Predictive Value Of ALB,NLR And PLR For Major Adverse Cardiovascular Events In Patients With Acute Coronary Syndrome During Hospitalization

Objective:Acute coronary syndrome(ACS)is a common type of disease in the emergency department,and atherosclerosis is the pathological basis of it.Inflammatory reaction plays a vital role in the occurrence and development of atherosclerosis.In recent years,the research on the influence of nutrition-related indicators on common clinical diseases has become a hot spot.Serum albumin(ALB),as a common clinical nutritional indicator,can bind and transport inflammatory substances and inflammatory mediators,promote inflammatory response and stimulate the activation of immune cells.Although there have been relevant studies on the prognostic value of neutrophil-lymphocyte ratio(NLR)and platelet/lymphocyte ratio(PLR)of novel blood inflammation markers in patients with ACS,there is currently no study that combined ALB,NLR and PLR analysis.Therefore,this paper mainly discusses the clinical application value of ALB,NLR and PLR for major adverse cardiovascular events(MACE)in ACS patients,and analyzes the correlation between these three factors and three different clinical types of ACS,with a view to guiding medical workers to better carry out clinical work.Method:A total of 526 ACS patients admitted to the emergency department of the Affiliated Hospital of Qingdao University from October 2018 to May 2020 were retrospectively analyzed.After admission,all patients had completed routine blood tests,biochemical tests,electrocardiogram and cardiac ultrasound,and all patients had completed coronary angiography during admission.NLR and PLR were calculated according to the clinical data of the patients,and the occurrence of MACE events in all patients during hospitalization was statistically analyzed.First,baseline clinical data,ALB,NLR,and PLR were compared among three ACS subtypes: ST-segment elevation myocardial infarction(STEML),non-ST-segment elevation myocardial infarction(NSTEMI),and unstable angina pectoris(UA).Secondly,the patients were divided into low/high ALB group,low/high NLR group and low/high PLR group according to the ALB,NLR and PLR levels of all patients at admission,and the differences in baseline clinical data and in-hospital MACE incidence between the two groups were compared.Finally,the patients were divided into two groups according to whether MACE occurred during hospitalization,and the baseline clinical data,ALB,NLR and PLR of the two groups were compared.Regression analysis and receiver operating characteristic(ROC)curve were used to analyze whether ALB,NLR and PLR were predictive factors of MACE during ACS hospitalization and their predictive value.Results:(1)Compared with the NSTEMI group and the UA group,the heart rate,hypersensitive troponin,total bilirubin,ALT,TC,fasting blood glucose were higher in the STEMI group,while the LVEF% was lower,the difference was statistically significant(P<0.05).There was no significant difference in ALB among the three groups(P>0.05),but there were significant differences in NLR and PLR among the three groups(P<0.05),and STEMI>NSTEMI>UA.The incidence of in-hospital MACE was significantly different among the three groups(P<0.05),both are STEMIE>NSTEMI>UA.(2)According to the values of ALB,NLR and PLR,the included patients were divided into low/high ALB group,low/high NLR group and low/high PLR group.Male proportion,hs-TNI,total bilirubin,AST,ALT,muscle stack and HDLC contents in low ALB,high NLR and PLR groups.The neutrophil count and mean platelet volume were significantly higher than those in low NLR and PLR groups(P<0.05);On the contrary,the age and LVEF(%)of low ALB,low NLR and PLR group were significantly higher than those of high NLR and PLR group.There were no statistically significant differences in platelet count and lymphocyte count between the high and low NLR groups,but among different PLR groups,the platelet count in the high PLR group was significantly higher than that in the low PLR group,while the lymphocyte count was the opposite,the difference was statistically significant(P<0.05).Compared with the low NLR and PLR groups,the incidence of in-hospital MACE was higher in the high NLR and PLR groups,and the difference was statistically significant.(P<0.05)(3)Univariate and multivariate Logistic regression analysis of the occurrence of nosocomial MACE:The ALB regression coefficient of patients was-0.036,with a significant 0.05 level(Z=-2.478,P=0.013<0.05),indicating that ALB would have a significant negative influence on MACE in the hospital.And the odds ratio(OR value)was 0.965,meaning that when ALB increased by one unit,the change(decrease)amplitude of hospital MACE was 0.965 times.The regression coefficient of NLR in patients was 0.496,with a significant level of0.05(Z=9.087,P<0.05),indicating that NLR has a significant positive influence on in-hospital MACE.And the odds ratio(OR value)was 1.643,meaning that when NLR increased by one unit,the variation of hospital MACE was 1.643 times.The regression coefficient of PLR in patients was 0.008 and significant at 0.05 level(Z=5.181,P<0.05),indicating that PLR had a significant positive influence on MACE in the hospital.And the odds ratio(OR value)is 1.008,which means that when the PLR increases by one unit,the variation of MACE in the hospital is 1.008 times.(4)We constructed ROC curves for NLR,PLR and ALB to determine their diagnostic value for in-hospital MACE.We concluded that the AUC value corresponding to NLR was 0.828(95%CI: 78.53%-87.13%),indicating that NLR had a relatively high diagnostic value for in-hospital MACE.The AUC value corresponding to PLR was 0.682,indicating that the diagnostic value of PLR for in-hospital MACE was low.The AUC value corresponding to ALB is 0.646,indicating that ALB has a low diagnostic value for hospital MACE.In conclusion,NLR has a high diagnostic value for in-hospital MACE.The AUC value corresponding to NLR was 0.828,indicating that NLR had a relatively high diagnostic value for in-hospital MACE,and the corresponding optimal cutoff value was 0.626(the sensitivity was 0.662,and the specificity was 0.964).The AUC value corresponding to PLR was 0.682,indicating that the diagnostic value of PLR for in-hospital MACE was low.The AUC value corresponding to ALB is 0.646,indicating that ALB has a low diagnostic value for hospital MACE.In conclusion,NLR has a high diagnostic value for in-hospital MACE.Conclusion: 1.Compared with the three different types of ACS,the incidence of NLR,PLR and in-hospital MACE in the STEMI group was significantly higher than that in the other two groups.2.Low ALB was negatively correlated with the incidence of MACE in patients with ACS during hospitalization,while NLR and PLR were positively correlated with the incidence of MACE in patients with ACS during hospitalization.3.NLR has relatively high diagnostic value for in-hospital MACE,while ALB and PLR have relatively low diagnostic value for in-hospital MACE.