Evaluation of white blood cell and neutrophil/lymphocyte ratio in acute coronary syndrome patients admitted to emergency department (original) (raw)
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Introduction: Inflammation plays an important role in atherosclerosis which is the primary cause of acute coronary syndrome (ACS) that encompasses acute myocardial infarction (AMI) and unstable angina (UA). Objective: To investigate and characterize white blood cells (WBC) count, differential blood count in peripheral blood and neutrophil to lymphocyte ratio (NLR) in patients by the type of ACS. Patients and methods: The cross-sectional study included 100 patients with ACS (50 males, 50 females), aged 41 to 91 years, classified into two groups: AMI group (n=50) and UA group (n=50). Patients were hospitalized at the Clinic for Heart Diseases, University Clinical Center of Sarajevo. From patients' medical histories the following data were obtained: WBC, neutrophil, eosinophil and basophil granulocytes count, monocyte and lymphocyte count, levels of high sensitive troponin I (hsTnI), creatine kinase MB (CK-MB) and C-reactive protein (CRP). The results were analyzed using software package SPSS, version 19.0. Results: Average WBC count, neutrophil granulocytes, and monocytes were significantly higher in AMI group than in UA group (p = 0.001, p < 0.0005, p = 0.03, respectively). Eosinophil count was significantly lower in patients with AMI (p = 0.022). NLR was significantly higher in AMI group in relation to patients with UA (p = 0.001). Significantly higher values of hsTnI and CK-MB were established in patients with AMI. NLR correlated significantly positive with the values of hsTnI, CK-MB, CRP, WBC and neutrophil count, and significantly negative with lymphocyte count. Conclusion: Average values of NLR were significantly higher in patients with AMI in relation to patients with UA, indicating the importance of this inflammatory marker in discrimination of clinical forms of ACS. A positive correlation was established between NLR and markers of myocardial necrosis, and between NLR and CRP, indicating the importance of NLR in the assessment of the extent of the myocardial lesion and in inflammation intensity assessment in ACS.
Konuralp Tıp Dergisi, 2021
In this study, we aimed to determine the roles of neutrophil, MPV, and NLR, in the diagnosis of ACS and the differentiation of ACS subtypes (ST-elevation myocardial infarction and non-ST elevation myocardial infarction), in patients presented to the emergency department with chest pain and were diagnosed with ACS (acute coronary syndrome). Methods: This study was designed as a single-center, cross-sectional, and retrospective. 402 patients who were applied to University Hospital Emergency Department between January 2020 and November 2020; and registered to hospital automation system with chest pain; and underwent further examinations and treatments were included in the study. Ethical approval was obtained from the Local Clinical Research Ethics Committee before the study. Patients who were hospitalized after further examination, who received medical treatment, and did not undergo PCI (Percutaneous coronary intervention) were accepted as NSTMI (n = 202). Patients who were hospitalized after further examination and underwent PCI were accepted as STMI (n = 200). Results: 36.3% of the patients were female (n = 146) and 63.7% (n = 256) were male. The mean age of the cases was detected to be 61.46 ± 14.06. The number of hospitalized ACS patients for NSTMI suspicion and received medical treatment was 202. The number of patients who underwent PCI and accepted as STMI was 200.Mean neutrophils, MPV, NLR, and Troponin values were also significantly higher than those who are not hospitalized (p <0.001). The mean WBC, Neutrophil, NLR, and Troponin values of the patients underwent PCI were also significantly higher than those without PCI (p <0.001). Conclusions: We believe that NLR is a diagnostic valuable that can be used as a biomarker in diagnosing ACS and determining the PCI.
BMC Cardiovascular Disorders, 2021
Background Inflammation plays a key role in the development of atherosclerosis and in the pathogenesis of acute coronary syndrome (ACS). Leukocytes and leukocytes ratios were recognized as inflammatory markers in predicting the presence and severity of ACS. Methods This study aimed to investigate the diagnostic accuracy of neutrophil to lymphocyte ratio (NLR) and monocyte to lymphocyte ratio (MLR) with ACS. One hundred patients admitted to the Cardiac Center who were confirmed to have ACS and 100 healthy controls confirmed not to have ACS were enrolled in this study. ECG and troponin I test were used as gold standards to make sure that the participants with or without ACS. Total white blood cells (WBCs) count, NLR, and MLR values were estimated. Results Total WBCs, neutrophil, and monocyte counts were significantly higher while lymphocyte counts were significantly lower in ACS patients than in the healthy controls (p < 0.001). NLR and MLR were significantly higher in ACS patients...
