Heart Failure
Usefulness of Neutrophil-to-Lymphocyte Ratio in Risk Stratification of Patients With Advanced Heart Failure

https://doi.org/10.1016/j.amjcard.2014.10.008Get rights and content

Highlights

  • Higher NLR portends increased risk of mortality or heart transplantation in patients with advanced heart failure.

  • This association was mainly driven by higher mortality risk, as we did not find association between NLR and heart transplantation after multivariate adjustments.

  • It appears that NLR is more likely a risk marker than the altered composition of leukocytes being a risk mediator for advanced heart failure.

Elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with increased mortality in patients with acute heart failure (HF) and neoplastic diseases. We investigated the association between NLR and mortality or cardiac transplantation in a retrospective cohort of 527 patients presented to the Cleveland Clinic for evaluation of advanced HF therapy options from 2007 to 2010. Patients were divided according to low, intermediate, and high tertiles of NLR and were followed longitudinally for time to all-cause mortality or heart transplantation (primary outcome). The median NLR was 3.9 (interquartile range 2.5 to 6.5). In univariate analysis, intermediate and highest tertiles of NLR had a higher risk than the lowest tertile for the primary outcome and all-causes mortality. Compared with the lowest tertile, there was no difference in the risk of heart transplantation for intermediate and high tertiles. In multivariate analysis, compared with the lowest tertile, the intermediate and high NLR tertiles remained significantly associated with the primary outcome (hazard ratio [HR] = 1.61, 95% confidence interval [CI] 1.10 to 2.37 and HR = 1.55, 95% CI 1.02 to 2.36, respectively) and all-cause mortality (HR = 1.83, 95% CI 1.07 to 3.14 and HR = 2.16, 95% CI 1.21 to 3.83, respectively). In conclusion, elevated NLR is associated with increased mortality or heart transplantation risk in patients with advanced HF.

Section snippets

Methods

We analyzed 549 consecutive patients presented to the Cleveland Clinic (Cleveland, Ohio) from 2007 to 2010 for evaluation of advanced HF therapies and consideration for heart transplantation or mechanical circulatory assist devices. Electronic medical records were used to obtain demographic variables (age, gender, and race), clinical variables, laboratory values, and medications. Among this cohort, 527 patients had documented values of NLR within the time frame and clinical stability to

Results

Of the 527 patients, 176, 177, and 174 patients were in the lowest, intermediate, and higher NLR tertile, respectively. Baseline characteristics of the patients across NLR tertiles are listed in Table 1. Overall, NLR correlated directly with B-type natriuretic peptide (r = 0.14, p <0.01). There was no correlation between NLR and left ventricular ejection fraction, peak oxygen consumption, and hemodynamic variables. The distribution of the logarithm of NLR is presented in Figure 1, stratified

Discussion

The key finding of this analysis is that patients with advanced HF and higher levels of NLR portend higher mortality or heart transplantation risk. This association was mainly driven by higher all-cause mortality risk, as we did not find association between NLR and heart transplantation after multivariate adjustments. Although NLR may link to mortality like several other conditions, the potential contributory role of NLR in disease progression is not supported by our analysis. Thus, it appears

Disclosures

The authors have no conflicts of interest to disclose.

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This research was supported by National Institutes of Health grant RO1 HL103931.

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