Predictive value of admission neutrophil to lymphocyte ratio in casdiovascular outcomes and mortality of patients with acute coronary syndrome

Introduction and purpose: Acute coronary syndrome ( ACS ) is associated with many hereditary and acquired predisposing factors. It has been recently shown that inflammation may play a role in myocardial ischemia. Hence, the white blood cell ( WBC ) count provides a simple and inexpensive method for assesment of inflammatory status in patients with ACS. An elevated WBC count has been associated with cardiovascular risk, but which leukocyte subtype carries this risk is uncertain. The risk scores for evaluating the cardiovascular outcomes in patients with ACS has been validated but these scores contains multiple comlicated and variable parameters. Hence the risk classification of the patients with ACS is inadequite, it requires improving with new and practical parameters. The aim of this study was to invastigate the utility of admission neutrophil / lympocyte ratio ( NLR ) in predicting the likelihood of poor outcomes in patients with ACS.Method: A total of 209 consecutive patients admitted to the Cardiology Department, Dokuz Eylul Universty Medicine Faculty hospital with the diagnosis of ACS from June 2009 to November 2009 were included in this study. Patients were divided into tertile groups, low (<3.0 ) intermediate (3,0-4,7 ) high (>4,7 ) according to the NLR . The admitting findings, laboratory values, GRACE and TIMI risk scores was recorded and in-hospital mortality, and the total mortality/hospitalisation due to cardiovasculary complications after discharge evaluated in three NLR groups.Results: : The mean age of patients included in this cohort was 63 years. Between NLR and SPB ( p=0,003 r=-0,206 ) DBP (p=0,001 r=-0,224 ), LVEF ( p=0,001 r=-0,222 ) significant negative correlation founded. Between NLR and CRP ( p=0,001 r=0,238 ) troponin I (p=0,000 r=0,499 ), CKMB ( p=0,000 r=0,550 ) significant positive correlation founded. Between NLR and admisson GRACE score ( p=0,000 r=0,496 ) discharge GRACE score (p=0,000 r=0,368 ) significant positive correlation founded, The correlation between STEMI TIMI risk score and NLR was nearly significant ( p=0,054 r=0,134 ). There was no difference in mortality neither in hospitalisation due to cardiovasculary complications between NLR groups.Conclusion : Although there was no difference in mortality neither in hospitalisation due to cardiovasculary complications between NLR groups, the findings of significant correlation between NLR and admitting findings and GRACE/TIMI risk scores, supports the data from the previous studies.