title: Predictive and prognostic value of admission neutrophil-to-lymphocyte ratio in patients with CHD.
abstract: OBJECTIVE
  The aim of this study was to examine the association between the admission neutrophil-to-lymphocyte ratio (N/L ratio) with coronary heart disease (CHD), separately from acute coronary syndrome (ACS) and stable angina (SA). A further aim was to investigate the clinical value of the N/L ratio in predicting in-hospital CHD events and the long-term prognosis of patients with CHD.
  
  
  METHODS
  In all, 942 patients were enrolled and classified into a CHD group (comprising an ACS group and an SA group) and a normal group. Laboratory data including regular blood test results were obtained at baseline. The relationship between the N/L ratio and CHD, ACS, Gensini score, and multivessel lesions was analyzed by logistic regression. Receiver operating characteristics (ROC) curve analysis was used to identify the value of the N/L ratio in the diagnosis of CHD, ACS, and the severity of CHD. We divided the patients into four groups according to the N/L ratio quartiles and compared the differences in major adverse cardiac events (MACEs) that occurred in hospital and in the 4.26 ± 0.57-year follow-up out of hospital.
  
  
  RESULTS
  Patients with an elevated N/L ratio had a significantly increased risk of CHD [odds ratio (OR) = 1.697, 95 % confidence interval (CI) = 1.483-1.942], and an elevated N/L ratio was closely related to a higher risk of ACS (OR = 1.652, 95 % CI = 1.434-1.902). The admission N/L ratio (0.664; 95 % CI = 1.942-1.616) showed a greater ROC area than the WBC and LDL-C values. Patients with a higher N/L ratio in both the SA group and the ACS group had a higher incidence of in-hospital and out-of-hospital MACEs, including long-term mortality and occurrence of new-onset heart failure or re-occurrence of heart failure. An elevated N/L ratio on admission was also found to be a significant indicator of 4.26-year MACEs.
  
  
  CONCLUSIONS
  The admission N/L ratio was significantly associated with CHD and may become a risk predictor in the prognosis of patients with CHD.
authors.affiliation: Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, No197 Ruijin Er Road, 200025, Shanghai, China.
authors.forename: C
authors.initials: C
authors.lastname: Yu
authors.affiliation: Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, No197 Ruijin Er Road, 200025, Shanghai, China.
authors.forename: M
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, No197 Ruijin Er Road, 200025, Shanghai, China. zhenyue1224@yahoo.com.
authors.forename: Z
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, No197 Ruijin Er Road, 200025, Shanghai, China. drluguoping@163.com.
authors.forename: G
authors.initials: G
authors.lastname: Lu
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000401:mortality* / Q000473:pathology; D017677:Age Distribution; D015415:Biomarkers / Q000097:blood; D002681:China / Q000453:epidemiology; D003327:Coronary Disease / Q000097:blood* / Q000401:mortality* / Q000473:pathology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007958:Leukocyte Count / Q000706:statistics & numerical data; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D010343:Patient Admission; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D015996:Survival Rate
chemical_list: D015415:Biomarkers
keywords: Acute coronary syndromes; Coronary heart disease; Diagnosis; Neutrophil-to-lymphocyte ratio; Prognosis