What is the clinical evidence from this study?

Study design: Observational. Population: Coronary artery disease (n=1107). Intervention: Lymphocyte-to-C-reactive protein ratio (LCR) vs. Control group (without CAD). Primary outcome: Presence of coronary artery disease (OR 0.635, 95% CI 0.477-0.845, p=0.002).

December 12, 2023Open Access

Relationship between the lymphocyte to C‑reactive protein ratio and coronary artery disease severity

Key Result

The lymphocyte-to-C-reactive protein ratio (LCR) was identified as an independent protective factor against the development of coronary artery disease (OR 0.635).

Study Design

Type

Observational (n=1,107)

Multicenter

Structured PICO

Is the lymphocyte-to-C-reactive protein ratio (LCR) associated with the development and severity of coronary artery disease?

Population

1,107 patients (479 control, 628 CAD) hospitalized due to typical symptoms of chest tightness and chest pain, with suspected CAD who underwent coronary angiography. Median age 64, 736 males, 371 females. Single-center in China. Excluded previous MI, PCI, CABG, acute cerebral infarction within 6 months, other heart diseases, tumors, or infectious diseases.

Intervention

Lymphocyte-to-C-reactive protein ratio (LCR) measured from venous blood before coronary angiography

Outcome

Presence of coronary artery disease (CAD) and severity of CAD assessed by Gensini scoresurrogate

A higher lymphocyte-to-C-reactive protein ratio (LCR) is independently associated with a lower risk of developing coronary artery disease and less severe coronary stenosis.

Main Result

Effect estimate: OR 0.635 (95% CI 0.477-0.845)

p-value: p=0.002

Limitations

Only patients initially diagnosed with CAD were included, while those previously diagnosed with CAD were excluded.
Only a single blood sample was collected from patients after admission, and the LCR was not regularly assessed, leaving its long-term predictive effect unclear.
Did not further explore the predictive efficacy of LCR compared with traditional inflammatory biomarkers NLR and PLR.
Single-center study with a small sample size.

Abstract

Coronary atherosclerosis is a chronic systemic inflammatory disease. Laboratory parameters such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune inflammation index (SII) have been used to assess inflammation degree and coronary artery disease (CAD) severity. The lymphocyte-to-C-reactive protein ratio (LCR) is a new SII. However, its relationship with CAD development and severity is unclear. A total of 1,107 patients (479 in control group, 628 in CAD group) underwent coronary angiography. The routine and biochemical indices of the venous blood of patients were assessed before coronary angiography. LCR, SII, NLR and PLR were calculated and statistical analyses were performed. Propensity score matching (PSM) and a logistic regression model were used to analyze the relationship between LCR and CAD. After the PSM, 384 pairs of patients with or without CAD were successfully matched. After the median binary classification of all indicators, uni- and multivariate logistic regression analyses showed that platelet count was an independent risk factor and LCR was an independent protective factor. Using the same method, in the coronary heart disease severity group, 212 pairs were successfully matched and NLR and PLR were independent risk factors, while LCR was an independent protective factor. In conclusion, LCR is an independent protective factor against CAD development and severity.

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