title: Neutrophil to Lymphocyte (N/L) and Platelet to Lymphocyte (P/L) Ratios in Differentiating Acute Heart Failure from Respiratory Infection.
abstract: BACKGROUND
  The clinical manifestations of acute heart failure (AHF) and respiratory infection (RI) frequently overlap in patients presenting with dyspnoea at the emergency department (ED). The neutrophil to lymphocyte (N/L) and platelet to lymphocyte (P/L) ratios have been proposed as diagnostic and prognostic indices in this setting.
  
  
  OBJECTIVE
  To evaluate the ability of N/L and P/L ratios to discriminate the cause of dyspnoea in patients admitted with an initial diagnosis of AHF-RI.
  
  
  METHODS
  100 consecutive dyspnoeic chronic heart failure (CHF) patients diagnosed as AHF-RI in the ED of Sotiria Chest Diseases General Hospital were monitored for a series of parameters. The diagnostic efficacy of the registered parameters in discriminating the AHF from RI patients was evaluated.
  
  
  RESULTS
  The N/L and P/L ratios did not differ statistically depending on the pharmaceutical therapy applied in the study population, with the exception of furosemide and spironolactone-treated patients, who both had higher ratio values. In the AHF patients, only N/L was influenced by the pharmaceutical treatment administered. Patients with higher N/L ratio values were more likely to have RI-triggereddyspnoea (odds ratio, OR=1.35, 95% confidence interval-CI: 0.99-1.42, p=0.047). ROC curve (receiver operating characteristic curve) analysis revealed a significant ability of the N/L ratio to differentiate pure AHF from RI (area under the curve AUC=0.773, p<0.001, cut-off value N/L= 3.15).
  
  
  CONCLUSIONS
  The N/L ratio, a cheap and easily assessed biomarker, warrants further investigation as a potential diagnostic tool for the ED physician facing dyspnoeic CHF patients.
authors.affiliation: Department of Cardiology, Sotiria Chest Diseases General Hospital, 152 Messogeion Av., Athens, 11527. Greece.
authors.forename: Eftychios E
authors.initials: EE
authors.lastname: Siniorakis
authors.affiliation: Department of Cardiology, General University Hospital of Larissa, Terma Mezourlo, Larissa 41110. Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsarouhas
authors.affiliation: General Chemical State Laboratory of Greece, Department of Hazardous Substances, Mixtures & Articles,16 An. Tsocha Str., Athens115121. Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Tsitsimpikou
authors.affiliation: Department of Cardiology, Sotiria Chest Diseases General Hospital, 152 Messogeion Av., Athens, 11527. Greece.
authors.forename: Theodora Ch
authors.initials: TC
authors.lastname: Batila
authors.affiliation: Department of Cardiology, Sotiria Chest Diseases General Hospital, 152 Messogeion Av., Athens, 11527. Greece.
authors.forename: Stamatia
authors.initials: S
authors.lastname: Panta
authors.affiliation: Department of Cardiology, Sotiria Chest Diseases General Hospital, 152 Messogeion Av., Athens, 11527. Greece.
authors.forename: Konstantinos G
authors.initials: KG
authors.lastname: Zampelis
authors.affiliation: Department of Cardiology, Amalia Fleming General Hospital, 14 25th Martiou, Athens 15127. Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Rentoukas
authors.affiliation: Department of Cardiology, General University Hospital of Larissa, Terma Mezourlo, Larissa 41110. Greece.
authors.forename: Filippos
authors.initials: F
authors.lastname: Triposkiadis
authors.affiliation: Department of Cardiology, Sotiria Chest Diseases General Hospital, 152 Messogeion Av., Athens, 11527. Greece.
authors.forename: Sotiria J
authors.initials: SJ
authors.lastname: Limberi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D001792:Blood Platelets / Q000378:metabolism; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism*; D010976:Platelet Count; D011379:Prognosis; D012141:Respiratory Tract Infections / Q000175:diagnosis*
chemical_list: D015415:Biomarkers
keywords: Acute heart failure; CHF; WBC; neutrophil to lymphocyte ratio; platelet to lymphocyte ratio; respiratory infection