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Background: Inflammatory cytokines such as interleukin-6 (IL-6) have been implicated in chronic heart failure (CHF) progression & development, mediating adverse cardiac remodeling. Neutrophils and lymphocytes are cellular components of systemic inflammation that are regulated by cytokines especially IL-6. We investigated the prognostic significance of a composite inflammation-based biomarker derived from Neutrophils and lymphocytes called the Neutrophil to Lymphocyte ratio (NLR) in predicting outcome in CHF patients.
Methods: 1660 patients with CHF (age 73±11, 33.6% females, 93.8% IHD; 58.3% in NYHA III/IV) were evaluated prospectively from the BIOSTAT-CHF Scotland cohort. Routine laboratory measurements, including full blood count, were performed at baseline from which NLR was determined. The cut-off value of NLR was chosen at 3.00 to maximise model fit, backed up by receiver operating characteristic curve analysis. Cox regression models were used to assess all-cause mortality rates, adjusting for significant covariates.
Results: During a median follow-up period of 3.04 yrs (IQR 1.71,4.06), there were 43% all-cause deaths. Mortality rates (95%CL) were significantly higher (73% vs 27%; p<0.001) in patients with NLR above 3 as compared to those with NLR below 3. Cox regression model, adjusted for significant covariates, showed that NLR ≥ 3, was independently and significantly associated with all-cause mortality (HR=2.076 CI(1.716,2.510) p<0.001). Those with poor NYHA functional classification had a higher median NLR (NYHA II, 2.89; NYHA III, 3.50; NYHA IV, 4.35, p<0.001). Subgroup analyses showed that the association between NLR and ejection fraction was similar in both heart failure with reduced ejection fraction (HFrEF, HR=2.22, CI(1.62,3.04) p<0.001) and preserved ejection fraction(HFpEF HR=2.055 CI(1.33,3.18) p<0.001).
Conclusions: NLR is an independent predictor of all-cause mortality in CHF patients. NLR is a simple and inexpensive inflammatory marker that could potentially help to risk stratify patients.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Making Progress in Understanding Heart Failure
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1123-280
- 2017 American College of Cardiology Foundation