Relationship of Troponin I with Neutrophil Lymphocyte Ratio and Serum Amyloid A in Acute Coronary Syndrome

Abstract

Abstract
 Introduction: Acute coronary syndrome (ACS) is the leading cause of death in the world. Acute myocardial infarction can initiate an acute inflammatory process by inducing pro-inflammatory cytokines at the cellular level measured by NLR, at the biomolecular level characterized by SAA production in liver. The relationship of elevated troponin I levels as a marker of myocardial necrosis with NLR and SAA as inflammatory markers need further discussion. The purpose of this study was to determine the relationship between cardiac necrosis markers and inflammatory parameters in ACS.
 Methods: An analytic observational study with a cross-sectional approach was conducted from March to May 2019. This study involved 32 patients with ACS at the Emergency Department of Dr.Kariadi Hospital, with the onset of attacks of 4-6 hours which met the inclusion and exclusion criteria. Examination of troponin I level was done using the ELFA method, NLR value was measured using a hematology analyzer, and SAA level was measured using the ELISA method. Statistical test was done using Spearman correlation. Value of p < 0.05 was considered significant.
 Results: The median (min-max) of troponin I, NLR, and SAA values were 0.617 (0.001-40,000) μg/L, 4.92 (1.38-18.16) and 40.454 (5.879-66.059) μg/ml, respectively. The correlation of troponin I level with NLR and SAA were r=0.180, p=0.243 and r=0.655, p=0.000.
 Conclusions: There was a significant positive moderate relationship between troponin I level and SAA which could be used as a marker of acute inflammation in ACS, whereas cell inflammation marker of NLR did not provide a significant meaning.
 Keywords: ACS, NLR, SAA, troponin