Neutrophil-to-Lymphocyte Ratio (NLR) Useful as a Cost-Effective Preliminary Prognostic Marker in ST-Elevation Myocardial Infarction (STEMI): An Observational Study From a Tertiary Care Hospital in Northeast India

Abstract

IntroductionMyocardial infarction, a major consequence of coronary artery disease, is an important cause of in-hospital mortality and morbidity worldwide. Blood neutrophil-to-lymphocyte ratio (NLR) is a novel laboratory marker of systemic inflammation that can predict the severity and mortality in various non-cardiovascular illnesses, including malignancy and infective pathology. We sought to evaluate its potential in predicting the outcome in hospitalized patients with myocardial infarction. Material and methodsThe index study was conducted at Silchar Medical College and Hospital from June 1, 2021 to May 31, 2022, with the aim of evaluating the role of NLR in determining the outcomes of ST-elevation myocardial infarction (STEMI). A total of 110 patients fulfilling the requisite criteria and admitted to the cardiology and medicine departments of the hospital with evidence of STEMI were included in the study and evaluated for the relationship of NLR with various outcome variables in STEMI. ResultsOut of 110 patients, 69.1% were males. The mean age of the study population was 58.2±15.3 years. The baseline characteristics and risk factors of patients who survived the acute attack of STEMI and those who died from complications of STEMI were similar. Laboratory parameters which correlated with worse outcomes included a higher fasting triglyceride level (173.4 mg vs. 215.6 mg, p < 0.001), a higher blood neutrophil count at baseline, 24 hours and 72 hours (70.1% vs. 69.04%, 66.3% vs. 75.2%, 81.6% vs. 73.8%, p<0.05), a higher NLR value at baseline, 24 hours and 72 hours (2. 91 ± 1.13 vs. 3.19 ± 2.32, 2.39 ± 0.74 vs. 5.56 ± 4.11, 5.1 ± 4.38 vs. 3.01 ± 1.02, p < 0.05). Among patients hospitalized with STEMI who had high NLR, had significantly elevated incidence of complications, including a higher acute, left ventricular failure (42.8% vs. 35.9%; p < 0.05) as well as increased risk of mortality (66.7% vs. 33.3%; p < 0.05) compared to low NLR group. ConclusionNLR can predict the outcome among STEMI patients in terms of morbidity and mortality and correlates with poor left ventricular function. NLR can serve as a potential tool for early identification and efficient triage of STEMI patients during initial presentation to the ED. Its utility is more so in resource-constrained developing countries with limited access to health care. The significant advantage of NLR is its easy accessibility, rapid turnaround time, and inexpensiveness.

A Retrospective Analysis of the Association of Neutrophil–Lymphocyte Ratio (NLR) with Anemia in the Saudi Population

“…Furthermore, NLR and anemia were independent risk factors for mortality in breast cancer patients [ 30 ]. Elevated NLR combined with decreased Hb predicted the onset of major adverse cardiovascular events in patients with ST-elevation myocardial infarction [ 14 ]. Taken together, it appears that NLR is most appropriate for following up and managing anemia associated with chronic disease rather than screening or diagnosing anemia at the population level; yet, further longitudinal studies are certainly warranted.…”

“…In a study involving a Saudi population, NLR ratio was found to be an important tool in determining COVID-19 clinical status [ 12 ]. NLR is also an emerging marker in patients with heart failure, acute coronary syndrome, hypertension, and diabetes [ 13 , 14 , 15 , 16 , 17 ].…”

Evaluation of Uric Acid to Albumin Ratio as a Marker of Coronary Artery Disease Severity in Acute Coronary Syndrome: A Cross-Sectional Study

“…However, a meta-analysis of 17 studies suggested that high NLR was associated with severity of CAD and could be useful for predicting severe stenosis [ 18 , 19 ].…”

Preoperative Systemic Immune-Inflammatory Index as a Predictive Biomarker for Lower Extremity Deep Vein Thrombosis after Breast Cancer Surgery: Stratified Nursing Intervention to Reduce Incidence

“…Lymphocytes, as part of the adaptive immune response, are important elements of the immunoregulatory pathway. Recently, several studies have found that an elevated neutrophil count and low lymphocyte count are closely related to the progression of atherosclerosis, or ischemia-reperfusion injury after revascularization of acute myocardial infarction [ 32 , 33 ]. Platelets are the initiating factors of thrombosis.…”