title: The neutrophil-to-lymphocyte ratio as a marker of systemic endothelial dysfunction in asymptomatic subjects.
abstract: OBJECTIVE
  The neutrophil-to-lymphocyte ratio has demonstrated to be a prognostic inflammatory marker in cardiovascular disease. The objective of this study is to evaluate the association between neutrophil-to-lymphocyte ratio and pathologic urinary albumin/creatinine ratio as an early marker of cardiovascular risk and systemic endothelial dysfunction, associated with microvascular disease, in asymptomatic subjects.
  
  
  METHODS
  A unicenter cross-sectional study was conducted, including 1816 asymptomatic subjects. Patients with previous cardiovascular disease, those who were treated with ACE inhibitors and/or angiotensin II receptor blockers and patients with albumin/creatinine ratio over 300mg/g were excluded. The outcome of the study was the presence of a pathologic urinary albumin/creatinine ratio.
  
  
  RESULTS
  The neutrophil-to-lymphocyte ratio was significantly associated with altered urinary albumin/creatinine ratio in the univariate analysis and after adjustment for other known endothelial and cardiovascular risk factors (age, hypertension, dyslipidaemia, diabetes or altered glomerular filtration rate). Based on the sensitivity and specificity of different neutrophil-to-lymphocyte ratio thresholds, 3 risk groups were created for altered urinary albumin/creatinine ratio: low risk in those with neutrophil-to-lymphocyte ratio < 1.5, intermediate risk in patients between 1.5 and 3, and high risk in those with neutrophil-to-lymphocyte ratio > 3. These groups were found to have a statistically significant and independent prognostic power for altered urinary albumin/creatinine ratio in asymptomatic patients.
  
  
  CONCLUSIONS
  The neutrophil-to-lymphocyte ratio appears to be a cost-efficient, non-invasive and independent potential marker of systemic endothelial dysfunction in asymptomatic subjects.
authors.affiliation: Departamento de Medicina Interna, Clínica Universidad de Navarra, Pamplona, Navarra, España.
authors.forename: Diego
authors.initials: D
authors.lastname: Martínez-Urbistondo
authors.affiliation: Departamento de Medicina Interna, Clínica Universidad de Navarra, Pamplona, Navarra, España.
authors.forename: Almudena
authors.initials: A
authors.lastname: Beltrán
authors.affiliation: Departamento de Medicina Interna, Clínica Universidad de Navarra, Pamplona, Navarra, España.
authors.forename: Oscar
authors.initials: O
authors.lastname: Beloqui
authors.affiliation: Departamento de Medicina Interna, Clínica Universidad de Navarra, Pamplona, Navarra, España. Electronic address: ahuerta@unav.es.
authors.forename: Ana
authors.initials: A
authors.lastname: Huerta
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000652:urine; D058070:Asymptomatic Diseases; D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000097:blood* / Q000276:immunology / Q000503:physiopathology; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D004727:Endothelium / Q000276:immunology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D009504:Neutrophils; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012907:Smoking / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: Asymptomatic subjects; Cardiovascular risk; Cociente albúmina/creatinina urinario; Disfunción endotelial; Endothelial dysfunction; Neutrophil-to-lymphocyte ratio; Riesgo cardiovascular; Sujetos asintomáticos; Urinary albumin/creatinine ratio; Índice neutrófilo/linfocito