Usefulness of the Neutrophil to Lymphocyte Ratio in Predicting Long-Term Mortality in ST Segment Elevation Myocardial Infarction
Neutrophil to lymphocyte ratio (N/L) has been associated with poor outcomes in patients who underwent cardiac angiography. Nevertheless, its role for risk stratification in acute coronary syndromes, specifically in patients with ST-segment elevation myocardial infarction (STEMI), has not been elucid...
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| creator | Núñez, Julio, MD Núñez, Eduardo, MD, MPH Bodí, Vicent, MD Sanchis, Juan, MD Miñana, Gema, MD Mainar, Luis, MD Santas, Enrique, MD Merlos, Pilar, MD Rumiz, Eva, MD Darmofal, Helene Heatta, Anne M Llàcer, Angel, MD |
| description | Neutrophil to lymphocyte ratio (N/L) has been associated with poor outcomes in patients who underwent cardiac angiography. Nevertheless, its role for risk stratification in acute coronary syndromes, specifically in patients with ST-segment elevation myocardial infarction (STEMI), has not been elucidated. We sought to determine the association of N/L maximum value (N/Lmax ) with mortality in the setting of STEMI and to compare its predictive ability with total white blood cell maximum count (WBCmax ). We analyzed 515 consecutive patients admitted with STEMI to a single university center. White blood cells (WBC) and differential count were measured at admission and daily for the first 96 hours afterward. Patients with cancer, inflammatory diseases, or premature death were excluded, and 470 patients were included in the final analysis. The association between N/Lmax and WBCmax with mortality was assessed by Cox regression analysis. During follow-up, we registered 106 deaths (22.6%). A positive trend between mortality and N/Lmax quintiles was observed; 6.4%, 12.4%, 11.7%, 34%, and 47.9% of deaths occurred from quintiles 1 to 5 (p |
| doi_str_mv | 10.1016/j.amjcard.2007.11.004 |
| format | Article |
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Nevertheless, its role for risk stratification in acute coronary syndromes, specifically in patients with ST-segment elevation myocardial infarction (STEMI), has not been elucidated. We sought to determine the association of N/L maximum value (N/Lmax ) with mortality in the setting of STEMI and to compare its predictive ability with total white blood cell maximum count (WBCmax ). We analyzed 515 consecutive patients admitted with STEMI to a single university center. White blood cells (WBC) and differential count were measured at admission and daily for the first 96 hours afterward. Patients with cancer, inflammatory diseases, or premature death were excluded, and 470 patients were included in the final analysis. The association between N/Lmax and WBCmax with mortality was assessed by Cox regression analysis. During follow-up, we registered 106 deaths (22.6%). A positive trend between mortality and N/Lmax quintiles was observed; 6.4%, 12.4%, 11.7%, 34%, and 47.9% of deaths occurred from quintiles 1 to 5 (p <0.001), respectively. In a multivariable setting, after adjusting for standard risk factors, patients in the fourth (Q4 vs Q1) and fifth quintile (Q5 vs Q1) showed the highest mortality risk (hazard ratio 2.58, 95% confidence interal 1.06 to 6.32, p = 0.038 and hazard ratio 4.20, 95% confidence interal 1.73 to 10.21, p = 0.001, respectively). When WBCmax and cells subtypes were entered together, N/Lmax remained as the only WBC parameter; furthermore, the model with N/Lmax showed the most discriminative ability. In conclusion, N/Lmax is a useful marker to predict subsequent mortality in patients admitted for STEMI, with a superior discriminative ability than total WBCmax.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2007.11.004</identifier><identifier>PMID: 18328833</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Biological and medical sciences ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Cause of Death - trends ; Confidence Intervals ; Coronary Angiography ; Coronary heart disease ; Electrocardiography ; Female ; Follow-Up Studies ; Heart ; Heart attacks ; Humans ; Leukocyte Count ; Lymphocytes - pathology ; Male ; Medical imaging ; Medical sciences ; Middle Aged ; Mortality ; Myocardial Infarction - blood ; Myocardial Infarction - diagnosis ; Myocardial Infarction - mortality ; Myocarditis. Cardiomyopathies ; Neutrophils - pathology ; Prognosis ; Proportional Hazards Models ; Regression analysis ; Retrospective Studies ; Risk factors ; Survival Rate - trends ; Time Factors</subject><ispartof>The American journal of cardiology, 2008-03, Vol.101 (6), p.747-752</ispartof><rights>Elsevier Inc.