Preoperative neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are associated with major adverse cardiovascular and cerebrovascular events in coronary heart disease patients undergoing non-cardiac surgery

Abstract

Background Preoperative risk prediction in patients at elevated cardiovascular risk shows limited accuracy. Platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) indicate systemic inflammation. Both have been investigated for outcome prediction in the field of oncology and cardiovascular medicine, as well as risk prediction of adverse cardiovascular events in non-surgical patients at increased cardiovascular risk. Methods For this post-hoc analysis, we included all 38 coronary heart disease patients from the Leukocytes and Cardiovascular Perioperative Events cohort-1 study scheduled for elective non-cardiac surgery. We evaluated preoperative differential blood counts for association with major adverse cardiovascular and cerebrovascular events (MACCE) defined as the composite endpoint of death, myocardial ischemia, myocardial infarction, myocardial injury after non-cardiac surgery, or embolic or thrombotic stroke within 30 days after surgery. We used Youden’s index to calculate cut-off values for PLR and NLR. Additive risk-predictive values were assessed using receiver operating characteristic curve and net reclassification (NRI) improvement analyses. Results Patients with the composite endpoint MACCE had higher PLR and NLR (309 [206; 380] vs. 160 [132; 203], p = 0.001; 4.9 [3.5; 8.1] vs. 2.6 [2.2; 3.4]), p = 0.001). Calculated cut-offs for PLR > 204.4 and NLR > 3.1 were associated with increased risk of 30-day MACCE (OR 7, 95% CI [1.2; 44.7], p = 0.034; OR 36, 95% CI [1.8; 686.6], p = 0.001). Furthermore, NLR improved risk prediction in coronary heart disease patients undergoing non-cardiac surgery when combined with hs-cTnT or NT-proBNP (NRI total = 0.23, p = 0.008, NRI total = 0.26, p = 0.005). Conclusions Both PLR and NLR were associated with perioperative cardiovascular adverse events in coronary heart disease patients. NLR proved to be of additional value for preoperative risk stratification. Both PLR and NLR could be used as inexpensive and broadly available tools for perioperative risk assessment. Trial registration NCT02874508, August 22, 2016.

Elevated neutrophil‐to‐lymphocyte ratio but not platelet‐to‐lymphocyte ratio is associated with generalized aggressive periodontitis in a Chinese population

“…NLR can be affected by and may have a high value in predicting the prognosis of many systemic diseases. Elevated NLR in CVDs, especially in myocardial infarction and heart failure, is indicative of poor prognosis; in these studies, NLR was usually determined to be >3 7,8,36 . Increased NLR is also observed in patients with diabetes 9 .…”

“…Platelets are also involved in immune responses in inflamed gingivae through interactions with leukocytes 5 . In recent studies, the neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐leukocyte ratio (PLR), defined as the ratio of absolute neutrophil or platelet and lymphocyte counts, have been proposed as effective biomarkers in the prognosis of several cardiovascular diseases (CVDs), 7,8 diabetes 9,10 and other inflammatory diseases 11,12 . NLR was reported to increase in patients with periodontitis and systemic diseases, for example, in the presence of hyperlipemia, NLR was higher in patients with periodontitis than those without 13 .…”

Right Heart Changes Impact on Clinical Phenotype of Amyloid Cardiac Involvement: A Single Centre Study

“…Immunological evaluation became necessary in many settings. The evaluation of lymphocyte to neutrophils (Neutrophil-to-Lymphocyte ratio: NLR) or platelets (Platelet-to-lymphocyte ratio: PLR) has been proposed as an indicator of the systemic inflammatory response that is widely investigated in cardiovascular diseases [ 18 , 19 ]. NLR was significantly increased in CA (CA 4.25 ± 3.63 vs. nCA 3.12 ± 2.05; p = 0.0307) while no difference was found in PLR (CA 183.1 ± 118.0 vs. nCA 164.4 ± 95.75; p = ns) ( Table 2 ).…”

The prognostic value of NLR for early death in secondary Hemophagocytic lymphohistiocytosis patients: an analysis of 92 patients

“…In recent years, NLR as an in ammation indicator has been well studied in various in ammation associated pathological conditions [10][11][12][13]. Higher NLR was correlated with more advanced disease stage in autoimmune disease [17,18] and it was proved to be an independent prognosis factor in infections disease [11,19], diffuse large B-cell lymphoma [20,21], and so on.…”

“…Recently, a simple, rapid, inexpensive marker, the neutrophil-lymphocyte ratio (NLR) was suggested to be a robust biomarker of systemic in ammation and predicts early death and overall survival in various in ammation associated pathological conditions [10][11][12][13]. It is well known that increased neutrophil counts represent systemic in ammation and decreased lymphocyte counts represent the immune system [10], the combination of neutrophil and lymphocyte makes NLR as a more comprehensive biomarker.…”