The Predictive Value Of NLR And PLR For Adverse Cardiovascular Events In Patients With ACS

ObjectiveThe purpose of this study was to investigate the clinical value of the inflammation new markers in ACS,neutrophil/lymphocyte ratio(NLR)and platelet/lymphocyte ratio(PLR),including the correlation between NLR or PLR and different subtypes of ACS,Gensini score,as well as the prognostic value in ACS.MethodA total of 360 ACS patients admitted to the Department of Cardiology of our hospital from September 2018 to August 2019 were selected for retrospective analysis.Before the second day after admission,all patients completed the related blood routine and biochemical examination,and completed the coronary angiography during admission.NLR,PLR and Gensini scores were calculated according to the clinical data of the patients,and whether mace events occurred in all patients during hospitalization was counted.First,the differences of baseline clinical data,NLR,PLR and Gensini scores among three subtypes of ACS(STEMI,NSTEMI and UA)were compared.Secondly,all patients were divided into low/high NLR group and low/high PLR group according to the level of NLR and PLR at the time of admission.The differences of baseline clinical data,Gensini score and incidence of mace between the two groups were compared.At last,we divided the patients into two groups according to whether MACE occurred during hospitalization,and compared the baseline clinical data,NLR,PLR and Gensini scores of the two groups.Regression analysis and ROC curve were used to analyze whether NLR and PLR were predictors of in-hospital MACE in ACS.In addition,in order to further verify the previous research conclusions,we will also explore the application of NLR and PLR in the prognosis of ACS by Meta-analysis.The method of Meta-analysis is to search the Chinese and English articles about the relationship between NLR or PLR and ACS and their subtypes published in PubMed,Cochrane Library,CNKI,China biomedical literature database,VIP database and Wanfang database from the establishment of the database to July 2019.The key words include “ acute coronary syndrome” 、 “ neutrophil/lymphocyte ratio ” 、 “ platelet/lymphocyte ratio”.After literature selection,quality evaluation and data extraction,Revman 5.3 and Stata 14.0 software was used for comprehensive analysis.Results(1)Compared with NSTEMI and UA group,the heart rate,high-sensitivity troponin,total bilirubin,ALT,TC and fasting blood glucose of STEMI group were higher,while LVEF% was lower.The difference was statistically significant(P < 0.05).NLR,PLR,Gensini score and MACE incidence were significantly different among the three groups(P < 0.05),and they order were STEMI > NSTEMI > UA.According to the median NLR(NLR = 2.04)and the median PLR(PLR = 105.76),patients included in ACS were divided into low/high NLR group and low/high PLR group.Compared with the low NLR group,the high NLR group had higher sensitivity troponin,total bilirubin,ALT,AST,creatinine,and lower LVEF%.Compared with the low PLR group,the high PLR group had higher levels of high-sensitivity troponin,ALT,AST,creatinine,and lower LVEF%.There were significant differences in Gensini score and MACAE incidence between low/high NLR or PLR group,and they order were high value group > low value group.The difference was statistically significant(P < 0.05).(2)The relationship between NLR,PLR and Gensini score was analyzed.The results showed that Gensini score had a positive correlation with NLR and PLR.Pearson correlation analysis was used to analyze the correlation between NLR,PLR and Gensini score.The results showed that NLR was positively correlated with Gensini score(r=0.138,P=0.009),and PLR was positively correlated with Gensini score(r=0.135,P=0.01).(3)The result of single-and multi-factors Logistic regression analysis: advanced single factor analysis showed that the scores of highly sensitive troponins,glucose,LVEF%,NLR,PLR and Gensini score were independently related to the occurrence of mace in hospital(P<0.05).The results of multivariate Logistic regression analysis indicated that NLR(P<0.001)and PLR(P=0.015)were independent predictors of in-hospital MACE.(4)The prediction value of NLR,PLR and Gensini scores to in-hospital MACE was analyzed by ROC curve.Area under curve(AUC)was 0.750 and 0.655(> 0.5).The results of Medcalc analysis showed that when NLR=3.4,the predictive value of in-hospital MACE was the highest,with sensitivity of 55.56% and specificity of 85.42%;when PLR=131.3,the predictive value of in-hospital MACE was the highest,with sensitivity of 50% and specificity of 83.33%.(5)The Meta-analysis of the prognostic relationship between NLR and ACS showed that patients with high NLR had a significantly higher risk of death events [risk ratio(RR)=3.35,P < 0.01] and MACE(RR=2.26,P < 0.01)than those with low NLR patients;after long-term follow-up,patients with high NLR had a significantly higher risk of death events(RR = 3.06,P < 0.01)and MACE(RR = 2.71,P < 0.01)than those with low NLR patients.The Meta-analysis of the prognostic relationship between PLR and ACS showed that patients with high PLR had a significantly higher risk of death events(RR =2.26,P<0.01)and MACE(RR=2.33,P<0.01)than those with low PLR patients;after long-term follow-up,patients with high PLR had a significantly higher risk of death events(RR=2.14,P<0.01)and MACE(RR=1.68,P<0.01)than those with low PLR patients.ConclusionNLR and PLR were positively correlated with Gensini score,and were independent predictors of in-hospital MACE in ACS.NLR and PLR have a certain clinical value in the classification of severity and prognosis of ACS.