Prognostic value of neutrophil to lymphocyte ratio on acute coronary syndromes
E Alexandrou, V Patsiou, D Moysidis, A Samaras, G GiannakoulasAbstract
Background
Inflammation contributes to plaque destabilization and adverse outcomes in acute coronary syndromes (ACS). The neutrophil-to-lymphocyte ratio (NLR) is a low-cost marker available at presentation, but its independent prognostic value in contemporary, comorbidity-adjusted cohorts is not fully established.
Purpose
To determine whether admission NLR independently predicts post-discharge all-cause mortality, major in-hospital adverse events, and hospital length of stay (LOS).
Methods
We retrospectively analyzed adult patients from a large multicenter cardiovascular registry, hospitalized with ACS. NLR was derived from admission complete blood counts. Multivariable logistic regression tested associations between NLR and a major in-hospital composite (intubation, inotrope use, temporary pacemaker/defibrillator implantation, or cardiopulmonary resuscitation [CPR]) and each component. LOS was modeled as ln(LOS+1) using multivariable linear regression. Post-discharge all-cause mortality was evaluated with adjusted Cox models. Kaplan–Meier curves compared low, intermediate, and high NLR categories. Prespecified subgroup analyses were performed by sex, age (<75 vs ≥75 years), and ACS type (STEMI vs NSTEACS).
Results
Among 5,628 patients (median age 67 years; 23.8% women), higher NLR independently predicted longer LOS (β=0.180 for ln(LOS+1), p<0.001), higher post-discharge mortality (adjusted HR 1.030 per 1-unit increase, p<0.001), and higher odds of the in-hospital composite (adjusted OR 1.076 per 1-unit increase, p<0.001). Higher NLR was also associated with intubation (aOR 1.080), temporary pacing/defibrillation (aOR 1.061), inotrope support (aOR 1.057), and CPR (aOR 1.088) (all p<0.001). Survival declined stepwise across NLR categories (log-rank p<0.001 overall and within subgroups). Associations with in-hospital events were stronger in men, patients <75 years, and STEMI.
Conclusion
Admission NLR provides an independent risk factor for in-hospital clinical deterioration, prolonged hospitalization, and post-discharge mortality in ACS, supporting its use for early risk stratification in practice.nlr esc hr and ornlr esc km