio did not yield a significant AUC value (.595, P = .300).…”