Key result
Admission neutrophil-lymphocyte ratio >7.3 was associated with higher 30-day all-cause mortality compared to NLR ≤7.3 (73.7% vs 26.3%; HR 2.806; 95% CI 1.784-4.415; P<0.001).
Why the study?
Cardiogenic shock is the most severe complication after AMI with mortality above 50%, and inflammatory responses are involved in its pathology, prompting evaluation of the prognostic value of admission neutrophil-lymphocyte ratio.
Does admission NLR > 7.3 predict 30-day all-cause mortality and MACE in patients with cardiogenic shock complicating acute myocardial infarction?
Cohort (n=217)
Does admission NLR > 7.3 predict 30-day all-cause mortality and MACE in patients with cardiogenic shock complicating acute myocardial infarction?
Hazard Ratio: 2.806 (95% CI 1.784–4.415)
Absolute Event Rate: 73.7% vs 26.3%
p-value: p=<.001
Admission NLR > 7.3 is an independent predictor of increased 30-day all-cause mortality and MACE in patients with cardiogenic shock complicating acute myocardial infarction.
NLR >7.3 may aid risk stratification in AMI cardiogenic shock; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUNDS: Cardiogenic shock (CS) is the most severe complication after acute myocardial infarction (AMI) with mortality above 50%. Inflammatory response is involved in the pathology of CS and AMI. In this study, we aimed to evaluate the prognostic value of admission neutrophil-lymphocyte ratio (NLR) in patients with CS complicating AMI. METHODS: Two hundred and seventeen consecutive patients with CS after AMI were divided into two groups according to the admission NLR cut-off value ≤7.3 and >7.3. The primary outcome was 30-day all-cause mortality and the secondary end-point was the composite events of major adverse cardiovascular events (MACE), including all-cause mortality, ventricular tachycardia/ventricular fibrillation, atrioventricular block, gastrointestinal haemorrhage and non-fatal stroke. Cox proportional hazard models were performed to analyse the association of NLR with the outcome. NLR cut-off value was determined by Youden index. RESULTS: Patients with NLR > 7.3 were older and presented with lower lymphocyte count, higher admission heart rate, B-type natriuretic peptide, leucocyte, neutrophil and creatinine (all P < .05). During a period of 30-day follow-up after admission, mortality in patients with NLR > 7.3 was significantly higher than in patients with NLR ≤ 7.3 (73.7% vs. 26.3%, P < .001). The incidence of MACE was also remarkably higher in patients with NLR > 7.3 (87.9% vs. 53.4%, P < .001). After multivariable adjustment, NLR > 7.3 remained an independent predictor for higher risk of 30-day mortality (HR 2.806; 95%CI 1.784, 4.415, P < .001) and MACE (HR 2.545; 95%CI 1.791, 3.617, P < .001). CONCLUSIONS: Admission NLR could be used as an important tool for short-term prognostic evaluation in patients with CS complicating AMI and higher NLR is an independent predictor for increased 30-day all-cause mortality and MACE.
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Sasmita et al. (2021) conducted a cohort in Cardiogenic shock complicating acute myocardial infarction (n=217). Admission neutrophil-lymphocyte ratio (NLR) > 7.3 vs. Admission NLR ≤ 7.3 was evaluated on 30-day all-cause mortality (HR 2.806, 95% CI 1.784, 4.415, p=<.001). Admission neutrophil-lymphocyte ratio >7.3 was associated with higher 30-day all-cause mortality compared to NLR ≤7.3 (73.7% vs 26.3%; HR 2.806; 95% CI 1.784-4.415; P<0.001).
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