Abstract
BackgroundImmuno-inflammation plays a major role in the process of hypertension. We aimed to evaluate the association between inflammatory markers, neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW) and all-cause mortality in elderly patients with hypertension.MethodsA total of 341 hypertensive patients over 80 years of age were included to this study. The NLR and RDW were measured on admission and all the selected patients were followed up for up to 90 days. Kaplan–Meier curves were plotted to evaluate the association between the NLR and the all-cause mortality at follow-up. Using Cox regression models, we investigated the prognostic value of NLR and RDW for all-cause mortality.ResultsPatients with higher quartile of NLR linked to high mortality in hypertensive patients at 90 day after admission (16.47%,13.25%,1.14%,1.17% respectively; χ2 = 20.581,P = 0.000). Surviving patients had lower RDW (13.61 ± 1.37 VS 14.18 ± 1.38, p = 0.041) and NLR (4.97 ± 5.72 VS 7.95 ± 6.88,p = 0.011). The receiver operating curve (ROC) of the NLR for all-cause mortality had an area under the curve (AUC) =0.714 (95%CI: 0.629–0.798, P = 0.000), with acritical value of 2.97, with sensitivity of 92.6%, and a specificity of 52.5%. The ROC of the RDW to predict all-cause mortality, had an AUC =0.654 (95%CI:0.548–0.761, P = 0.008), with acritical value of 13.2%.The Kaplan–Meier curve showed a significant difference between different NLR levels (p = 0.002). Multivariate Cox proportional hazard analysis shown 3rd quartile of NLR(RR = 9.646, 95% CI 1.302–34.457, P = 0.041) and 4th quartiles(RR = 16.451, 95% CI 2.137–66.643, P = 0.007) were found to independently predict all-cause death in hypertensive patients over 80 years of age. Higher rank of NLR was link to higher incidence of all-cause death for such patients.ConclusionThe findings of the present study demonstrate the potential utility of NLR in risk stratification of elderly patients with hypertension to provide information for clinical treatment strategies.
Highlights
Immuno-inflammation plays a major role in the process of hypertension
What is already known about this topic? neutrophil-to-lymphocyte ratio (NLR) and red cell distribution width (RDW) have been proved to be a good indicator of the prognosis of a variety of diseases, such as cancer, coronary heart disease and pulmonary embolism
67 cases were with chronic heart failure, while 167 cases with diabetes mellitus (DM). 125 patients were with anemia and all of them received therapy, whose hemoglobin levels in the normal range
Summary
We aimed to evaluate the association between inflammatory markers, neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW) and all-cause mortality in elderly patients with hypertension. The role of inflammatory and oxidative stress in cardiovascular diseases has been extensively investigated in multiple studies. Many of them have shown a strong and consistent relationship between cardiovascular diseases and inflammation markers, such as, C-reactive protein. Both the neutrophil to lymphocyte ratio (NLR) and the red blood cell distribution (RDW) are novel, inexpensive and accessible inflammatory markers which have been shown to be associated with various cardiovascular diseases [2, 3]. Regarding the RDW, the considerable available evidence suggests that the clinical use of the RDW may be broadened beyond the conventional boundaries of erythrocyte disorders, in particular for assisting the diagnosis and prognosis of patients with acute coronary syndrome (ACS), ischemic cerebrovascular disease, peripheral artery disease (PAD), heart failure (HF) and atrial fibrillation (AF) [6]
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