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

Abstract

Introduction. At the crossroads of heart failure (HF) and systemic inflammation, platelets and lymphocytes are both influenced as well as actively participating in the bidirectional relationship. The platelet to lymphocyte ratio (PLR) could therefore be a marker of severity. This review aimed to assess the role of PLR in HF. Methods. We searched the PubMed (MEDLINE) database using the keywords “platelet”, “thrombocyte”, “lymphocyte”, “heart failure”, “cardiomyopathy”, “implantable cardioverter defibrillator”, “cardiac resynchronization therapy” and “heart transplant”. Results. We identified 320 records. 21 studies were included in this review, with a total of 17,060 patients. PLR was associated with age, HF severity, and comorbidity burden. Most studies reported the predictive power for all-cause mortality. Higher PLR was associated with in-hospital and short-term mortality in univariable analysis, however, it was not consistently an independent predictor for this outcome. PLR > 272.9 associated an adjusted HR of 3.22 (95%CI 1.56 – 5.68, p<0.001) for 30-day fatality. During long-term follow-up from 6 months to 5 years, PLR was an independent predictor of mortality in most studies, with cut-off values ranging from > 150 to > 194.97 and adjusted HR from 1.47 (95%CI 1.06 – 2.03, p=0.019) to 5.65 (95%CI 2.47–12.96, p<0.001). PLR > 173.09 had an adjusted OR 2.89 (95%CI 1.17–7.09, p=0.021) for predicting response to cardiac resynchronization therapy. PLR was not associated with outcomes after cardiac transplant or implantable cardioverter-defibrillator. Conclusion: Increased PLR could be an auxiliary biomarker of severity and survival prognosis in HF patients.

Correlation between Neutrophil-to-Lymphocyte Ratio, Platelets-to-Lymphocyte Ratio, C-Reactive Protein-to-Albumin Ratio and Clinical Picture of Elderly Chronic Heart Failure Patients

“…Additionally, it demonstrated a rather low diagnostic accuracy for predicting death due to HF, with AUCs of 0.58 and 0.64, respectively [25]. A recent comprehensive review showed that PLR is not consistently an independent predictor for survival in HF, and this is probably related to the different cut-off values proposed by different authors [26].…”

Short-Term Mortality in Hospitalized Patients with Congestive Heart Failure: Markers of Thrombo-Inflammation Are Independent Risk Factors and Only Weakly Associated with Renal Insufficiency and Co-Morbidity Burden

“…However, Heidarpour et al and Pourafkari et al found that PLR predicted neither short-term nor long-term outcomes in CHF patients [ 61 , 62 ]. Delcea et al, in a comprehensive review evaluating over 17,000 patients, showed not only that PLR was associated with short-term mortality outcomes [ 65 ], but also that during long-term follow-up, ranging from 6 months to 5 years, PLR was an independent predictor of long-term mortality [ 65 ]. Demir et al revealed that an increase in PLR in patients with acute CHF was associated with an increase in hospital and total mortality [ 66 ].…”

The Simplified Thrombo-Inflammatory Score as a Novel Predictor of All-Cause Mortality in Patients with Heart Failure: A Retrospective Cohort Study

“… 37 Similarly, Immune-inflammation, platelet activation and thrombus formation are interdependent in HF. 38 The utilization of solely inflammatory or thrombotic biomarkers is inadequate for comprehensively understanding the underlying pathophysiologic mechanisms of HF. Consequently, ongoing research is concentrating on strategies and markers that specifically target the interactions between platelets and leukocytes.…”