The Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Patients Hospitalized with Acute Pulmonary Embolism.

Orly Efros,Omri Cohen,Eshcar Meisel,Gili Kenet,Noam Barda,Shelly Soffer,Tal Beit Halevi,Aharon Lubetsky

doi:10.3390/jcm10184058

Abstract

Early risk stratification is essential for determining the appropriate therapeutic management approach of pulmonary embolism (PE). This study aimed to evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients hospitalized with acute pulmonary embolism by investigating its association with mortality in a large-scale population diagnosed and hospitalized with acute PE. We retrieved all consecutive patients hospitalized in an internal medicine department or an intensive care unit in a tertiary medical center from December 2007 to April 2021 with a discharge diagnosis of pulmonary embolism. A total of 2072 patients were included. Patients with above-median NLR (i.e., 5.12) had a higher 30-day mortality risk (adjusted odds ratio (aOR), 2.82; 95% confidence interval (CI) 2.14–3.70) and higher one-year mortality risk (aOR, 2.51; 95% CI 2.04–3.08). Similar trends were demonstrated in a sub-analysis of patients without cancer and hemodynamically stable (i.e., systolic blood pressure over 90 mmHg). Furthermore, the median hospital length of stay in patients with an elevated NLR was higher, and so was the in-hospital mortality rate. Elevated NLR in acute PE is associated with a worse short-term and long-term prognosis and with a longer duration of hospitalization.

Highlights

Pulmonary embolism (PE) is the third most common cause of cardiovascular mortality worldwide [1]
Accurate early risk stratification is essential for determining the appropriate therapeutic management approach [6]
Von Bruhl et al demonstrated in vivo that the initiating stimulus for deep vein thrombosis (DVT) development is accounted for by the adherence of monocytes and neutrophils in the blood to endothelium [11]

Summary

Introduction

Pulmonary embolism (PE) is the third most common cause of cardiovascular mortality worldwide [1]. There are approximately 200,000 annual hospital admissions for PE in the United States, causing a significant healthcare burden [2,3]. Deaths attributable to PE occur mainly within the first week following diagnosis, but related morbidity is seen years later [4,5]. Accurate early risk stratification is essential for determining the appropriate therapeutic management approach [6]. Von Bruhl et al demonstrated in vivo that the initiating stimulus for deep vein thrombosis (DVT) development is accounted for by the adherence of monocytes and neutrophils in the blood to endothelium [11]. It was shown that neutrophils are essential for thrombus propagation [12]

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