Vol. 42 | No. 1 | January-June 2014 Back

Open Access

Association of the Neutrophil–lymphocyte Ratio with Outcomes of Patients Admitted for Acute Coronary Syndrome

Jaime Alfonso M. Aherrera, Lowe O. Chiong, Paul Ferdinand M. Reganit, Felix Eduardo R. Punzalan Jr
Jun 2014 DOI 10.69944/pjc.18510c7b58

Abstract

BACKGROUND: Patients with documented acute coronary syndromes (ACS) have an early risk of death of up to 10%. An elevated leukocyte count has been identified as an independent predictor of an increased risk for long-term mortality and myocardial infarction. An elevated neutrophil count predicts a worse outcome in ACS. In contrast, a low lymphocyte count is related to higher risk of adverse outcomes and mechanical complications, low ejection fraction, high degree of myocardial necrosis and mortality in patients with ACS. The neutrophil-lymphocyte ratio (NLR) integrates the two leukocyte subtype counts with opposing actions in terms of vascular inflammation. 

METHODS: This was a prospective cohort study on adult patients admitted for ACS, and had a complete white blood cell count. Patients were stratified into two groups: low to intermediate NLR (NLR ≤6.5) and high NLR (NLR > 6.50). The primary outcome was in-hospital mortality. Secondary outcomes include development or worsening of congestive heart failure (CHF) and the development of cardiogenic shock, re-infarction, dialysis-requiring renal failure, hospital-acquired pneumonia, and arrhythmias. 

RESULTS: One hundred seventeen patients were included in the study, with a mean age of 60 years +/- 13. The diagnoses on admission were: unstable angina (28%), non-ST elevation myocardial infarction (34%), and ST elevation myocardial infarction (38%). The odds of in-hospital deaths among those with a high NLR were 5.71 times higher compared to those with low-intermediate NLR (OR 5.71 [1.53-21.23]; p=0.009). Using linear regression, the mean NLR of non-survivors was 9.91, while that of survivors was 5.47. A high NLR was also predictive of the development or worsening of CHF (OR 4.75 [1.47-15.3]; p=0.009), shock (OR 5.0 [1.97-12.67]; p=0.001), re-infarction (OR 6.26 [1.91-20.53]; p=0.002), development of significant arrhythmias (OR 4.12 [1.45-11.7]; p=0.008), and development of any adverse cardiovascular outcome (OR 6.46 [1.40-29.8]; p=0.017). 

CONCLUSION: Among patients with ACS, an elevated NLR (>6.5) taken within 24 hours of presentation is a useful marker to predict in-hospital mortality, development or worsening or CHF, and development of shock, re-infarction, and arrhythmias. 

KEYWORDS: Neutrophil-lymphocyte ratio, acute coronary syndrome.

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