Heart failure
Utility of the Neutrophil to Lymphocyte Ratio in Predicting Long-Term Outcomes in Acute Decompensated Heart Failure

https://doi.org/10.1016/j.amjcard.2010.09.039Get rights and content

Neutrophil-to-lymphocyte ratio (NLR) has been associated with poor outcomes in patients with acute coronary syndromes. However, its role for risk stratification in acute decompensated heart failure (ADHF) has not been well described. In this study, 1,212 consecutive patients admitted with ADHF who had total white blood cell and differential counts measured at admission were analyzed. The patients were divided into tertiles according to NLR. The association between NLR and white blood cell types with all-cause mortality was assessed using Cox regression analysis. During a median follow-up period of 26 months, a total of 284 patients (23.4%) had died, and a positive trend between death and NLR was observed; 32.8%, 23.2%, and 14.2% of deaths occurred in the higher, middle, and lower tertiles, respectively (p <0.001). After adjusting for confounding factors, multivariate analysis demonstrated that patients in the higher NLR tertile had the highest mortality (adjusted hazard ratio 2.23, 95% confidence interval (CI) 1.63 to 3.02, p <0.001), followed by those in the middle tertile (adjusted hazard ratio 1.62, 95% CI 1.16 to 2.23, p = 0.001). Furthermore, tertiles of NLR were superior in predicting long-term mortality compared with white blood cell, neutrophil, and relative lymphocyte counts. Patients in the higher NLR tertile (adjusted odds ratio 3.46, 95% CI 2.11 to 5.68, p <0.001) had a significantly higher 30-day readmission rate. In conclusion, higher NLR, an emerging marker of inflammation, is associated with an increased risk for long-term mortality in patients admitted with ADHF. NLR is a readily available inexpensive marker to aid in the risk stratification of patients with ADHF.

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Methods

The study population (n = 1,212) included consecutive patients admitted (from January 2006 to December 2008) with diagnoses of ADHF to the New England Heart Institute at Catholic Medical Center, a large urban hospital in Manchester, New Hampshire. The diagnosis of ADHF was based on standard guidelines.12 Patients with medical conditions known to affect the total and differential WBC counts, such as disorders of the hematopoietic system, history of cancer and/or previous treatment with

Results

Of the total of 1,296 consecutive patients admitted to our institution with ADHF during the study duration, 84 patients were excluded because they did not meet the inclusion criteria, and thus 1,212 patients became eligible for the study. The baseline characteristics of the study population according to NLR tertile are listed in Table 1. Membership in the higher NLR tertile was associated with older age, female gender, systemic hypertension, diabetes mellitus, history of coronary artery

Discussion

The primary finding of this study is that higher NLR tertile is associated with increased risk for mortality in patients admitted with ADHF. Furthermore, the predictive ability of NLR was superior to those of neutrophil count, total WBC count, and relative low lymphocyte count for mortality in patients admitted with ADHF. Additional analysis revealed that higher NLR tertile was associated with increased risk for 30-day ADHF-related readmission and increased mortality irrespective of LVEF.

Acknowledgment

We acknowledge the invaluable assistance of Cynthia David, MLS, MPS, and Revathi Hariram, BS.

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