title: The predictive Value of Total Neutrophil Count and Neutrophil/Lymphocyte Ratio in Predicting In-hospital Mortality and Complications after STEMI.
abstract: BACKGROUND
  Leukocytosis, predominantly neutrophilia, has previously been described following ST elevation myocardial infarction (STEMI). The exact contribution of this phenomenon to the clinical outcome of STEMI is yet to be shown. We examined cellular inflammatory response to STEMI in the blood and its association with in-hospital mortality and/or adverse clinical events.
  
  
  METHODS
  In this cross-sectional study, 404 patients who were admitted with the diagnosis of acute STEMI at Madani Heart Hospital from March 2010 to March 2012 were studied. The complete blood cell count (CBC) was obtained from all patientswithin12-24 hours of the onset of symptoms. Total leukocytes were counted and differential count was obtained for neutrophils, lymphocytes and neutrophil/lymphocyte ratio (NLR) were evaluated. Association of cellular response with the incidence of post-MI mortality/complications was assessed by multiple logistic regression analyses.
  
  
  RESULTS
  In-hospital mortality and post-STEMI complication rate were 3.7% and 43.6%, respectively. Higher age (P=0.04), female gender (0.002), lower ejection fraction (P<0.001) and absolute neutrophil count (P=0.04) were predictors of mortality. Pump failure in the form of acute pulmonary edema or cardiogenic shock occurred in 35 (8.9%) of patients. Higher leukocyte (P<0.03) and neutrophil counts (P<0.03) and higher NLR (P=0.01) were predictors of failure. The frequency of ventricular tachyarrhythmias (VT/VF) at the first day was associated with higher neutrophil count (P<0.001) and higher NLR level (P<0.001). In multivariate analysis neutrophil count was an independent predictor of mortality (OR=2.94; 1.1-8.4, P=0.04), and neutrophil count [OR=1.1, CI (1.01-1.20), P=0.02], female gender [OR=2.34, CI (1.02-4.88), P=0.04] and diabetes [OR=2.52, CI (1.21-5.2), P=0.003] were independent predictors of heart failure.
  
  
  CONCLUSIONS
  A single CBC analysis may help to identify STEMI patients at risk for mortality and heart failure, and total neutrophil count is the most valuable in predicting both.
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Samad
authors.initials: S
authors.lastname: Ghaffari
authors.affiliation: Tohid Hospital, Sanandaj, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Nadiri
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Leili
authors.initials: L
authors.lastname: Pourafkari
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Nariman
authors.initials: N
authors.lastname: Sepehrvand
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Aliakbar
authors.initials: A
authors.lastname: Movasagpoor
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Neda
authors.initials: N
authors.lastname: Rahmatvand
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Mohammadamin
authors.initials: M
authors.lastname: Rezazadeh Saatloo
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Mona
authors.initials: M
authors.lastname: Ahmadi
authors.affiliation: VA Western New York Healthcare System, University of Buffalo, Buffalo, USA.
authors.forename: Nader D
authors.initials: ND
authors.lastname: Nader
keywords: Acute Myocardial Infarction; Neutrophil/Lymphocyteratio; ST Segment Elevation; Total Neutrophil Count; White Blood Cell
references.citation: Am J Cardiol. 2008 Sep 15;102(6):653-7
references.pmid: 18773982
references.citation: Am J Cardiol. 2010 Aug 15;106(4):470-6
references.pmid: 20691303
references.citation: Int J Cardiol. 2013 Sep 30;168(2):853-62
references.pmid: 23158928
references.citation: Eur Heart J. 2008 Apr;29(8):984-91
references.pmid: 18346960
references.citation: Circulation. 1994 Oct;90(4):2126-46
references.pmid: 7718033
references.citation: Am J Cardiol. 2006 Apr 1;97(7):993-6
references.pmid: 16563903
references.citation: Acad Emerg Med. 2004 Oct;11(10):1049-60
references.pmid: 15466147
references.citation: Circ Cardiovasc Qual Outcomes. 2009 Nov;2(6):656-62
references.pmid: 20031905
references.citation: Ann Intern Med. 1995 Mar 1;122(5):335-41
references.pmid: 7847644
references.citation: Circulation. 2000 Nov 7;102(19):2329-34
references.pmid: 11067784
references.citation: Am J Cardiol. 2003 Jul 15;92(2):136-40
references.pmid: 12860213
references.citation: Am J Med. 2007 Jul;120(7):616-22
references.pmid: 17602936
references.citation: Circ J. 2006 Mar;70(3):342-51
references.pmid: 16501303
references.citation: Cardiovasc Hematol Disord Drug Targets. 2011;11(2):58-60
references.pmid: 22044033
references.citation: Expert Rev Cardiovasc Ther. 2013 Jan;11(1):55-9
references.pmid: 23259445
references.citation: Am J Cardiol. 2004 Mar 1;93(5):532-6
references.pmid: 14996574
references.citation: N Engl J Med. 1999 Jan 14;340(2):115-26
references.pmid: 9887164
references.citation: Circulation. 2003 Dec 16;108(24):3006-10
references.pmid: 14623805
references.citation: Trans Am Clin Climatol Assoc. 1936;52:97-104.1
references.pmid: 21407523
references.citation: Am J Cardiol. 2001 Mar 1;87(5):636-9, A10
references.pmid: 11230853
references.citation: Am J Cardiol. 2003 Aug 15;92(4):368-72
references.pmid: 12914863
references.citation: Am J Cardiol. 2009 Feb 1;103(3):333-7
references.pmid: 19166685
references.citation: J Am Coll Cardiol. 2005 May 17;45(10):1638-43
references.pmid: 15893180
references.citation: Am J Cardiol. 2008 Mar 15;101(6):747-52
references.pmid: 18328833