Neutrophil-to-lymphocyte ratio as a prognostic factor in patients with acute pulmonary embolism on the background of oncological disease

The purpose of the study Тo determine the clinical and prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients with acute pulmonary embolism (PE) on the background of cancer. Materials and methods A retrospective analysis of 291 medical histories of patients with acute PE, was conducted. Among them were 92 patients with a verified oncological disease. The diagnosis of PE was confirmed in all patients by computed tomography and/or autopsy results. All patients underwent laboratory and ultrasound examination. Patients were assessed for PE risk factors and risk of early death according to the ESC 2019 guidelines. Оbtained data were statistically processed. Results and discussion A comparative assessment of clinical, instrumental and laboratory data of patients with PE was carried out depending on the presence or absence of oncological disease. Patients with PE were divided into 2 groups: group 1 included 199 patients without cancer, group 2 - 92 patients with oncology. It was reliably determined that patients in whom PE developed on the background of oncological process were older ( 64± years, without oncology 60.4± years), with greater proportion of elderly patients, they had more episodes of venous thrombosis in the past (15.08 % and 12.68% respectively), and predictably more often they had such additional risk factors as previous hemotransfusions and use of central venous catheters . No significant difference in the frequency and intensity of other risk factors was found between the groups. In the analysis of the entire group of patients, it was found that an increase in the NLR ratio >3 was observed more often in the following patient groups: elderly (p<0.008), with acute cerebral incidences that were accompanied with paresis and paralysis in the past (p<0.045), bed rest for more than 3 days (p<0.065), diabetes mellitus (p<0.008), obesity (p<0.089) and with a high risk of early death from PE (p<0.0006), PESI class V (p<0.001) and PESI high risk (p<0.0002). An additional factor, associated with an increase in the level of NLR in cancer patients, was kidney disease (p<0.013). Correlation analysis showed a reliable direct relationship between the level of NLR in patients with PE on the background of oncology with bed rest for more than three days, the sizes of the right and left atrium , the end-systolic diameter of the left ventricle , the level of leukocytes, fibrinogen and troponin I, as well as inverse relationship with the level of oxygen saturation and ejection fraction . Conclusions In oncology patients, the increase in NLR is associated with more pronounced decrease in oxygen saturation, increase in the size of heart chambers, level of troponin I, and a higher percentage of patients with a high risk of death in the hospital period