Author + information
- Neeraj Shah,
- Nileshkumar Patel,
- Ankit Rathod,
- Apurva Badheka,
- Abhishek Deshmukh,
- Deepak Asti,
- Valay Parikh and
- James Lafferty
Role of neutrophil lymphocyte ratio (NLR) in predicting cardiovascular events has not been studied in general population.
To see if NLR adds to Framingham risk score (FRS) for prediction of coronary heart disease (CHD) mortality in a nationally representative cohort.
We included 6,413 subjects of NHANES-III cohort, aged 30-79 years, without prior history of CHD or CHD equivalent, with mean follow-up of 14.1 years. We excluded subjects with malignancies, chronic inflammatory & autoimmune disorders. Cox proportional hazards model was used to predict CHD mortality. Two models were created incorporating FRS covariates with & without NLR, & were compared using discrimination, calibration & net reclassification index (NRI).
NLR was an independent predictor of CHD mortality with adjusted hazards ratio 1.3, 95% confidence interval (CI) 1.1-1.5, p<0.01. With addition of NLR to FRS model, overall NRI was 6.9% (95% CI 1.9% to 11.8%, p<0.01), event NRI was 5.7% (p=0.02) & non-event NRI was 1% (p<0.01). Absolute integrated discrimination index (IDI) was 0.004 (p=0.04) & relative IDI was 4.9%. Model with NLR showed improved C-index (0.8731 vs. 0.8717) & area under curve (0.8575 vs. 0.8560), albeit statistically non-significant (p>0.05). Hosmer-Lemeshow chi-square was 8.38 (<20) & likelihood ratio test was significant (p<0.01) in model with NLR, consistent with better calibration.
Addition of NLR to FRS significantly improves prediction of mortality from CHD.
|Model with FRS covariates without NLR||Model with FRS covariates plus Neutrophil lymphocyte ratio (NLR)|
|<5%||5–10%||10 – 20%||>=20%||Total||Higher reclassification||Lower reclassification|
|Subjects with CHD events|
|10 – 20%||0||2||49||9||60||9||2|
|NRI for events||0.0573, p=0.022|
|Subjects without CHD events|
|10 – 20%||0||57||307||14||378||14||57|
|NRI for non-events||0.009, p<0.001|
|Overall NRI||0.0686, 95% CI 0.0194 to 0.1178, p=0.006|
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: The Best of Risk Stratification in SIHD
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 1110M-74
- 2013 American College of Cardiology Foundation