</rights><rights>2008 Elsevier Inc.</rights><rights>2008 INIST-CNRS</rights><rights>Copyright Elsevier Sequoia S.A. Mar 15, 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c541t-6dfa492df34ca52399371bfe85a4150ba21cb5b607a451332b9e612c19c5bff13</citedby><cites>FETCH-LOGICAL-c541t-6dfa492df34ca52399371bfe85a4150ba21cb5b607a451332b9e612c19c5bff13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914907022205$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20197193$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18328833$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Núñez, Julio, MD</creatorcontrib><creatorcontrib>Núñez, Eduardo, MD, MPH</creatorcontrib><creatorcontrib>Bodí, Vicent, MD</creatorcontrib><creatorcontrib>Sanchis, Juan, MD</creatorcontrib><creatorcontrib>Miñana, Gema, MD</creatorcontrib><creatorcontrib>Mainar, Luis, MD</creatorcontrib><creatorcontrib>Santas, Enrique, MD</creatorcontrib><creatorcontrib>Merlos, Pilar, MD</creatorcontrib><creatorcontrib>Rumiz, Eva, MD</creatorcontrib><creatorcontrib>Darmofal, Helene</creatorcontrib><creatorcontrib>Heatta, Anne M</creatorcontrib><creatorcontrib>Llàcer, Angel, MD</creatorcontrib><title>Usefulness of the Neutrophil to Lymphocyte Ratio in Predicting Long-Term Mortality in ST Segment Elevation Myocardial Infarction</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Neutrophil to lymphocyte ratio (N/L) has been associated with poor outcomes in patients who underwent cardiac angiography. Nevertheless, its role for risk stratification in acute coronary syndromes, specifically in patients with ST-segment elevation myocardial infarction (STEMI), has not been elucidated. We sought to determine the association of N/L maximum value (N/Lmax ) with mortality in the setting of STEMI and to compare its predictive ability with total white blood cell maximum count (WBCmax ). We analyzed 515 consecutive patients admitted with STEMI to a single university center. White blood cells (WBC) and differential count were measured at admission and daily for the first 96 hours afterward. Patients with cancer, inflammatory diseases, or premature death were excluded, and 470 patients were included in the final analysis. The association between N/Lmax and WBCmax with mortality was assessed by Cox regression analysis. During follow-up, we registered 106 deaths (22.6%). A positive trend between mortality and N/Lmax quintiles was observed; 6.4%, 12.4%, 11.7%, 34%, and 47.9% of deaths occurred from quintiles 1 to 5 (p <0.001), respectively. In a multivariable setting, after adjusting for standard risk factors, patients in the fourth (Q4 vs Q1) and fifth quintile (Q5 vs Q1) showed the highest mortality risk (hazard ratio 2.58, 95% confidence interal 1.06 to 6.32, p = 0.038 and hazard ratio 4.20, 95% confidence interal 1.73 to 10.21, p = 0.001, respectively). When WBCmax and cells subtypes were entered together, N/Lmax remained as the only WBC parameter; furthermore, the model with N/Lmax showed the most discriminative ability. In conclusion, N/Lmax is a useful marker to predict subsequent mortality in patients admitted for STEMI, with a superior discriminative ability than total WBCmax.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cause of Death - trends</subject><subject>Confidence Intervals</subject><subject>Coronary Angiography</subject><subject>Coronary heart disease</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Leukocyte Count</subject><subject>Lymphocytes - pathology</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial Infarction - blood</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocarditis. Cardiomyopathies</subject><subject>Neutrophils - pathology</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Survival Rate - trends</subject><subject>Time