Neutrophil to Lymphocyte Ratio Is Related to Thrombotic Complications and Survival in Continuous Flow Left Ventricular Assist Devices

Ferrera, Carlos; González-Fernández, Óscar; Bouzas, Noelia; Castrodeza, Javier; Green, Thomas; Woods, Andrew; Robinson-Smith, Nicola; Tovey, Sian; Jakovljevic, Djordje G.; Shah, Asif; Booth, Karen; Parry, Gareth; Schueler, Stephan; MacGowan, Guy A.

doi:10.1097/mat.0000000000000971

Cited by 8 publications

(13 citation statements)

References 25 publications

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“…Another longitudinal analysis of NLR in patients with advanced HF receiving LVAD therapy as bridge to transplant, carried out by Ferrera et al, confirmed the rise and fall in NLR levels immediately after and several months after surgery [46]. Patients with NLR higher than median during the 4-6 months follow-up had higher rates of stroke and mortality [46].…”

Section: Left Ventricular Assist Devicementioning

confidence: 85%

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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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Section: Left Ventricular Assist Devicementioning

confidence: 85%

“…Patients with NLR higher than median during the 4-6 months follow-up had higher rates of stroke and mortality [46]. NLR during follow-up higher than 4.4 was an independent predictor of mortality, associating significantly shorter survival time [46].…”

Section: Left Ventricular Assist Devicementioning

confidence: 94%

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

Delcea

Buzea

Dan

2019

Romanian Journal of Internal Medicine

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“…We have shown that the neutrophil to lymphocyte ratio as a marker of inflammation predicted adverse outcomes including strokes and mortality. 24 Likewise, Batra et al have shown that preimplant CRP levels predicted mortality, right ventricular failure, and stroke. 25…”

Section: Cte and Infection Cte But Never Infection Pmentioning

confidence: 99%

Does infection predispose to thrombosis during long‐term ventricular assist device support?

et al. 2022

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Background Infections and thrombotic events remain life‐threatening complications in patients with ventricular assist devices (VAD). Methods We describe the relationship between both events in our cohort of patients (n = 220) supported with the HeartWare VAD (HVAD). This is a retrospective analysis of patients undergoing HVAD implantation between July 2009 and March 2019 at the Freeman Hospital, Newcastle upon Tyne, United Kingdom. Results Infection was the most common adverse event in HVAD patients, with 125 patients (56.8%) experiencing ≥ one infection (n = 168, 0.33 event per person year (EPPY)), followed by pump thrombosis (PT) in 61 patients (27.7%, 0.16 EPPY). VAD‐specific infections were the largest group of infections. Of the 125 patients who had an infection, 66 (53%) had a thrombotic event. Both thrombotic events and infections were related to the duration of support, though there was only limited evidence that infections predispose to thrombosis. Those with higher than median levels of C‐reactive protein during the infection were more likely to have an ischaemic stroke (IS) (34.5% vs 16.7%, p = .03), though not PT or a combined thrombotic event (CTE: first PT or IS). However, in multivariate analysis, there was no significant effect of infection predisposing to CTE. Conclusions Infection and thrombotic events are significant adverse events related to the duration of support in patients receiving HVADs. Infections do not clearly predispose to thrombotic events.

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“…Nevertheless, inflammation not related to infection though associated with chronic disease may be thrombogenic. We have shown that the neutrophil‐to‐lymphocyte ratio as a marker of inflammation predicted adverse outcomes 5 …”

Section: Relationship Between Infection and Thrombotic Eventsmentioning

confidence: 98%

“…We have shown that the neutrophil-to-lymphocyte ratio as a marker of inflammation predicted adverse outcomes. 5…”

Section: Infection and Thrombotic Eventsmentioning

confidence: 99%

Relationship between thrombosis and infections in ventricular assist device patients

Bouzas-Cruz

MacGowan

2022

Artificial Organs

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We thank the editors for the opportunity to respond to the Editorial Comment by Dr. Pektok on our article on the relationship between thrombosis and infections in ventricular assist device (VAD) patients. 1 Despite advances in VAD technology, infections and thrombotic events remain potentially life-threatening complications. 2 In brief, we agree with all Dr. Pektok's comments-he highlights well the difficulties in such a large retrospective study looking at events such as infections that may not have clear starting and ending timepoints. Nevertheless, our conclusions are based on the data that we have acquired and analyzed rigorously, so are valid in the context of the limitations that are inherent in such studies. Below we detail our explanation for some of the issues raised.How to cite this article: Bouzas-Cruz N, MacGowan GA. Relationship between thrombosis and infections in ventricular assist device patients.

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Neutrophil to Lymphocyte Ratio Is Related to Thrombotic Complications and Survival in Continuous Flow Left Ventricular Assist Devices

Cited by 8 publications

References 25 publications

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

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

Does infection predispose to thrombosis during long‐term ventricular assist device support?

Relationship between thrombosis and infections in ventricular assist device patients

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