Key result
Elevated neutrophil-to-lymphocyte ratio linked to higher risk of death or transplant in pediatric DCM.
Why the study?
The prognostic value of neutrophil-to-lymphocyte ratio and platelet–lymphocyte ratio in children and adolescents with dilated cardiomyopathy and their correlation with BNP and clinical outcomes was unclear.
Observational (n=57)
No
Effect estimate: AUC 72.9% (95% CI 0.540-0.873)
p-value: p=0.016
Should not yet change risk stratification in pediatric dilated cardiomyopathy; hypothesis-generating and requires prospective validation.
Objective: The objective of this study is to evaluate the neutrophil-to-lymphocyte ratio (NLR) and platelet–lymphocyte ratio, from the hemograms obtained from children and adolescents with dilated cardiomyopathy (DCM), and to correlate them with the levels of B-type natriuretic peptide (BNP) and with the clinical evolution of these patients in the long term. Materials and Methods: Follow-up of 57 patients with DCM was made retrospectively, with hemogram and BNP level determination being performed after optimized therapy for heart failure. We compared the findings of the patients' examinations that progressed with stability in relation to the occurrence of transplant listing, cardiac transplantation, or evolution to death. Results: The average age was 48 months, and the follow-up was 64 months. The average of the levels of neutrophils was greater in poor evolution group (7026 vs. 3903; P = 0.011) as well as the average of NLR (5.5 vs. 1.9; P = 0.034). The averages of hemoglobin, total leukocytes, lymphocytes, and platelets were similar in the groups. The area under the receiver operating characteristic curve for NLR in relation to the poor evolution was of 72.9%, being the best cutoff point of NLR ≥5.2 (sensitivity: 93.8% and specificity: 87.8%). Kaplan–Meier curves demonstrate that patients with NLR ≤5.2 (P = 0.001) and BNP <1000 pg/dl (P < 0.0001) presented greater survival. Conclusions: NLR (≥5.2) and lymphopenia (≤1000 lymphocyte/μL) were associated with a poor prognosis and a higher chance of evolution to death or cardiac transplant, similar to the findings for BNP.
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Araújo et al. (2019) conducted an observational in Dilated cardiomyopathy and chronic heart failure (n=57). Elevated neutrophil-to-lymphocyte ratio (NLR ≥5.2) vs. NLR <5.2 was evaluated on Poor clinical evolution (death or cardiac transplant) (AUC 72.9%, 95% CI 0.540-0.873, p=0.016). An elevated neutrophil-to-lymphocyte ratio (≥5.2) was significantly associated with a poor prognosis and a higher likelihood of death or cardiac transplant in children and adolescents with dilated cardiomyopathy.
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