Assessment of the neutrophil to lymphocyte ratio in young patients with acute coronary syndromes
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2013
It is well known that inflammation plays a key role in both initiation and propagation of acute coronary syndrome (ACS). White blood cell (WBC) and its subtypes are an indicator of inflammation in patients with ACS. We aimed to evaluate the WBC and its subtypes in patients aged <45 year with acute coronary syndromes. We retrospectively analyzed WBC and its subtypes (including neutrophil and lymphocyte) in 84 patients (<45 year) who were admitted to the emergency department for chest pain suggestive of ACS (44 unstable angina pectoris, 40 non-ST-segment elevation myocardial infarction [NSTEMI]), and 40 healthy controls. Hypertension, diabetes mellitus, smoking, and family history were significantly higher in NSTE-ACS patients. Also, LDL levels was significantly higher and HDL levels was significantly lower in NSTE-ACS patients (p=0.041 and p=0.009). The difference in percent of lymphocytes between the groups was significant (p=0.048). N/L ratio was significantly different betwe...
International Journal of Cardiology, 2006
Background: The role of inflammation in the pathogenesis of acute coronary syndrome (ACS) is established. Little is known however, regarding the use of inflammatory markers as predictors of future cardiovascular events in patients presenting to the emergency department (ED) with suspected ACS. Hypothesis: To assess whether biomarkers that predict cardiovascular risk in apparently healthy individuals and coronary artery disease patients are useful predictors of future cardiovascular events in patients presenting to the ED with chest pain suggestive of ACS. Methods: We compared the abilities of serum C-reactive protein (hs-CRP), albumin and leukocyte count to identify subjects with ACS and those who are at high risk of developing events during a 30-day follow-up. Results: 144 patients (mean age 62 T 13 years, 45 female) presenting to the ED < 3 h after the onset of symptoms suggestive of ACS were evaluated. Final hospital diagnoses were non-ischemic chest pain in 43 (30%) and ACS in 101 (70%) patients. Patients with ACS had significantly higher leukocyte count ( p < 0.0001) and hs-CRP levels ( p < 0.02) and lower albumin concentrations, compared to patients with NICP ( p < 0.0001). Lower albumin concentrations ( p = 0.03) and hs-CRP ( p = 0.049) were predictors of recurrent events at 30 days. On multivariate analysis, however, only leukocyte count was a predictor of ACS (OR 20.9; 95% CI: 3.7 -19.5; p = 0.01) and high hs-CRP levels were a predictor of clinical outcome (OR 2.8; 95% CI: 1.5 -5.2; p = 0.001). Conclusions: Leukocyte count is an independent predictor of ACS in patients presenting to the ED with chest pain suggestive of ACS and high hs-CRP levels are an independent predictor of clinical outcome in ACS patients. D
The European Research Journal, 2018
Objectives: Atherosclerosis represents an active inflammation that leukocytes play a major role. Neutrophil-lymphocyte ratio (NLR) has been shown as an indicator of systemic inflammation. Our aim was to evaluate inflammatory markers in obstructive coronary artery disease (CAD) and cardiac syndrome X (CSX) and to evaluate NLR in predicting CAD in patients with typical chest pain and coronary risk factors. Methods: Eighty patients with CSX, 80 patients with obstructive CAD with unstable angina pectoris and a control group of 80 subjects were recruited into the study. Hematologic and biochemical parameters were investigated. Results: High-sensitive C-reactive protein (hs-CRP) was increased in CAD group and CSX group compared to the control group (p < 0.001); however it was comparable between CAD and CSX groups (p = 0.065). Mean NLR was higher in CAD group than CSX group and control group that the lowest value was in the control group. In CAD group, hs-CRP was positively correlated w...
