The Predictive role of Neutrophil-to-Lymphocyte Ratio (NLR) and Mean Platelet Volume-to-Lymphocyte Ratio (MPVLR) for Cardiovascular Events in Adult Patients with Acute Heart Failure

Abstract

Introduction. The inflammatory response plays a potential role for the pathogenesis and adverse outcomes of heart failure (HF). We aimed to explore the predictive role of baseline neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume-to-lymphocyte ratio (MPVLR) on cardiovascular events (CVEs) in patients hospitalized with acute HF. Materials and Methods. A retrospective cohort study was conducted in 321 patients with HF between January 2017 and December 2019. The association between their NLR, MPVLR, and combined NLR and MPVLR and CVEs, rehospitalization for HF, in-hospital death, and a composite outcome was explored by survival analysis using a Cox proportional hazard model. They were separately investigated and compared with the area under the receiver operating characteristics curve (AUC). Results. Up to the end of the 3-year follow-up, 96 (29.9%) had CVEs, 106 (33.0%) died, 62 (19.3%) were rehospitalized with HF, and 21 (6.5%) died during admission. The NLR and MPVLR were significantly associated with CVEs (adjusted HR for NLR ≥ 3.29 , 3.11; 95% CI, 1.98-4.89; MPVLR ≥ 8.57 , 2.86; 95% CI, 1.87-4.39), readmissions for HF (adjusted HR for NLR ≥ 3.58 , 2.70; 95% CI, 1.58-4.61; MPVLR ≥ 6.43 , 2.84; 95% CI,1.59-5.07), in-hospital mortality (adjusted HR for NLR ≥ 3.29 , 9.54; 95% CI, 2.19-41.40; MPVLR ≥ 8.57 , 7.87; 95% CI, 2.56-24.19), and composite outcome (adjusted HR for NLR ≥ 3.32 , 4.76; 95% CI, 3.29-6.89; MPVLR ≥ 7.07 , 3.64; 95% CI, 2.58-5.15). The AUC of NLR and MPVLR for CVEs were 0.67 (95% CI, 0.61-0.72) and 0.63 (95% CI, 0.58-0.69). Combined NLR and MPVLR increased the AUC to 0.77 (95% CI, 0.72-0.83) with statistical significance. Conclusion. The elevated NLR and MPVLR on admission in patients with acute HF were independently associated with worse CVEs, rehospitalization for HF, in-hospital death, and composite outcomes. These economical biomarkers should be considered in the management and follow-up care of patients with acute HF.

Associations of systemic inflammatory markers with the risks of chronic heart failure: A case-control study

“… 25 Previous studies have found that several systemic inflammatory indicators are independent risk factors in the prognosis of patients with AHF. 26 , 27 The systemic inflammatory mechanism in patients with AHF is relatively clear. But the role of systemic inflammatory indicators (such as LMR and MHR) in CHF have not yet been elaborated.…”

Prognostic value of neutrophils to lymphocytes and platelets ratio for 28-day mortality in patients with acute respiratory distress syndrome: a retrospective study

“…An elevated NLR value usually means an increase in neutrophils (reflecting a proinflammatory state) and/ or a decrease in lymphocytes (reflecting the weak adaptive immunity to diseases). Therefore, NLR has been suggested to predict the severity and mortality of various diseases, such as sepsis [7], community-acquired pneumonia [8,9], chronic obstructive pulmonary disease [10,11], acute limb ischemia [12], acute cholecystitis [13], cardiovascular disease [14][15][16], and intracerebral hemorrhage [17,18], as well as the recent pandemic COVID-19 pneumonia [14,[19][20][21].…”

Combination of White Blood Cell Count to Mean Platelet Volume Ratio and Neutrophil-to-Platelet Ratio Predicts Long-Term Adverse Events in Patients with MINOCA

“…The increased neutrophil count is associated with a higher risk of cardiovascular events, and a low lymphocyte count may reflect systemic stress and immunodeficiency, which has been associated with cardiovascular complications and increased mortality rates [16,17]. In addition, white blood cell count to mean platelet volume ratio (WMR), neutrophil-to-platelet ratio (NPR), plateletto-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) are four easily calculated inflammatory biomarkers from blood cell counts that have been shown to predict unfavorable clinical outcomes in a variety of cardiovascular illnesses, including in AMI [18][19][20][21][22][23]. Recent clinical studies suggest that MINOCA individuals may also have a proinflammatory predisposition, as seen by several inflammatory biomarkers [24] or more common inflammatory conditions [25].…”