Neutrophil-to-Lymphocyte Ratio as a Predictor of Cardiovascular Events in Psoriatic Disease: A Retrospective Cohort Study.

OBJECTIVE: The aim of this study was to evaluate the neutrophil-to-lymphocyte ratio (NLR) as an independent predictor of major adverse cardiovascular events (MACEs) and all-cause mortality in patients with psoriasis (PsO) or psoriatic arthritis (PsA). METHODS: We conducted a retrospective cohort study of 967 patients (825 with PsO and 142 with PsA) at a large university hospital in Buenos Aires, Argentina. The NLR was calculated at study entry and after 6 to 12 months of treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) or biologic/targeted synthetic DMARDs for those patients receiving treatment. The primary outcomes were incident MACEs (nonfatal stroke, nonfatal myocardial infarction, or cardiovascular death) and all-cause mortality. Secondary outcomes included treatment effects on NLR and correlation with disease activity. RESULTS: During a mean follow-up period of 14 years, 67 MACEs and 97 deaths occurred. Baseline NLR >2.5 was associated with an increased risk of MACEs (hazard ratio 1.67, 95% confidence interval 1.00-2.77, P = 0.048) after adjusting for a validated composite cardiovascular risk score, sex, and systemic treatment. The all-cause mortality risk was higher among patients with an elevated NLR; however, the significance was lost after adjustment. Biologic therapy reduced the proportion of patients with an elevated NLR from 30.1% to 15.7% after 6 to 12 months of treatment. CONCLUSION: Baseline NLR is a simple and universally available biomarker associated with increased cardiovascular risk in psoriatic disease, providing incremental value beyond established cardiovascular risk scores.