title: Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction.
abstract: Neutrophil/lymphocyte ratio (NLR) is the strongest white blood cell predictor of adverse outcomes in stable and unstable coronary artery syndromes. The aim of our study was to explore the utility of NLR in predicting long-term mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Consecutive patients with NSTEMI at Staten Island University Hospital were evaluated for study inclusion. Of the 1,345 patients with NSTEMI admitted from September 2004 to September 2006, 619 qualified for study inclusion. Survival analysis, stratified by NLR tertiles, was used to evaluate the predictive value of average inpatient NLR levels. Four-year vital status was accessed with electronic medical records and Social Security Death Index. Patients in the highest NLR tertile (NLR >4.7) had a higher 4-year mortality rate (29.8% vs 8.4%) compared to those in the lowest tertile (NLR <3, Wilcoxon chi-square 34.64, p <0.0001). After controlling for Global Registry of Acute Coronary Events risk profile scores, average NLR level remained a significant predictor of inpatient and 4-year mortality. Hazard ratios per unit increase of average NLR (log) increased by 1.06 (p = 0.0133) and 1.09 (p = 0.0006), respectively. In conclusion, NLR is an independent predictor of short-term and long-term mortalities in patients with NSTEMI with an average NLR >4.7. We strongly suggest the use of NLR rather than other leukocyte parameters (e.g., total white blood cell count) in risk stratification of the NSTEMI population.
authors.affiliation: Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York, NY, USA. basemnady2000@yahoo.com
authors.forename: Basem
authors.initials: B
authors.lastname: Azab
authors.forename: Medhat
authors.initials: M
authors.lastname: Zaher
authors.forename: Kera F
authors.initials: KF
authors.lastname: Weiserbs
authors.forename: Estelle
authors.initials: E
authors.lastname: Torbey
authors.forename: Kenson
authors.initials: K
authors.lastname: Lacossiere
authors.forename: Sainath
authors.initials: S
authors.lastname: Gaddam
authors.forename: Romel
authors.initials: R
authors.lastname: Gobunsuy
authors.forename: Sunil
authors.initials: S
authors.lastname: Jadonath
authors.forename: Duccio
authors.initials: D
authors.lastname: Baldari
authors.forename: Donald
authors.initials: D
authors.lastname: McCord
authors.forename: James
authors.initials: J
authors.lastname: Lafferty
mesh_terms: D004562:Electrocardiography; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D009504:Neutrophils; D012189:Retrospective Studies; D018570:Risk Assessment