title: An assessment of neutrophils/lymphocytes ratio in patients suspected of acute coronary syndrome.
abstract: BACKGROUND
  Leukocytes total count is an independent risk marker for cardiovascular events. The ratio between neutrophils and lymphocytes (N/L) count has been investigated as a new predictor for cardiovascular risk, although its diagnostic role when assessing patients suspected of an acute coronary syndrome (ACS) condition is not yet known.
  
  
  OBJECTIVE
  To evaluate the diagnostic power of N/L ratio in patients who have been admitted at a Chest Pain Unit (CPU) with the suspicion of ACS.
  
  
  METHODS
  Evaluation was conducted in 178 patients admitted with chest pain. Diagnostic flowchart including clinical, electrocardiographic, and laboratory data. Diagnosis obtained was: acute myocardial infarction (AMI) with (AMI-STE) and with no segment T elevation (AMI-NSTE), unstable angina (UA ) and non-cardiac pain (NC). Total and differential leukocyte count was conducted in peripheral blood sample collected at admission.
  
  
  RESULTS
  Patients diagnosed with non-cardiac pain reported the lowest N/L ratio (n=45; 3.0 +/- 1.6), followed by UA (n=65; 3.6 +/- 2.9), AMI-NSTE (n=33; 4.8 +/- 3.7) and AMI-STE (n=35; 6.9 +/- 5.7); p < 0.0001. N/L ratio above 5.7 (highest quartile) reported 91.1% specificity, 4.51 odds ratio (CI 95% 1.51 to 13.45) for the final diagnosis of ACS when compared to the groups at lower quartiles.
  
  
  CONCLUSIONS
  The N/L ratio presents correlation with final diagnosis of patients with suspicion of ACS at admission. Considering this is a low cost, good reproductibility test, new studies should ellucidate whether the ratio may be of relevance for diagnosis flowcharts currently in use.
authors.affiliation: Pontifícia Universidade Católica do Paraná, Santa Casa de Misericórdia Hospital, Curitiba, PR - Brazil.
authors.forename: Ana Denise
authors.initials: AD
authors.lastname: Zazula
authors.forename: Daniel
authors.initials: D
authors.lastname: Précoma-Neto
authors.forename: Aline Maria
authors.initials: AM
authors.lastname: Gomes
authors.forename: Heidi
authors.initials: H
authors.lastname: Kruklis
authors.forename: Giovano Franco
authors.initials: GF
authors.lastname: Barbieri
authors.forename: Rafael Yared
authors.initials: RY
authors.lastname: Forte
authors.forename: André Ribeiro
authors.initials: AR
authors.lastname: Langowiski
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Facin
authors.forename: Luiz César
authors.initials: LC
authors.lastname: Guarita-Souza
authors.forename: Luiz Cesar Guarita de
authors.initials: LC
authors.lastname: Souza
authors.forename: José Rocha
authors.initials: JR
authors.lastname: Faria Neto
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis; D000789:Angina, Unstable / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood*; D009504:Neutrophils / Q000473:pathology*
chemical_list: D015415:Biomarkers