Do Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Predict In-Hospital and Long-Term Mortality in Endocarditis Patients?: A Systematic Review and Meta-Analysis
Amro Assayed, Saif Aburumman, Abdul Haleem Altahhan, Amez Radha Faraj Salih, Kiven W. Ramos-Vega, Hanan Gruhonjic, Ashot Minasyan, Daniel Fabian, Charles Ledonio, Rakesh Prashad
Abstract:
Infective endocarditis (IE) remains a severe condition associated with significant in-hospital and long-term mortality despite advances in antimicrobial therapy and surgical management, highlighting the need for simple and reliable prognostic markers. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), derived from routine complete blood counts, have emerged as accessible inflammatory indices with potential prognostic value in cardiovascular and infectious diseases. We conducted a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to evaluate the ability of admission NLR and PLR to predict mortality in adult patients with IE. A comprehensive search of PubMed, MEDLINE, the Cochrane Library, CINAHL, and Web of Science through May 2024 identified 7 eligible observational studies comprising 847 patients. Random-effects meta-analysis using restricted maximum likelihood estimation with Hartung–Knapp adjustment demonstrated that NLR levels were consistently higher among nonsurvivors than survivors, yielding a pooled standardized mean difference of 1.25 (95% CI −0.13 to 2.63), although statistical significance was not achieved and substantial heterogeneity was observed (I
2
= 94.5%). Diagnostic accuracy analysis demonstrated good prognostic performance of NLR for in-hospital mortality, with a pooled area under the curve of 0.85 (95% CI 0.57–1.00;