Neutrophils and clinical outcomes in patients with acute coronary syndromes and/or cardiac revascularisation

Abstract

Some studies have suggested that high levels of total white blood cell (WBC) count and C-reactive protein (CRP) may be considered as independent prognostic factors in patients with acute coronary syndromes (ACS) and/or after cardiac revascularisation by percutaneous coronary intervention or coronary artery bypass grafting surgery. Evidence on the role of neutrophils in cardiovascular disease is less compelling. Therefore, we conducted a systematic review of the literature with the aim of identifying all the available evidence to clarify the role of neutrophils (absolute or relative count, neutrophil/lymphocyte ratio) as a prognostic risk factor in patients with ACS and/or cardiac revascularisation. All published studies evaluating the role of neutrophils as a risk factor for clinical outcomes were assessed using the MEDLINE and EMBASE databases. Study selection, data extraction and validity assessment was performed independently by two reviewers. Twenty-one studies (17 of which had positive results) for a total of more than 34,000 patients were included. Ten of 13 studies in ACS patients found that neutrophils measured on-admission are related to mortality rate and/or to major adverse clinical events. A predictive value of neutrophils after cardiac revascularisation procedures was reported in seven out of eight studies. Most of the studies showed that neutrophils were independent predictors of cardiovascular outcomes when analysed concomitantly with other markers of inflammation (WBC, CRP). The findings of our systematic review highlight the potential application of this inexpensive and readily available inflammatory marker for risk stratification in patients with ACS and/or cardiac revascularisation.

The neutrophil-to-lymphocyte ratio (NLR) after surgery for hip fracture (HF)

“…Secondly, neutrophils induce secretion of growth factors, reactive oxygen species, prostaglandins, TNF-alpha and enzymes which induce further vascular damage (Tousoulis, Antoniades, Koumallos, & Stefanadis, 2006;Turkmen, Guney, Yerlikaya, & Tonbul, 2012). These effects are dependent of the magnitude and the duration of the response (Guasti et al, 2011). In response to neutrophil-linked activation, platelets induce an additional recruitment of neutrophils.…”

Association of Neutrophil–Lymphocyte Ratio With the Presence and Severity of Rheumatic Mitral Valve Stenosis

“…21 In a review that included more than 34 000 patients, the NLR was shown to be a simple, readily available inflammatory marker for the risk stratification of patients with acute coronary syndrome or for whom revascularization was performed. 22 Increased levels of NLR, as a marker of inflammation, have been associated with increased mortality in patients with stable coronary artery disease 23 and those undergoing coronary angiography 24 and percutaneous coronary intervention. 25 In addition, higher NLR levels were associated with an increased risk of long-term mortality in patients admitted with acute decompensated heart failure (HF).…”

Pro- and anti-inflammatory actions in coronary artery disease : with focus on CD56+ T cells and Annexin A1

“…As expected, the numbers of neutrophils were significantly increased in ACS patients (5.1 (4.0 -8.2) x 10 3 cells/µL) compared with post-ACS patients and controls, p = 0.011 for trend. Elevated neutrophil count is a well-known characteristic of ACS patients and has also been shown to be a predictor of cardiovascular outcome (Guasti et al, 2011).…”