title: Neutrophil Lymphocyte Ratio: APrognostic Marker in Acute ST Elevation Myocardial Infarction.
abstract: OBJECTIVE
  To investigate if neutrophil lymphocyte ratio (NLR) predicts in-hospital adverse events and mortality, and shortterm (30-day) mortality in ST-elevated myocardial infarction (STEMI) patients thrombolysed with streptokinase (SK).
  
  
  METHODS
  An observational study.
  
  
  METHODS
  Rawalpindi Institute of Cardiology, from June 2014 till January 2015.
  
  
  METHODS
  The STEMI patients, thrombolysed with SK had blood samples at admission, analysed for complete blood counts and NLR calculated. They were grouped into two, low and high NLR, taking 4.50 as cut-off. Chi square test was used to compare rate of adverse events and death in hospital stay. Mann-Whitney test was used to compare median NLR between patients died and discharged alive. Logistic regression analysis was used to estimate predictive ability of NLR for 30-day mortality.
  
  
  RESULTS
  Atotal of 145 (45.3%) patients had complications; 49 (15.3%) died in hospital, and 13 (4.06%) died in 30 days. Patients in high NLR group had higher rate of complications (63.5% vs. 25.5%, p <0.0001) and death (19.2% vs. 11.1%, p=0.046) in hospital than those in low NLR group. Cardiogenic shock (27.5% vs.11.1%, p <0.0001), heart failure (19.2% vs. 7.2%, p=0.002), arrhythmias (18% vs. 6.5%, p <0.0001), reinfarct/angina (9.6% vs.2% p=0.004) occurred more in high NLR group. Median NLR in patients died was higher than those discharged alive (7.46 vs. 4.70, p <0.0001). Regression analysis showed NLR an independent predictor of mortality (OR 1.131 at 95% CI, p = 0.029). Age, serum creatinine, Killip class were other predictors (p=0.002 and p=0.02, respectively). ROC curve showed AUC 0.908 (p <0.0001).
  
  
  CONCLUSIONS
  Ahigh NLR predicted increased in hospital complication rate, and in-hospital as well as 30-day mortality in STEMI patients thrombolysed with streptokinase.
authors.affiliation: Department of Cardiology, Rawalpindi Institute of Cardiology (RIC), Rawalpindi.
authors.forename: Uzma
authors.initials: U
authors.lastname: Gul
authors.affiliation: Department of Cardiology, Rawalpindi Institute of Cardiology (RIC), Rawalpindi.
authors.forename: Azhar Mehmood
authors.initials: AM
authors.lastname: Kayani
authors.affiliation: Research and Development, Rawalpindi Institute of Cardiology (RIC), Rawalpindi.
authors.forename: Rubab
authors.initials: R
authors.lastname: Munir
authors.affiliation: Department of Cardiology, Armed Forces Institute of Cardiology, Rawalpindi.
authors.forename: Sajjad
authors.initials: S
authors.lastname: Hussain
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D017052:Hospital Mortality; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D000072657:ST Elevation Myocardial Infarction / Q000097:blood* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality*; D018709:Statistics, Nonparametric; D013300:Streptokinase / Q000627:therapeutic use; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000379:methods
chemical_list: D015415:Biomarkers; D013300:Streptokinase