Usefulness of Neutrophil-to-Lymphocyte Ratio in Risk Stratification of Patients With Advanced Heart Failure

Abstract

Elevated neutrophil-to-lymphocyte Ratio (NLR) has been associated with increased mortality in patients with acute heart failure (HF) as well as in neoplastic diseases. We investigated the association between NLR and mortality or cardiac transplantation in a retrospective cohort of 527 patients presented to the Cleveland Clinic for evaluation of advanced HF therapy options between 2007 and 2010. Patients were divided according to low, intermediate, and high tertiles of NLR, and were followed longitudinally for time to all-causes mortality or heart transplantation (primary outcome). The median NLR was 3.9 (IQR 2.5, 6.5). In univariate analysis, intermediate and highest tertiles of NLR had a higher risk than the lowest tertile for the primary outcome and all-causes mortality. Compared to the lowest tertile, there was no difference in the risk of heart transplantation for intermediate and high tertiles. In multivariate analysis, when compared to the lowest tertile, the intermediate and high NLR tertiles remained significantly associated with the primary outcome (HR=1.61 [95%CI 1.10 to 2.37] and HR=1.55 [95%CI 1.02 to 2.36], respectively), and all-causes mortality (HR=1.83 [95%CI 1.07 to 3.14] and HR=2.16 [95%CI 1.21 to 3.83], respectively). In conclusion, elevated NLR is associated with increased mortality or heart transplantation risk in patients with advanced HF.

The highs and lows of tumor biomarkers: lost illusions

“…In fact, most of these changes are not specific to cancer and are reported in a number of other disorders associated with systemic inflammatory response. Similar findings have been reported for the neutrophil/lymphocyte ratio in a spectrum of diseases, including atherosclerosis and its complications [35][36][37]. This spectrum of disorders is very similar to other biomarkers that have been used for decades, including C-reactive protein (CRP) or neopterin.…”

Neopterin as a biomarker of immune response in cancer patients

“…As mentioned above these ratios in fact represent relative lymphocyte counts, and the prognostic significance of the parameters further underlines the role of immune system in controlling malignant disorders. However, changes of PBC-derived ratios are non-specific and can be encountered also in non-neoplastic disorders, notably atherosclerosis and its complications (28,29).…”

The role of baseline indirect inflammatory markers in prediction of response to cardiac resynchronisation therapy

“…Various predictors of CRT response, including clinical, electrocardiographic, laboratory, and imaging parameters, have been identified in previous studies [3][4][5][6][7][8]. Both neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are recently found parameters and have been shown to be associated with adverse cardiovascular events in several disease conditions [9][10][11][12]. However, the role of pre-implantation inflammatory condition assessed using routine laboratory tests has been rarely investigated [6][7][8].…”