title: Usefulness of neutrophil-to-lymphocyte ratio to predict in-hospital outcomes in infective endocarditis.
abstract: BACKGROUND
  The neutrophil-to-lymphocyte ratio is an independent predictor of worse prognosis in both infectious and cardiovascular disease. We hypothesized that an increased neutrophil-to-lymphocyte ratio at admission would predict in-hospital unfavourable outcomes in patients with infective endocarditis (IE).
  
  
  METHODS
  We retrospectively analyzed clinical, laboratory, and echocardiographic data in a total of 121 consecutive adult patients (64 men; mean age, 54.7 ± 14.2 years) with definite IE.
  
  
  RESULTS
  Among all patients, the prespecified clinical outcomes were experienced in 46 patients (38%). In-hospital mortality and central nervous system (CNS) events occurred in 29 (24%) and 21 patients (17%), respectively. The neutrophil-to-lymphocyte ratio at admission was found to be significantly higher for either composite end point. On using multiple Cox regression analysis, vegetation size ≥ 10 mm, end-stage renal disease, Staphylococcus aureus infection, low hemoglobin level, increased C-reactive protein (CRP) level, and high neutrophil-to-lymphocyte ratio at admission emerged as independent predictors of in-hospital unfavourable outcomes. In the receiver operating characteristics (ROC) curve analysis, a neutrophil-to-lymphocyte ratio > 7.1 had 80% sensitivity and 83% specificity in predicting adverse outcomes.
  
  
  CONCLUSIONS
  High neutrophil-to-lymphocyte ratio at admission is an independent predictor of in-hospital mortality and CNS events in patients with IE. However, prospective validation of these findings is required.
authors.affiliation: Department of Cardiology, Türkiye Yüksek Ihtisas Education and Research Hospital, Ankara, Turkey. Electronic address: osmanturak@yahoo.com.
authors.forename: Osman
authors.initials: O
authors.lastname: Turak
authors.forename: Firat
authors.initials: F
authors.lastname: Özcan
authors.forename: Ahmet
authors.initials: A
authors.lastname: Işleyen
authors.forename: F Nurcan
authors.initials: FN
authors.lastname: Başar
authors.forename: Murat
authors.initials: M
authors.lastname: Gül
authors.forename: Samet
authors.initials: S
authors.lastname: Yilmaz
authors.forename: Erdoğan
authors.initials: E
authors.lastname: Sökmen
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Yüzgeçer
authors.forename: Gökhan
authors.initials: G
authors.lastname: Lafçi
authors.forename: Serkan
authors.initials: S
authors.lastname: Topaloğlu
authors.forename: Sinan
authors.initials: S
authors.lastname: Aydoğdu
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality; D005260:Female; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology*; D010343:Patient Admission; D063868:Patient Outcome Assessment; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000276:immunology / Q000401:mortality; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality; D014421:Turkey; D055815:Young Adult