Comparison of procalcitonin/albumin ratio, hemoglobin/creatinine ratio, and platelet/lymphocyte ratio in patients diagnosed with acute coronary syndrome in the emergency department and their impact on prognosis

Aim: Despite the use of several specific biomarkers in the diagnosis of Acute Coronary Syndrome (ACS), diagnostic failures persist, necessitating the investigation of supportive laboratory indicators. Accordingly, biomarkers related to hemostasis-thrombosis, oxidative stress, energy homeostasis, inflammation, and plaque instability are being explored. This study aimed to evaluate the prognostic impact of the procalcitonin/albumin ratio, hemoglobin/creatinine ratio, and platelet/lymphocyte ratio—alongside conventional cardiac biomarkers—in patients diagnosed with ACS who presented to the emergency department. Materials and Methods: This prospective study included data from individuals aged 18 and above who presented to the Emergency Department of Balıkesir University Medical Faculty Training and Research Hospital and were diagnosed with ACS between December 1, 2024, and May 31, 2025. Patient data included age, sex, comorbidities, risk factors, anticoagulant use, hemoglobin/creatinine ratio, platelet/lymphocyte ratio, procalcitonin/albumin ratio, BNP, CRP, and troponin-I levels, coronary angiographic interventions, use of antiplatelet and anticoagulant drugs, ejection fraction values, and clinical outcomes. Patients were grouped into STEMI, NSTEMI, and UA categories based on inclusion and exclusion criteria. The data were analyzed using statistically validated methods. Results: PAR and the HB/CRE ratio were identified as significant biomarkers for predicting mortality (p<0.05), whereas the PLR ratio showed no statistically significant association with mortality (p>0.05). Receiver operating characteristic (ROC) analysis demonstrated that both PAR and the HB/CRE ratio exhibited strong discriminatory power. Subgroup analysis revealed that mortality was significantly higher in patients with STEMI compared with those in the NSTEMI and UA groups. Conclusion: The results indicate that biomarkers associated with inflammatory response and tissue perfusion disorders may support clinical decision-making in early risk stratification of ACS patients. Therefore, there is a need for larger, multicenter, and prospectively designed studies. Such investigations could more robustly demonstrate the clinical utility of novel biomarkers and facilitate their integration into risk scoring systems. In the long term, the role of these biomarkers in personalized medical approaches and clinical decision support systems may become more clearly defined. Keywords: Chest pain, inflammation, biomarker, emergency department, mortality