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

Abstract

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.

Role of circulatory leukocyte based indices in short-term mortality of patients with heart failure with reduced ejection fraction

“…In a study on HF patients performed by Yan et al it was shown that high NLR is associated with a higher rate of major cardiovascular events in elderly patients with HF [ 25 ]. Moreover, the prognostic role of increased NLR in HF patients was confirmed by Delcea et al in a comprehensive review [ 26 ]. We found a significant difference in NLR and PLR in HFrEF patients, but in the Cox regression the difference was not significant.…”

Neutrophil-to-Lymphocyte Ratio as an Independent Predictor of In-Hospital Mortality in Patients with Acute Intracerebral Hemorrhage

“…NLR is a reflection of physiological stress and a marker of the interaction between different immune pathways. NLR was shown to be an independent predictor of in-hospital mortality for many cardiovascular, neurovascular, and intensive-care conditions [17,18], and high NLR values can be observed in very heterogenous diseases and conditions. This is why NLR is generally considered a marker of physiologic stress among hospitalized patients.…”

Evaluación de los marcadores de inflamación en el prolapso de la válvula mitral

“…In our study, we observed that the mean CRP value was significantly higher in MVP patients compared to the control group, as expected. In reviewing the literature, we found a strong association between NLR and inflammation in cardiac and non-cardiac disorders 8,[29][30][31] . Several reports have shown that higher NLR levels are linked with increased inflammation in many cardiac diseases, such as coronary artery disease 9 and rheumatic valvular disease 32 .…”