Factors</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk9v1DAQxSMEotvCRwBZSHDL4rHz90KFqgKVtoDY7dlynMmul8RebKdSbv3oONpVkXrhZNn6vZk3fpMkb4AugULxcb-Uw15J1y4ZpeUSYElp9ixZQFXWKdTAnycLSilLa8jqs-Tc-328AuTFy-QMKs6qivNF8nDnsRt7g94T25GwQ_Idx-DsYad7EixZTcNhZ9UUkPySQVuiDfnpsNUqaLMlK2u26QbdQG6tC7LXYZqJ9YascTugCeS6x_tZaMjtZGfDWvbkxnTSqfn1VfKik73H16fzIrn7cr25-paufny9ufq8SlWeQUiLtpNZzdqOZ0rmjNc1L6HpsMplBjltJAPV5E1BS5nlwDlraiyAKahV3nQd8Ivkw7Huwdk_I_ogBu0V9r00aEcvSsrLkldlBN89Afd2dCZ6E4xHKC-gjlB-hJSz3jvsxMHpQbpJABVzPmIvTvmIOR8BIGI-Uff2VHxsBmz_qU6BROD9CZBeyb5z0ijtHzlGoS5j_8hdHjmMf3av0QmvNBoVg3Gogmit_q-VT08qqF4bHZv-xgn949AgPBNUrOdlmneJlpQxRnP-F275xi0</recordid><startdate>20080315</startdate><enddate>20080315</enddate><creator>Núñez, Julio, MD</creator><creator>Núñez, Eduardo, MD, MPH</creator><creator>Bodí, Vicent, MD</creator><creator>Sanchis, Juan, MD</creator><creator>Miñana, Gema, MD</creator><creator>Mainar, Luis, MD</creator><creator>Santas, Enrique, MD</creator><creator>Merlos, Pilar, MD</creator><creator>Rumiz, Eva, MD</creator><creator>Darmofal, Helene</creator><creator>Heatta, Anne M</creator><creator>Llàcer, Angel, MD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20080315</creationdate><title>Usefulness of the Neutrophil to Lymphocyte Ratio in Predicting Long-Term Mortality in ST Segment Elevation Myocardial Infarction</title><author>Núñez, Julio, MD ; Núñez, Eduardo, MD, MPH ; Bodí, Vicent, MD ; Sanchis, Juan, MD ; Miñana, Gema, MD ; Mainar, Luis, MD ; Santas, Enrique, MD ; Merlos, Pilar, MD ; Rumiz, Eva, MD ; Darmofal, Helene ; Heatta, Anne M ; Llàcer, Angel, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c541t-6dfa492df34ca52399371bfe85a4150ba21cb5b607a451332b9e612c19c5bff13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cause of Death - trends</topic><topic>Confidence Intervals</topic><topic>Coronary Angiography</topic><topic>Coronary heart disease</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Leukocyte Count</topic><topic>Lymphocytes - pathology</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Myocardial Infarction - blood</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocarditis. 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Nevertheless, its role for risk stratification in acute coronary syndromes, specifically in patients with ST-segment elevation myocardial infarction (STEMI), has not been elucidated. We sought to determine the association of N/L maximum value (N/Lmax ) with mortality in the setting of STEMI and to compare its predictive ability with total white blood cell maximum count (WBCmax ). We analyzed 515 consecutive patients admitted with STEMI to a single university center. White blood cells (WBC) and differential count were measured at admission and daily for the first 96 hours afterward. Patients with cancer, inflammatory diseases, or premature death were excluded, and 470 patients were included in the final analysis. The association between N/Lmax and WBCmax with mortality was assessed by Cox regression analysis. During follow-up, we registered 106 deaths (22.6%). A positive trend between mortality and N/Lmax quintiles was observed; 6.4%, 12.4%, 11.7%, 34%, and 47.9% of deaths occurred from quintiles 1 to 5 (p <0.001), respectively. In a multivariable setting, after adjusting for standard risk factors, patients in the fourth (Q4 vs Q1) and fifth quintile (Q5 vs Q1) showed the highest mortality risk (hazard ratio 2.58, 95% confidence interal 1.06 to 6.32, p = 0.038 and hazard ratio 4.20, 95% confidence interal 1.73 to 10.21, p = 0.001, respectively). When WBCmax and cells subtypes were entered together, N/Lmax remained as the only WBC parameter; furthermore, the model with N/Lmax showed the most discriminative ability. In conclusion, N/Lmax is a useful marker to predict subsequent mortality in patients admitted for STEMI, with a superior discriminative ability than total WBCmax.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>18328833</pmid><doi>10.1016/j.amjcard.2007.11.004</doi><tpages>6</tpages></addata></record> |
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| subjects | Aged Biological and medical sciences Cardiology Cardiology. Vascular system Cardiovascular Cause of Death - trends Confidence Intervals Coronary Angiography Coronary heart disease Electrocardiography Female Follow-Up Studies Heart Heart attacks Humans Leukocyte Count Lymphocytes - pathology Male Medical imaging Medical sciences Middle Aged Mortality Myocardial Infarction - blood Myocardial Infarction - diagnosis Myocardial Infarction - mortality Myocarditis. Cardiomyopathies Neutrophils - pathology Prognosis Proportional Hazards Models Regression analysis Retrospective Studies Risk factors Survival Rate - trends Time Factors |
| title | Usefulness of the Neutrophil to Lymphocyte Ratio in Predicting Long-Term Mortality in ST Segment Elevation Myocardial Infarction |
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