NLR >4 predicted adverse outcomes in acute myocarditis as well as or better than traditional classifications, especially in patients with preserved LVEF (AUC 0.73).
Does the neutrophil-to-lymphocyte ratio (NLR) accurately predict all-cause mortality or heart transplantation in patients with acute myocarditis compared to traditional classification systems?
An NLR >4 is a robust prognostic marker for mortality or heart transplantation in acute myocarditis, particularly outperforming traditional risk scores in patients with preserved ejection fraction.
Absolute Event Rate: 0% vs 0%
Abstract Background Acute myocarditis (AM) is a heterogeneous clinical condition with variable outcomes. Several classification systems have been devised to identify patients at increased risk of adverse outcomes but are typically only applicable to patients with reduced left ventricular ejection fraction at presentation. Neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential prognostic marker. Purpose This study aimed to compare the predictive accuracy of published AM classification systems, including NLR, for identifying patients with AM at a higher risk of adverse events. Methods Our multicenter cohort study included 1,150 patients with biopsy- or cardiac magnetic resonance (CMR)-proven AM from ten hospitals across six countries. Clinical, laboratory, echocardiographic, and CMR data were collected. The primary outcome was all-cause mortality or heart transplantation. Results Over a median follow-up of 228 weeks, 60 patients (5.2%) reached the primary outcome, with 4.2% mortality and 1.4% undergoing heart transplantation. The use of NLR (AUC 0.72) performed as well as other classification systems such as complicated (AUC 0.72), fulminant (AUC 0.71), and high-risk myocarditis classifications (AUC 0.73). Moreover, among patients with preserved left ventricular ejection fraction (LVEF 50%) at presentation, NLR 4 showed superior prognostic value (AUC 0.73; Fulminant: 0.52 p 0.002; Complicated 0.51 p 0.001; High Risk 0.52 p 0.002). Multivariate analysis confirmed that each classification contributed independently to risk prediction, with odds ratios ranging from 5.41 to 6.35 (all p 0.001), but their lower log-likelihood values suggest a weaker predictive performance than the NLR model. Conclusions While traditional high-risk AM classifications remain valuable, NLR 4 is a robust predictor and performs particularly well in patients with preserved LVEF. These findings suggest that NLR should be considered in clinical risk stratification of AM patients.
Madaudo et al. (Sat,) reported a other. NLR >4 predicted adverse outcomes in acute myocarditis as well as or better than traditional classifications, especially in patients with preserved LVEF (AUC 0.73).