Neutrophil-to-Lymphocyte Ratio for the Assessment of Long-term Mortality in Patients with Heart Failure

Background: The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory parameter, which has a predictor value in different cardiovascular disorders.The objective of this study is to evaluate the predictive value of the NLR for long-term mortality (5-year) in patients with heart failure. Materials and Methods:We retrospectively investigated the association between NLR and mortality in 785 patients who presented with CHF between 2006 and 2010.Of these, 201 patients were excluded because of factors that could impact the NLR level.Five hundred eighty four patients were categorized by the respect of low (NLR <1.5), intermediate (1.5≤ NLR <3), and high (NLR ≥3) tertiles of NLR and were followed for 5 years.Cox-proportional regression analysis was used to establish the relationship between NLR levels and all-cause long-term mortality.Results: The mean NLR was 2.82±2.54.The lowest long-term mortality was determined in patients with NLR level of <1.5.In a multivariable Cox-proportional regression analysis, the mortality risk was higher for patients with NLR of ≥1.5 [hazard ratio (HR), 1.98, 95% confidence interval (CI) 0.98-3.42and HR, 4.22, 95% CI 2.66-5.86,for patients with 1.5≤ NLR <3 and NLR ≥3, respectively].Additionally, NLR showed a significant correlation with B-type natriuretic peptide (BNP).The Spearman correlation coefficient identified the significant threshold effect (coefficient =0.34, p<0.001). Conclusion:We detected a significant association between the NLR and long-term mortality.Additionall, NLR showed a significant correlation with BNP.Therefore, NLR may become a simple and cheap biomarker in the state of unavailability of BNP.