Assessment of differential leukocyte count in patients with acute coronary syndrome
Journal of the Pakistan Medical Association, 2010
Inflammation, dyslipidaemia, hyperglycaemia, hypertension, endothelial lesions, smoking, genetic predisposition and activation of immune system cells play an important role in the pathogenesis of atherosclerosis (AS). 1 Various inflammatory markers are suggestive of coronary artery disease (CAD) and have been proposed for evaluation of cardiovascular risk. These inflammatory markers include C-reactive protein (CRP), tumour necrosing factor-alpha (TNF-α), fibrinogen, homocysteine and white blood cells count (WBCs). 2 White blood cells help to assess the adaptive, maladaptive, acute and chronic inflammatory status while elevated WBC count is associated with high short term and long term mortality, more serious AS, and a lower response to fibrinolytic treatment in patients with acute coronary syndrome (ACS). 3 Recent data has also revealed that some specific subtypes of leukocytes have higher predictive value in assessing the cardiovascular risk. 4 Various studies have shown that neutrophils are involved in adaptive infarct healing, leukocyte-platelet aggregate formation and a cause of reperfusion injury in acute coronary syndromes. On the other hand monocytes and lymphocytes are considered to be prevalent and pathogenic in unstable coronary artery plaques. 1 This study was designed to evaluate the predictive value of WBC and its elements in patients of ACS in local Pakistani population where lack of resources keep the access of so many to the best available diagnostic methods. WBC elements may become an additional parameter for the preliminary approach of patients with ACS. This study was approved by institutional review board and ethics committee on human research. Patients and Methods Sixty nine healthy subjects and 133 patients of ACS were included in the study by using convenience sampling technique. All patients were evaluated by taking detailed history and physical examination. The variables included in the study were age, sex, diabetes mellitus (DM), systolic and diastolic hypertension, hyperlipidaemia, smoking, family history of ischaemic heart disease (IHD), cardiac biomarkers (Troponin I, CK-MB), C-reactive protein (CRP), and the total and differential leukocyte counts. The inclusion criteria for the patients of ACS were those of American College of Cardiology and European Society of Cardiology. 5 The criteria for STEMI were as follows: an increase in the levels of myocardial necrosis (troponin I >1 ng/ml); new ST elevation from the J point in two or more contiguous leads
Prognostic implications of neutrophil lymphocyte ratio in acute myocardial infarction
International Journal of Health Sciences (IJHS), 2022
Background: Neutrophil Lymphocyte Ratio (NLR) is a readily available marker that conveys important information about the complex inflammatory activity in the vascular bed during the active phase of the syndrome. Hence it provides relevant information regarding the risk of mortality in patients who are admitted with acute myocardial infarction. Objectives: To estimate the neutrophil lymphocyte ratio in STEMI and NSTEMI of acute myocardial infarction. Materials and Methods: A total of 190 patients with acute myocardial infarction who fulfilled the inclusion criteria were selected. The neutrophil lymphocyte ratio was calculated in STEMI as well as NSTEMI and the value was compared. Patients were then categorized into three groups based on NLR. The relation of neutrophil lymphocyte ratio with the morbidity and mortality of acute myocardial infarction was then studied. Results : The mean age of patients in this study was 59.46± 15.29 years. In this study ,63.1 % were males and 37.9 % were females. The mean NLR value in acute myocardial infarction in this study was 6.175 ± 2.26. The mean NLR value among patients with STEMI is 6.49±2.30 while among patients with NSTEMI is 5.86± 2.17. Though the value is higher in STEMI, the difference was not statistically significant in this study. In this study we also compared the NLR grading with the morbidity and mortality parameters. In this study, statistically significant correlation was found between higher NLR grading and complications like acute decompensated heart failure, arrhythmias, LV dysfunction in admission echocardiography, need for prolonged ICU stay, mechanical ventilation and mortality. 11182 Conclusion: High NLR value has significant association with complications like ADHF, arrhythmias, LV dysfunction in admission echocardiography, need for prolonged ICU stay ,need for mechanical ventilation and in-hospital mortality in acute myocardial infarction irrespective of the type of ACS.