Risk stratification with longitudinal neutrophil to lymphocyte ratio assessment after left ventricular assist device implantation

Bhat, Geetha; Yost, Gardner; Ibrahim, Kamel; Pappas, Patroklos; Tatooles, Antone

doi:10.1177/0391398818784276

Cited by 6 publications

(5 citation statements)

References 27 publications

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Section: Left Ventricular Assist Devicementioning

confidence: 97%

“…Bhat et al further proved that the NLR variability in time was correlated to outcomes in HF patients receiving LVAD therapy [45]. Highest NLR levels were recorded immediately after surgery with a tendency to decrease after approximately 30 days to levels similar to the preoperative ones [45]. However, patients whose NLR failed to improve 10 days postoperative had higher probability of a longer length of stay, of developing right HF and a trend toward reduced survival rates [45].…”

Section: Left Ventricular Assist Devicementioning

confidence: 99%

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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: 97%

Section: Left Ventricular Assist Devicementioning

confidence: 99%

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

Delcea

Buzea

Dan

2019

Romanian Journal of Internal Medicine

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“…The preoperative NLR is typically above normal levels, and increases further postoperatively, reflecting the acute inflammatory response to surgery. However, the NLR then reduces logarithmically, reaching lower than preoperative values at 3–6 months follow-up [69–71]. Previous studies have reported that a high pre-LVAD NLR is predictive of mortality during the LVAD support period [69,72].…”

Section: Neutrophil-to-lymphocyte Ratio In Heart Failure and Heart Tr...mentioning

confidence: 99%

The prognostic value of neutrophil-to-lymphocyte ratio across all stages of coronary artery disease

Agarwal

Aurora

Siswanto

et al. 2021

Coronary Artery Disease

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The natural history of coronary heart disease (CAD) commonly begins with atherosclerosis, progressing to chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and eventually, heart failure. Despite advancements in preventive and therapeutic strategies, there is room for further cardiovascular risk reduction. Recently, inflammation has emerged as a potential therapeutic target. The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory biomarker which predicts poor prognosis in several conditions such as metabolic syndrome, sepsis, malignancy and CAD. In atherosclerosis, a high NLR predicts plaque vulnerability and severe stenosis. This is consistent with observations in CCS, where an elevated NLR predicts long-term major adverse cardiac events (MACEs). In ACS patients, high NLR levels are associated with larger infarct sizes and poor longterm outcomes. Possible reasons for this include failure of fibrinolysis, ischemia-reperfusion injury and in-stent restenosis, all of which are associated with raised NLR levels. Following myocardial infarction, an elevated NLR correlates with pathological cardiac remodeling which propagates chronic heart failure. Finally, in heart failure patients, an elevated NLR predicts long-term MACEs, mortality, and poor left ventricular assist device and transplant outcomes. Further studies must evaluate whether the addition of NLR to current risk-stratification models can better identify high-risk CAD patients.

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“…Previous studies on VAD patients reported a marked increase in neutrophil‐to‐lymphocyte ratio (NLR) by postoperative day (POD) one 8,9 . Although NLR normalized to preoperative levels by 1 month and plateaued by 3 months in some patients, 8,10 elevated levels at 3–6 months post‐implantation were associated with higher rates of stroke and mortality 9,10 . Another study of 20 patients showed an increase in MAC‐1 expression (i.e., activated neutrophils) postoperatively with sustained elevation even up to 30–60 days depending on VAD type 11 .…”

Section: Introductionmentioning

confidence: 98%

“…There is limited literature on the changes that occur to neutrophils under in vivo conditions in patients with implanted CF‐VADs. Previous studies on VAD patients reported a marked increase in neutrophil‐to‐lymphocyte ratio (NLR) by postoperative day (POD) one 8,9 . Although NLR normalized to preoperative levels by 1 month and plateaued by 3 months in some patients, 8,10 elevated levels at 3–6 months post‐implantation were associated with higher rates of stroke and mortality 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Increased phagocytosis capacity of circulating neutrophils in patients on continuous flow ventricular assist device support

Awad,

Sun,

Han

et al. 2023

Artificial Organs

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BackgroundNeutrophils take part in the innate immune response, phagocytosis, and pro‐inflammatory cytokine release. The phagocytic capacity of circulating neutrophils in patients on continuous flow (CF) ventricular assist device (VAD) has not been well studied.MethodsBlood samples from 14 patients undergoing CF‐VAD implantation were collected and analyzed preoperatively (at baseline) and on postoperative days (POD) 3, 7, 14, and 28. Flow cytometry was used to assess the surface expression levels of CD62L, CD162, and macrophage antigen‐1 (MAC‐1) and neutrophil phagocytic capacity. Interleukin 1 (IL1), IL6, IL8, TNF‐α, neutrophil elastase, and myeloperoxidase in plasma were measured using enzyme‐linked immunosorbent assays.ResultsAmong the 14 patients, seven patients had preoperative bridge device support. Relative to baseline, patients with no bridge device had elevated leukocyte count and neutrophil elastase by POD3 which normalized by POD7. Neutrophil activation level, IL6, IL8, and TNF‐α increased by POD3 and sustained elevated levels for 7–14 days postoperatively. Elevated neutrophil phagocytic capacity persisted even until POD28. Similar patterns were observed in patients on a preoperative bridge device.ConclusionsNeutrophil activation and phagocytic capacity increased in response to VAD support, while inflammatory cytokines remain elevated for up to 2 weeks postoperatively. These findings may indicate that VAD implantation elicits circulating neutrophils to an abnormal preemptive phagocytotic phenotype.

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Risk stratification with longitudinal neutrophil to lymphocyte ratio assessment after left ventricular assist device implantation

Cited by 6 publications

References 27 publications

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

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

The prognostic value of neutrophil-to-lymphocyte ratio across all stages of coronary artery disease

Increased phagocytosis capacity of circulating neutrophils in patients on continuous flow ventricular assist device support

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