Abstract 9278: Neutrophil to Lymphocyte Ratio is associated with All-cause, Cardiovascular and Ischemic Heart Disease Mortality: the National Health and Nutrition Examination Survey

Abstract

Introduction: The neutrophil to lymphocyte (NTL) ratio has emerged as a predictor of mortality following acute coronary syndrome, but the predictive role of NTL ratio on mortality has not yet been studied in epidemiologic study.

Objective: We examined association between NTL ratio and risk of all-cause, cardiovascular (CVD) and ischemic heart disease (IHD) mortality in a nationally representative cohort.

Methods: Participants between ages 30 and 74 enrolled in the National Health and Nutrition Examination Survey (NHANES) III study from 1988 to 1994 had WBC count with differential, and known CVD risk factors (age, sex, race, BMI, diabetes, hypertension, smoking history, total cholesterol, HDL cholesterol, history of CVD, family history of CVD, medication use) measured. All-cause, CVD and IHD mortality through 2006 were obtained via linkage with the National Death Index. Cox proportional hazards model was used to estimate hazards ratio (HR) and 95% confidence interval (CI) for mortality after adjusting for known CVD risk factors and total WBC count.

Results: 10296 participants (mean age 50 ± 13.5 years, 52.8 % females, and 39.3 % ethnic minorities) had complete data. Mean NTL ratio was 2 ± 1. During 140, 958 person-years follow-up (median follow-up: 14.4 years), there were 2188 deaths including 674 CVD deaths and 502 IHD deaths. In multivariate analysis, comparing participants in NTL ratio quartile 4 to quartile 1, the adjusted HR was 1.37 (95% CI, 1.21-1.56) for all-cause mortality, 1.58 (95% CI, 1.25-1.99) for CVD mortality, and 1.75 (95% CI, 1.33-2.3) for IHD mortality. Increasing quartiles of NTL ratio were a strong marker of risk for future all-cause, CVD and IHD mortality (p for trend < 0.001 for each outcome).

Conclusion: In a nationally representative sample of US adults, higher NTL ratio conveyed greater hazard for all-cause, CVD and IHD mortality. NTL ratio may reflect a simple, yet effective marker of cardiovascular risk and merits further study.