Peripheral Blood Neutrophil-to-Lymphocyte Ratio is Associated with Mortality across the Spectrum of Cardiogenic Shock Severity
Presenter
Yishay Szekely, MD, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada
Jacob C Jentzer, MD1, Yishay Szekely, MD2, Barry Burstein, MD3, Yashi Ballal, BSc3, Edy Y Kim, MD PhD4, Sean Van Diepen, MD, MSc5, Meir Tabi, MD1, Brandon Wiley, MD1, Kianoush B Kashani, MD MS6 and Patrick R Lawler, MD MPH2, (1)Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, (2)Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada, (3)Division of Cardiology, Trillium Health Partners, University of Toronto, Toronto, ON, Canada, (4)Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, (5)University of Alberta, Edmonton, AB, Canada, (6)Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
Keywords: Cardiogenic Shock
Background:
Systemic inflammation is associated with worse outcomes in patients with cardiogenic shock (CS). We evaluated the association between the neutrophil-to-lymphocyte ratio (NLR) and mortality across the CS severity spectrum. Methods:
We retrospectively analyzed unique cardiac intensive care unit (CICU) patients between 2007 and 2015. The association between admission NLR and in-hospital mortality was evaluated using logistic regression overall and stratified using the Society of Cardiovascular Interventions and Angiography (SCAI) shock stages. |
Results:
We included 8,280 patients aged 67.3±15.2 years (37.2% females). Moderately or severely elevated NLR (≥7) was present in 45% of patients. NLR increased with worsening SCAI stage and was associated with higher in-hospital mortality in shock stages A to C (all p <0.001). Discrimination for in-hospital mortality increased when NLR was added to the SCAI stages (AUC 0.80 vs. 0.76, p <0.001). After multivariable adjustment, NLR remained associated with higher in-hospital mortality (adjusted odds ratio 1.05 per 3.5 NLR units, 95% CI 1.03-1.08, p <0.001), with an optimal cut-off of ≥7 (in-hospital mortality 13.1% vs. 4.1%, adjusted odds ratio 1.44, 95% CI 1.14-1.81, p = 0.002). Patients in SCAI stage A or B with NLR ≥7 had higher in-hospital mortality than patients in SCAI stage B or C with NLR <7, respectively. Conclusions:
Elevated NLR is associated with higher in-hospital mortality in CICU patients with or at risk for CS. Future studies are needed to prospectively evaluate the utility of this marker to reclassify risk and examine the role of systemic inflammation in CS outcomes. |
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