title: The neutrophil to lymphocyte ratio is associated with severity of rheumatic mitral valve stenosis.
abstract: BACKGROUND
  Rheumatic heart disease (RHD) is a serious health concern in developing countries. Rheumatic mitral stenosis (RMS) is the most long-term sequel in RHD. The neutrophil to lymphocyte ratio (NLR) is a novel marker, and a higher NLR has been associated with poor clinical outcomes in various cardiovascular disorders. We evaluated the availability of NLR to predict severity of mitral stenosis (MS) in patients with RHD.
  
  
  METHODS
  We analyzed 300 consecutive patients with RMS. The patients were divided into tertiles according to NLR: 0.85< NLR ≤1.85 (n=100, tertile 1), 1.86≤ NLR ≤2.46 (n=100, tertile 2), and 2.47≤ NLR ≤7.08 (n=100, tertile 3). Patients with RMS were divided into three groups based on the degree of MS as mild, moderate, and severe MS. After the initial evaluation, 187 patients with moderate-to-severe RMS (Group 1) and 113 patients with mild RMS (Group 2) were reassessed.
  
  
  RESULTS
  The patients with severe RMS had significantly elevated NLR, mean platelet volume, and pulmonary artery systolic pressure values compared to patients with moderate and mild MS (P<0.001, P<0.001, P<0.001 respectively). Multivariate binary logistic regression analysis revealed that high levels of NLR was an independent predictor of severe RMS (odds ratio =0.68, P=0.008). Moderate-to-severe RMS incidence was significantly higher among patients in the tertile 3 (odds ratio =2.8, P=0.001).
  
  
  CONCLUSIONS
  NLR is a new inflammatory marker and a simple, rapid, and easily accessible prognostic parameter that can be associated with severity of RMS in patients with RHD.
authors.affiliation: Department of Cardiology, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey.
authors.forename: Erkan
authors.initials: E
authors.lastname: Baysal
authors.affiliation: Department of Cardiology, Ankara Yüksek İhtisas Education and Research Hospital, Ankara, Turkey.
authors.forename: Cengiz
authors.initials: C
authors.lastname: Burak
authors.affiliation: Department of Cardiology, Ankara Yüksek İhtisas Education and Research Hospital, Ankara, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Cay
authors.affiliation: Department of Cardiology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Aksu
authors.affiliation: Department of Cardiology, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey.
authors.forename: Bernas
authors.initials: B
authors.lastname: Altıntaş
authors.affiliation: Department of Cardiology, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey.
authors.forename: Barış
authors.initials: B
authors.lastname: Yaylak
authors.affiliation: Department of Cardiovascular Surgery, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey.
authors.forename: Utkan
authors.initials: U
authors.lastname: Sevük
authors.affiliation: Department of Cardiology, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey.
authors.forename: Önder
authors.initials: Ö
authors.lastname: Bilge
keywords: neutrophil to lymphocyte ratio; rheumatic heart disease; rheumatic mitral stenosis