Neeraj Shah1, Valay Parikh2, Nileshkumar Patel3, Nilay Patel4, Apurva Badheka5, Abhishek Deshmukh6, Ankit Rathod7, James Lafferty2. 1. Department of Medicine, Staten Island University Hospital, Staten Island, NY, United States. Electronic address: neerajshah86@gmail.com. 2. Department of Cardiology, Staten Island University Hospital, Staten Island, NY, United States. 3. Department of Medicine, Staten Island University Hospital, Staten Island, NY, United States. 4. Heart & Vascular Institute, Detroit Medical Center, Detroit, MI, United States. 5. Department of Cardiology, Wayne State University School of Medicine, Detroit, MI, United States. 6. Department of Cardiology, University of Arkansas for Medical Science, Little Rock, AR, United States. 7. Department of Cardiology, Cedars Sinai Medical Center, Los Angeles, CA, United States.
Abstract
BACKGROUND: Neutrophil lymphocyte ratio (NLR) has been shown to predict cardiovascular events in several studies. We sought to study if NLR predicts coronary heart disease (CHD) in a healthy US cohort and if it reclassifies the traditional Framingham risk score (FRS) model. METHODS: We performed post hoc analysis of National Health and Nutrition Examination Survey-III (1998-94) including subjects aged 30-79 years free from CHD or CHD equivalent at baseline. Primary endpoint was death from ischemic heart disease. NLR was divided into four categories: <1.5, ≥1.5 to <3.0, 3.0-4.5 and >4.5. Statistical analyses involved multivariate Cox proportional hazards models as well as discrimination, calibration and reclassification. RESULTS: We included 7363 subjects with a mean follow up of 14.1 years. There were 231 (3.1%) CHD deaths, more in those with NLR>4.5 (11%) compared to NLR<1.5 (2.4%), p<0.001. Adjusted hazard ratio of NLR>4.5 was 2.68 (95% CI 1.07-6.72, p=0.035). There was no significant improvement in C-index (0.8709 to 0.8713) or area under curve (0.8520 to 0.8531) with addition of NLR to FRS model. Model with NLR was well calibrated with Hosmer-Lemeshow chi-square of 8.57 (p=0.38). Overall net reclassification index (NRI) was 6.6% (p=0.003) with intermediate NRI of 10.1% (p<0.001) and net upward reclassification of 5.6%. Absolute integrated discrimination index (IDI) was 0.003 (p=0.039) with relative IDI of 4.3%. CONCLUSIONS: NLR can independently predict CHD mortality in an asymptomatic general population cohort. It reclassifies intermediate risk category of FRS, with significant upward reclassification. NLR should be considered as an inflammatory biomarker of CHD.
BACKGROUND: Neutrophil lymphocyte ratio (NLR) has been shown to predict cardiovascular events in several studies. We sought to study if NLR predicts coronary heart disease (CHD) in a healthy US cohort and if it reclassifies the traditional Framingham risk score (FRS) model. METHODS: We performed post hoc analysis of National Health and Nutrition Examination Survey-III (1998-94) including subjects aged 30-79 years free from CHD or CHD equivalent at baseline. Primary endpoint was death from ischemic heart disease. NLR was divided into four categories: <1.5, ≥1.5 to <3.0, 3.0-4.5 and >4.5. Statistical analyses involved multivariate Cox proportional hazards models as well as discrimination, calibration and reclassification. RESULTS: We included 7363 subjects with a mean follow up of 14.1 years. There were 231 (3.1%) CHD deaths, more in those with NLR>4.5 (11%) compared to NLR<1.5 (2.4%), p<0.001. Adjusted hazard ratio of NLR>4.5 was 2.68 (95% CI 1.07-6.72, p=0.035). There was no significant improvement in C-index (0.8709 to 0.8713) or area under curve (0.8520 to 0.8531) with addition of NLR to FRS model. Model with NLR was well calibrated with Hosmer-Lemeshow chi-square of 8.57 (p=0.38). Overall net reclassification index (NRI) was 6.6% (p=0.003) with intermediate NRI of 10.1% (p<0.001) and net upward reclassification of 5.6%. Absolute integrated discrimination index (IDI) was 0.003 (p=0.039) with relative IDI of 4.3%. CONCLUSIONS: NLR can independently predict CHD mortality in an asymptomatic general population cohort. It reclassifies intermediate risk category of FRS, with significant upward reclassification. NLR should be considered as an inflammatory biomarker of CHD.
Authors: Gro Grimnes; Lars D Horvei; Vladimir Tichelaar; Sigrid K Brækkan; John-Bjarne Hansen Journal: Haematologica Date: 2016-06-13 Impact factor: 9.941
Authors: G L Ackland; T E F Abbott; D Cain; M R Edwards; P Sultan; S N Karmali; A J Fowler; J R Whittle; N J MacDonald; A Reyes; L Gallego Paredes; R C M Stephens; A Gutierrez Del Arroyo; S Woldman; R A Archbold; A Wragg; E Kam; T Ahmad; A W Khan; E Niebrzegowska; R M Pearse Journal: Br J Anaesth Date: 2018-10-02 Impact factor: 9.166