PS-BPB02-7: THE ROLE OF NEUTROPHIL TO LYMPHOCYTE RATIO AS PREDICTIVE BIOMARKER IN ACUTE CORONARY SYNDROME: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Introduction: Current evidence suggests that the the neutrophil/lymphocyte ratio (NLR) is growing as a prognostic marker in patient with cardiovascular disease. It has been reported expanding evidence that involves innate and adaptive immune cell in the pathogenesis of Acute Coronary syndrome (ACS) which indicate the pivotal role of NLR as valuable diagnostic parameter in ACS patient. Purpose: The objective of our meta-analysis is to investigate the association of neutrophil lymphocyte ratio (NLR) for ACS risk and the prognostic utility of NLR in ACS patients. Method: We conducted a systematic literature search on various databases such as PubMed, Cochrane and Scopus to identify the relevant articles published until October 2021. Data extracted were pooled using odds ratios (OR) for incidence of ACS and non- ACS patients between high and low NLR. For studies that did not provide these estimates, data were extracted using weighted mean difference (WMD) of NLR for ACS and non-ACS patients. A random effects model was used to conduct this MA. The receiver operating characteristic (ROC) curve was utilized to analyze the prognostic ability of NLR in the ACS patients. Heterogeneity was evaluate using Cochran's Q- and the I 2 − test. GRADE was used to assess the study's quality. The presence of publication bias was evaluated by Egger's test and by visual inspection of the symmetry in funnel plots. Data analysis was conducted using Stata. Results: Nine studies met the inclusion criteria with more than 5215 participants. The MA that used OR as effect size was 1.44 (95% CI:1.082–1.92) with low heterogeneity (Chi- square = 6.2; P-value = 0,0012 I2 = 12.8%). The analyze that used WMD as effect size was 1.24 (95% CI: 1.04- 1.43) with high heterogeneity (Chi-square = 102.7; P-value < 0.001 I2 = 95.1%). There was no evidence of publication bias from Egger's test for OR effect size MA and for WMD MA (coefficient = 0.58; P-value = 0.558) and (coefficient = 3.06; P-value = 0.361). The ROC curve shows that AUC (ACS) = 88.8% (95% CI:0.73 – 1). The best cut- off point of the N/L was 4, with a sensitivity of 82.8 % and a specificity of 77.7 % Conclusion: The MA that used OR as effect size indicated high NLR was significantly associated with increased risk of ACS. The analyze that used WMD as effect size indicated mean NLR was significantly higher in ACS patients than in non-ACS patients. ROC curve analysis was significant for NLR in diagnosing ACS. Therefore, our results conclude that the NLR effect was strongest on ACS outcome and might also help in early diagnosis of ACS and all this make NLR a predictive biomarker in ACS patient .