Abstract
BackgroundThe intensity of the inflammatory response and hemodynamic repercussion in acute myocardial infarction causing the presence in the peripheral circulation of nucleated red blood cells (NRBCs), increases in mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR) are associated with a poorer prognosis. The aim of this study was to assess the role of these hematological biomarkers as predictors of all causes of mortality during the hospitalization of patients with acute myocardial infarction.MethodsNucleated red blood cells, mean platelet volume and neutrophil to lymphocyte ratio were measured daily during the hospitalization of the patients with acute myocardial infarction. We excluded patients younger than 18 years, on glucocorticoid therapy, with cancer or hematological diseases and those that were readmitted after hospital discharge. We performed a multiple logistic analysis to identify independent predictors of mortality.ResultsWe included 466 patients (mean age 64.2 ± 12.8 years, 61.6% male). The prevalence of NRBCs in the sample was 9.1% (42 patients), with levels > 200/μL in 27 patients (5.8%). The mean MPV value was 10.9 ±0,9 and the mean NLR value was 3.71 (2,38; 5,72). In a multivariate analysis of serum NRBCs (HR 2.42, 95% CI: 1.35–4.36, p = 0.003), MPV (HR 2.97, 95% CI: 1.15–7.67, p = 0.024) and NLR (HR 5.02, 95% CI: 1.68–15.0, p = 0.004). The presence in the peripheral blood of NRBCs, increased in mean platelet volume and neutrophil to lymphocyte ratio were associated with higher mortality.ConclusionsNucleated red blood cells, mean platelet volume and neutrophil to lymphocyte ratio are independent predictors of intrahospital mortality. Therefore, an important tool in intrahospital clinical surveillance.
Highlights
Acute myocardial infarction (AMI) is a frequent emergency in the world, with great potential for morbidity and mortality despite all advances in treatment in the last three decades [1]
The intensity of the inflammatory response and hemodynamic repercussion in acute myocardial infarction causing the presence in the peripheral circulation of nucleated red blood cells (NRBCs), increases in mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR) are associated with a poorer prognosis
The study of the complete blood count is of great importance in the acute coronary syndrome with, for examples, red cell distribution width (RDW) is a measure of variations in the volume of red blood cells and it is an essential predictor of severity coronary artery disease among patients with AMI [4,5], white blood cell count (WBC) elevated was found to be a relevant death risk factor during the first 30 days and 6 months following the myocardial infarction [6] and platelet distribution width (PDW) indicates a varied size of platelets and it serves as a useful prognostic factor for long-term mortality in patients after AMI [7,8]
Summary
Acute myocardial infarction (AMI) is a frequent emergency in the world, with great potential for morbidity and mortality despite all advances in treatment in the last three decades [1] It is an essentially inflammatory disease and, depends on the extent of cardiac damage, with hemodynamic repercussion. These inflammatory and hypoxemic processes have been associated with the presence of hematological markers in the peripheral blood owing to the high concentrations of erythropoietin, interleukin-3 and interleukin-6 caused by local or systemic disorders in critical cardiac patients [2]. The intensity of the inflammatory response and hemodynamic repercussion in acute myocardial infarction causing the presence in the peripheral circulation of nucleated red blood cells (NRBCs), increases in mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR) are associated with a poorer prognosis. The aim of this study was to assess the role of these hematological biomarkers as predictors of all causes of mortality during the hospitalization of patients with acute myocardial infarction.
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