Usefulness of the Neutrophil-to-Lymphocyte Ratio in Predicting the Severity of Coronary Artery Disease: A Gensini Score Assessment

Abstract

Aim:The usefulness of the white blood cell (WBC) count and neutrophil-to-lymphocyte ratio (NLR) in predicting the severity of stable coronary artery disease (CAD) has not been sufficiently evaluated, particularly based on strict coronary assessments. The aim of the present study was to investigate the WBC count and NLR in predicting the severity of angiographically proven CAD. Methods: A total of 2,976 CAD patients and 571 non-CAD patients were consecutively enrolled, and the CAD patients were classified into the three groups according to the tertile of the Gensini score (GS, low GS＜18, n = 989; intermediate GS 18-41, n = 995 and high GS＞41, n = 992). The efficacy of the WBC count and NLR in predicting the risk and severity of CAD as well as the correlations between these markers and the GS were analyzed. A receiver operating characteristic (ROC) curve analysis was also performed. Results: The NLR was found to be an independent predictor of both the presence of CAD (OR = 1.18, 95%CI: 1.09-1.27, p = 0.009) and a high GS (OR=1.10, 95%CI: 1.01-1.16, p = 0.032). In addition, there were mild positive correlations between the GS and the NLR, WBC and proportions of neutrophils and monocytes. In the ROC curves analysis, the NLR was found to have the largest area under the curve (AUC = 0.63, 95%CI: 0.59-0.67, p=0.000), with an optimal cut-off value of 2.04 (sensitivity: 62.1%, specificity: 54.8%) for predicting a high GS. Conclusions: The NLR is a valuable independent predictor of the severity of CAD assessed according to the GS. In particular, an NLR of ＞2.04 indicates a higher risk of CAD and greater severity of CAD lesions. Hypertension was diagnosed based on repeated blood pressure measurements of ≥ 140/90 mmHg (at least two times in different environments) or the use of antihypertensive drugs. DM was diagnosed based on a fasting serum glucose level of ≥ 6.99 mmol/L on multiple occasions and/or the use of insulin or oral hypoglycemic agents. Dyslipidemia was diagnosed according to a fasting total cholesterol level of (TC) ≥ 200 mg/dL or triglyceride (TG) level of ≥150 mg/dL. J Atheroscler Laboratory TestsAll baseline laboratory data were acquired from venous blood samples obtained after a 12-hour overnight fast prior to coronary angiography. The levels of WBC, neutrophils, lymphocytes and monocytes were determined using an automated blood cell counter, the Coulter LH780 Hematology Analyzer (Beckman Coulter Ireland Inc. Mervue, Galway, Ireland), and the levels of high-sensitivity C-reactive protein (hs-CRP) were assessed using immunoturbidimetry (Beckmann Assay 360, Bera, California, USA), as previously reported 16,17) . The NLR was calculated as the ratio of neutrophils to lymphocytes, the levels of which were obtained from the same blood samples. The normal range of hs-CRP in our hospital laboratory is 0-3 mg/L. Angiographic ExaminationsSelective coronary angiography was performed in all enrolled subjects using the standard Judkin's technique, and the results were analyzed by at least two interventional physicians w...

Reduced T-Cell Thymic Export Reflected by sj-TREC in Patients with Coronary Artery Disease

“…Similar to data from previous studies 29) , NLR was significantly higher in UA patients (4.0 2.6) than in SA patients (2.7 1.6, P 0.01) and controls (2.1 0.8, P 0.001), but no significant difference existed between SA and controls (Fig. 1a).…”

“…And the proportion of naïve T cells was ever used to reflect thymic output 48) . In addition, negative correlation between sj-TREC and NLR revealed that patients with higher NLR had more severe inflammatory status, more complex plaques 29,49) , and lower output of lymphocytes, such as T cells from the thymus. In this respect, this study high GS group was significantly lower than that of the low and intermediate GS groups.…”

“…Stenosis severity was evaluated based on Gensini scores (GS) 29) by two experienced cardiologists blinded to experimental data. Patients were grouped according to GS tertile (low, GS 18; intermediate, high, GS 41) [29][30][31][32][33] . Demographic data, classical cardiovascular risk factors, laboratory assay results, and previous medical treatment records were collected.…”

Neutrophil-to-lymphocyte ratio as an independent predictor of left main and/or three-vessel disease in patients with non-ST-segment elevation myocardial infarction

“…In addition to these well-recognized predictors, neutrophil-to-lymphocyte ratio (NLR) has recently been recognized as a predictor of CAD severity assessed by the number of diseased vessels [10], the SYNTAX score [11,12], and the Gensini score [13,14]. However, there is a paucity of data validating the predictive value of NLR in assessing the severity of CAD specifically in NSTEMI patients.…”

The neutrophile to lymphocyte ratio and mean platelet volume with Gensini score in patients with acute myocardial infarction

“…Fakat literatüre bakıldığında hem AKS olgularda hem de stabil koroner arter hastalarında N/L oranı ve koroner arter hastalığı yaygınlığı arasında anlamlı ilişki olduğunu gösteren çalışmalar mevcuttur [23,24]. Chen ve arkadaşlarının yaptığı çalışmada 2976 stabil koroner arter hastası değerlendirilmiş, N/L oranının Gensini skoru ile belirlenen koroner arter hastalığı ciddiyetinin bağımsız prediktörü olduğu görülmüştür [25]. Benzer şekilde Tanındı ve arkadaşlarının yaptığı çalışmada, AKS olgular ve stabil anjina pektorisli olgularda, N/L oranı ve koroner arter hastalığı ciddiyeti(SYNTAX ve Gensini skoru ile belirlenen) arasında anlamlı korelasyon tespit etmişlerdir [26].…”