Abstract 15218: Neutrophil to Lymphocyte ratio Predicts All-cause Mortality in Patients with Chronic Heart Failure
Introduction: Chronic heart failure (CHF) patients are characterised by systemic inflammation and there is increasing evidence that this may contribute to the development and progression of heart failure. Neutrophil to Lymphocyte ratio (NLR), a composite inflammatory marker, has been shown as a predictor of adverse outcomes in critically ill patients.
Hypothesis: In this study, we assessed the hypothesis that NLR is associated with poor prognosis in CHF patients.
Methods: Patients with medical conditions known to affect the total and differential WBC counts were excluded from the analyses. After exclusion, a total of 1679 patients with CHF (mean age 75±10, 45% females, 95% IHD; 56% in NYHA III/IV) were evaluated prospectively from the BIOSTAT-CHF Scotland cohort. NLR was used as a categorical variable (above and below the median). A Cox proportional Hazard model was used to investigate the effect of NLR on all-cause mortality, adjusting for age, sex, BMI, eGFR, SBP, LDL and haemoglobin.
Results: During a median follow-up period of 2.1 years, there were 21% all-cause deaths. The median NLR in the study population was 3.25 (IQR=2.3-4.8). Mortality rate was significantly higher in those with NLR above the median (14%vs 29% P <0.0001) as compared to those with NLR below the median. A cox proportional hazard model, adjusted for above covariates, showed that NLR was independently and significantly associated with all-cause mortality (HR=1.95 CI=1.46-2.6, P-value<0.0001). Those with poor functional class on NYHA had a higher median NLR (NYHA II, 3.0, NYHA III, 3.3, NYHA IV, 3.7, p=0.0004). However, a subgroup analysis showed that the association between NLR and all-cause mortality was higher in NYHA functional class II (HR=2.74 CL=1.4-5.0, P-value= 0.001) as compared to NYHA functional class III (HR=1.65 CL=1.1-2.4, P-value= 0.01) and NYHA functional class IV (HR=1.3 CL=0.6-1.2, P-value= 0.1).
Conclusions: In conclusion, NLR is an independent predictor of all-cause mortality in CHF patients. NLR is a simple and inexpensive inflammatory marker that could potentially help to risk stratify patients.
Author Disclosures: M. Mohan: None. H. Deshmukh: None. F. Baig: None. S. Hawkey: None. L. Rutherford: None. A. Struthers: None. A. Maria: None. C. Lang: None.
- © 2014 by American Heart Association, Inc.