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Abstract
Elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with increased mortality in patients with acute heart failure (HF) and neoplastic diseases. We investigated the association between NLR and mortality or cardiac transplantation in a retrospective cohort of 527 patients presented to the Cleveland Clinic for evaluation of advanced HF therapy options from 2007 to 2010. Patients were divided according to low, intermediate, and high tertiles of NLR and were followed longitudinally for time to all-cause mortality or heart transplantation (primary outcome). The median NLR was 3.9 (interquartile range 2.5 to 6.5). In univariate analysis, intermediate and highest tertiles of NLR had a higher risk than the lowest tertile for the primary outcome and all-causes mortality. Compared with the lowest tertile, there was no difference in the risk of heart transplantation for intermediate and high tertiles. In multivariate analysis, compared with the lowest tertile, the intermediate and high NLR tertiles remained significantly associated with the primary outcome (hazard ratio [HR]= 1.61, 95% confidence interval [CI] 1.10 to 2.37 and HR= 1.55, 95% CI 1.02 to 2.36, respectively) and all-cause mortality (HR= 1.83, 95% CI 1.07 to 3.14 and HR= 2.16, 95% CI 1.21 to 3.83, respectively). In conclusion, elevated NLR is associated with increased mortality or heart transplantation risk in patients with advanced HF.
Highlights
Several studies over the past few decades have demonstrated the potential of neutrophil-to-lymphocyte ratio (NLR), a widely available hematologic marker of oxidative stress damage, to serve as a good prognostic marker of mortality in cardiac and noncardiac diseases.3e7 In this study, we evaluated the association between NLR and future risk of mortality or cardiac transplantation in a large contemporary cohort of patients with advanced heart failure (HF)
Compared with the lowest tertile, the intermediate and highest NLR tertiles were associated with the primary outcome (HR 1⁄4 1.61, 95% confidence intervals (CIs) 1.10 to 2.37 and HR 1⁄4 1.55, 95% CI 1.02 to 2.36, respectively; Table 2)
In multivariate analysis and compared with the lowest tertile, the intermediate and high NLR tertiles remained significantly associated with all-causes mortality (HR 1⁄4 1.83, 95% CI 1.07 to 3.14 and HR 1⁄4 2.16, 95% CI 1.21 to 3.83, respectively; Table 2)
Summary
Benítes-Zapata, Vicente A.; Hernández, Adrian V.; Nagarajan, Vijaiganesh; Cauthen, Clay A.; Starling, Randall C.; Tang, W.H. Wilson. 1. Benites-Zapata VA, Hernandez AV, Nagarajan V, Cauthen CA, Starling RC, Wilson Tang WH. Usefulness of Neutrophil-toLymphocyte Ratio in Risk Stratification of Patients With Advanced Heart Failure. MD, PhDb,c, Vijaiganesh Nagarajan, MD, MRCPd, Clay A. Several studies over the past few decades have demonstrated the potential of neutrophil-to-lymphocyte ratio (NLR), a widely available hematologic marker of oxidative stress damage, to serve as a good prognostic marker of mortality in cardiac and noncardiac diseases.3e7 In this study, we evaluated the association between NLR and future risk of mortality or cardiac transplantation in a large contemporary cohort of patients with advanced HF Lymphocytopenia has long been associated with poor prognosis in heart failure (HF). Several studies over the past few decades have demonstrated the potential of neutrophil-to-lymphocyte ratio (NLR), a widely available hematologic marker of oxidative stress damage, to serve as a good prognostic marker of mortality in cardiac and noncardiac diseases.3e7 In this study, we evaluated the association between NLR and future risk of mortality or cardiac transplantation in a large contemporary cohort of patients with advanced HF
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