Key result
Higher admission ANC linked to ~74% greater risk of adverse in-hospital myocarditis outcomes per SD.
Why the study?
It was unknown whether admission absolute neutrophil count, lymphocyte count, and neutrophil-to-lymphocyte ratio are associated with adverse in-hospital outcomes in clinically diagnosed myocarditis.
Are admission absolute neutrophil count and neutrophil-to-lymphocyte ratio associated with adverse in-hospital outcomes in patients with clinically diagnosed myocarditis?
Cohort (n=941)
Yes
Are admission absolute neutrophil count and neutrophil-to-lymphocyte ratio associated with adverse in-hospital outcomes in patients with clinically diagnosed myocarditis?
Answers are grounded in this paper and cite their sources.
Admission ANC and NLR are independently associated with adverse in-hospital outcomes in myocarditis, offering a simple tool for early risk stratification.
Purpose To evaluate whether admission absolute neutrophil count (ANC), lymphocyte count, and the neutrophil-to-lymphocyte ratio (NLR) are associated with adverse in-hospital outcomes in clinically diagnosed myocarditis. Methods We analyzed a merged nationwide myocarditis dataset (N=941). The primary composite outcome comprised in-hospital death, extracorporeal membrane oxygenation (ECMO), other mechanical circulatory support (IABP/Impella/VAD/LVAD), or heart transplantation, identified from date/time fields and device indicators. ANC was taken from the initial CBC. Absolute lymphocyte count was derived as WBC×(lymphocyte%)×1000; NLR=ANC/lymphocytes. Logistic regression estimated odds ratios (ORs) per 1 SD increase. Discrimination was evaluated by ROC AUC. Youden’s J provided optimal thresholds. Results Of 941 patients, 291 (30.9%) reached the composite endpoint. In univariable models, ANC and NLR were associated with higher risk (ANC OR 1.68, 95%CI 1.45-1.95, p=1.29×10⁻¹¹; NLR OR 1.58, 1.30-1.92, p=4.58×10⁻⁶), whereas lymphocyte count showed no linear association (OR 0.94, 0.81-1.09, p=0.394). After adjustment for available covariates (age, sex), associations remained for ANC and NLR (ANC OR 1.74, 1.50-2.03, p=1.09×10⁻¹²; NLR OR 1.53, 1.25-1.88, p=3.38×10⁻⁵); lymphocytes remained non-significant (OR 1.00, 0.86-1.16, p=0.974). Discrimination was modest: AUC 0.639 for ANC, 0.650 for NLR, and 0.408 for lymphocytes. Event rates rose stepwise across quartiles (p-trend <10⁻⁹ for ANC and NLR), with ≈49% events in the highest quartiles vs ≈20-24% in the lowest. Youden-optimal thresholds were NLR 5.25 (Se 0.573, Sp 0.687) and ANC 9,400/µL (Se 0.436, Sp 0.793); lymphocytes had poor threshold performance (4,480/µL; Se 0.062, Sp 0.966). Conclusion In this national myocarditis cohort, admission ANC and NLR were independently associated with adverse in-hospital outcomes, whereas lymphocyte count alone was not. These readily obtainable inflammatory indices may support early risk stratification; prospective validation and integration with clinical/imaging variables are warranted.
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Kim et al. (2026) conducted a cohort in Myocarditis (n=941). Admission absolute neutrophil count (ANC) and neutrophil-to-lymphocyte ratio (NLR) vs. Lower counts/ratios was evaluated on Composite of in-hospital death, ECMO, other mechanical circulatory support, or heart transplantation (OR 1.74, 95% CI 1.50-2.03, p=1.09×10⁻¹²). Higher admission absolute neutrophil count was independently associated with adverse in-hospital outcomes in myocarditis (adjusted OR per 1 SD increase 1.74; 95% CI 1.50-2.03; p=1.09×10⁻¹²).
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