The Impact of Neutrophil-to-Lymphocyte Ratio on Heart Failure Prognosis

[Voice of Hope, July 13, 2023](Editor: Li Wenhan) Heart failure is a complex clinical syndrome, which is caused by multiple mechanisms that lead to structural and functional abnormalities of the heart, in which systemic immune activation and inflammatory mediators participate in its pathophysiological process . The ratio of neutrophil count to lymphocyte count (NLR) reflects the index of the body’s inflammatory state.

Scholars at Shengjing Hospital have found that as this ratio increases, the worse the cardiac function of patients with heart failure with preserved ejection fraction (HFpEF), the higher the risk of in-hospital death, cardiovascular death, and all-cause death.

Patients with a higher ratio of neutrophil count to lymphocyte count also had a higher proportion of advanced age, diabetes, elevated troponin, NT-proBNP, and elevated creatinine.

Diabetes (Photo AC)

The study showed that after excluding the interference of other confounding factors, multivariate Cox analysis showed that NLR is still a risk factor for the prognosis of heart failure patients. For every 1 increase in this ratio, the risk of cardiovascular death increased by 1.3%, and the risk of all-cause death increased by 1.2%. .

Kaplan-Meier survival analysis showed that the higher the ratio, the lower the cumulative survival rate of all-cause death and cardiovascular death.

This study also showed that the optimal cut-off value of NLR for predicting long-term cardiovascular death was 3.29 (AUC=0.630, sensitivity 62.6%, specificity 57.9%).

The AUC of NLR combined with NT-proBNP in predicting cardiovascular death in HFpEF patients was 0.702, and the sensitivity was 65.1%.

NLR is currently widely used in the diagnosis and prediction of cardiovascular diseases, which can reflect the degree of inflammation in patients to a certain extent, and has good predictive and auxiliary diagnostic effects. This is because activated neutrophils release a variety of protein-cleaving enzymes, such as myeloperoxidase, acid phosphatase, and elastase, which promote tissue destruction and affect cardiac function, leading to higher NYHA functional class and lower LVEF.

At the same time, it is speculated that the underlying mechanism of lymphopenia affecting cardiac function in patients includes down-regulation of lymphocyte proliferation and differentiation, neurohumoral activation induced by activated neutrophils, and lymphocyte apoptosis caused by elevated cortisol and catecholamines.

The study included the clinical data of 3 608 patients with HFpEF who were hospitalized for heart failure, and were divided into three groups according to the admission NLR level: low-value group (≤ 2.47), median-value group (NLR 2.48-4.12) and high-value group (NLR ≥ 4.13).

Editor in charge: Li Zhi

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2023-07-13 09:06:10

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