Relation of neutrophil -to- lymphocyte ratio with the presence and complexity of coronary artery disease: an observational study

Abstract

Objective: The neutrophil -to-lymphocyte ratio (NLR) is a new predictor for cardiovascular risk and mortality. The SYNTAX score is an angiographic tool used in grading the complexity of coronary artery disease (CAD). However, its relation with CAD severity and complexity is not yet known. We hypothesized that NLR would be associated with a greater complexity of CAD as assessed using the SYNTAX score. Methods: This cross-sectional observational study included 106 patients who had undergone coronary angiography for stable angina pectoris and 69 patients who had normal coronary angiogram. Baseline NLR was measured by dividing neutrophil count to lymphocyte count. The patients were classified two groups as CAD (-) (n=69) and CAD (+) (n=106), then patients in CAD (+) group were divided into 3 groups according to SYNTAX scores (SYNTAX score 1-22, 23-32, >32) as pointed in European Society of Cardiology (ESC) revascularization guideline. Statistical analysis was performed using the Mann-Whitney U and Kruskal-Wallis tests, and multiple logistic regression analysis was used to identify the independent predictors of complexity of CAD-SYNTAX score. Results: Patients with CAD had a significantly higher value of NLR [1.6 median (1.2-3.3 IQR) vs. 2.3 median (1.8-3.0 IQR) p<0.001]. The group with high SYNTAX scores (>32) more frequently had diabetes mellitus (DM), hypercholesterolemia (HL), were of older age, and also had significantly elevated NLR values [2.4 (1.3-2.6), 2.6 (2.3-3.9), 2.0 (1.5-2.6) p=0.006]. In univariate analysis, age, DM, HL, creatinine, neutrophil count and NLR were predictors of high SYNTAX score. In the multiple logistic regression analysis, only NLR [odds ratio (OR)=2.1, 95% confidence interval (CI) 1.2-3.8, p=0.09], was identified as independent predictor of a high SYNTAX score. Conclusion: NLR is a strong clinical laboratory value that is associated with presence and complexity of CAD. (Anadolu Kardiyol Derg 2013; 13: 662-7) Key words: Neutrophil -to-lymphocyte ratio, complexity, coronary artery disease, regression analysis, sensitivity, specificity Original Investigation Özgün Araşt›rma 662ÖZET Amaç: Nötrofil lenfosit oranı (NLO) kardiovasküler risk ve mortalite için yeni bir öngördürücüdür. SYNTAX skoru koroner arter hastalığı (KAH) karmaşıklığını derecelendirmede anjiyografik bir yöntemdir. NLO ile KAH varlığı ve karmaşıklığı arasındaki ilişki henüz ortaya konmamıştır. Biz SYNTAX skorunu kullanarak NLO ile KAH varlığı ve karmaşıklığı arasında daha güçlü bir ilişki olabileceği tezini öne sürdük. Yöntemler: Bu enine kesit gözlemsel çalışmaya 106 koroner anjiyografisi yapılmış stabil angina pectoris hastası ve 69 normal koronere sahip hastalar dahil edildi. Bazal NLO nötrofil sayısının lenfosit sayısına oranı olarak hesaplandı. Hastalar KAH olan ve olmayan şeklinde iki gruba ayrıldı. KAH grubu SYNTAX skoruna göre Avrupa Kardiyoloji Cemiyeti miyokardiyal girişim kılavuzuna dayanarak 3 gruba ayrıldı (23)(24)(25)(26)(27)(28)(29)(30)(31)(32) >32). İstatistiksel analiz Mann-Whitney U ve Kruskal-Wal...

The Relationship between Ventricular Repolarization Indexes and Neutrophil to Lymphocyte Ratio in Patients with Slow Coronary Flow

“…During the pathogenesis of cardiac disease and arrhythmia, there is an increase in inflammatory activity [23][24][25] and in SCF patients inflammatory activity is further increased [6,26]. In our study, the inflammation level was evaluated by NLR and our results correlated with previous studies demonstrating that inflammation levels were higher in SCF patients compared to controls.…”

Assesment of Coronary Artery Disease by The Detection of Inflammatory Marker Like Erythrocyte Sedimentation Rate, Neutrophil Lymphocyte Ratio and Leucocyte Count

“…There was also statistically significant association between the groups (p <0.001). 5,21,22,23 In this study, we found a relation of ESR, NLR with the presence of coronary artery disease. There is no doubt in cardiovascular medical science that atherosclerosis is a chronic inflammatory disease.…”

“…Sonmez O et al, (2013) also found higher total count WBC in patients with coronary artery disease (p <0.001). 5 In our study mean NLR in Group I was 2.76 (±0.74), whereas it was 1.56 (±0.15) in Group II. There was statistically significant association between two groups in this regards (p <0.001).…”

“…Sonmez O et al, (2013) also found higher mean NLR in patients with coronary artery disease (2.3 vs 1.6) (p <0.001). 5 ESR, NLR can be a useful tool to detect and measure the future prognosis of CAD. In this study, we found a relationship between ESR, NLR and CAD proven with angiography and ESR, NLR as a useful inflammatory marker in detection of CAD.…”

Atherosclerosis Is Associated with Neutrophil Lymphocyte Ratio As An Inflammatory Marker in Type 2 Diabetes Mellitus Patients with Coronary Artery Disease

“…1 NLR is a new indicator for cardiovascular risk and mortality and by which we can predict the risk of coronary artery disease (CAD) in type 2 DM patients. 2 Increased NLR is associated with major adverse cardiac events in type 2 diabetes mellitus patients. 3,4 The relationship between various inflammatory markers and CAD has been established.…”