Neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio predict length of hospital stay in myocarditis

Moritz Mirna,Albert Topf,Uta C Hoppe,Lukas Schmutzler,Michael Lichtenauer

doi:10.1038/s41598-021-97678-6

Moritz Mirna, Albert Topf + Show 3 more

Open Access

https://doi.org/10.1038/s41598-021-97678-6

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Journal: Scientific Reports	Publication Date: Sep 13, 2021
Citations: 28	License type: open-access

Affiliation: Paracelsus Medical University

Abstract

Neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are associated with the severity of various diseases. The aim of this study was to demonstrate the relationship of NLR and MLR with the severity of myocarditis. 202 consecutive patients with myocarditis were retrospectively enrolled in this study. Laboratory parameters and clinical data were extracted from hospital records and discharge letters. Median NLR was 2.48 (IQR 1.55–4.58) and median MLR was 0.42 (IQR 0.39–0.58). NLR and MLR correlated with HF, CRP and leukocyte count, MLR further correlated inversely with LV systolic function (rs = − 0.379, p = 0.030). Both ratios correlated better with length of hospital stay (NLR: rs = 0.435, p = 0.003; MLR: rs = 0.534, p < 0.0001) than CRP, leukocyte count, IL-6 or procalcitonin. AUCs for the prediction of prolonged hospital stay (NLR = 0.75, MLR = 0.80), and optimal cut-offs therefor were calculated. Patients who had in-hospital complications showed a higher NLR, however, this remained statistically insignificant. NLR and MLR correlated with the length of stay, as well as with several clinical and laboratory parameters in patients with myocarditis. Since white blood cell differentials are relatively easy and fast to perform, both ratios could facilitate further risk stratification in affected patients.

Highlights

Neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are associated with the severity of various diseases
While neutrophil-to-lymphocyte ratio (NLR) and MLR have been described in a large number of disease entities previously, there is, to the best of our knowledge, currently no evidence available regarding their predictive potential in patients diagnosed with myocarditis
In the last two decades, several studies reported that neutrophil-to-lymphocyte ratio (NLR) and monocyteto-lymphocyte ratio (MLR) correlate with the severity of different disease entities, such as sepsis, communityacquired pneumonia or coronary artery disease[8,9,12,15]

Summary

Introduction

Neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are associated with the severity of various diseases. NLR and MLR correlated with the length of stay, as well as with several clinical and laboratory parameters in patients with myocarditis. While inflammatory responses are generally beneficial processes to oppose impeding pathogens, severe inflammation and exaggerated immunological responses can result in prolonged hospital stay, end-organ damage and adverse outcomes for affected patients. An ever increasing number of studies showed that neutrophil-to-lymphocyte ratio (NLR) could adequately predict severity in several disease entities, for example in community-acquired pneumonia, sepsis, hepatocellular carcinoma and even COVID-199–12. Monocyte-to-lymphocyte ratio (MLR) was previously associated with adverse outcomes in different forms of c ancer[13,14], and in patients with non-ST-segment elevation myocardial infarction[15].

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