Abstract 19756: Neutrophil to Lymphocyte Ratio Decreases After Ventricular Assist Device Implantation in Advanced Systolic Heart Failure but Remains Predictive of Mortality
Background: Systolic heart failure (HF) is a low-grade systemic inflammatory state. Neutrophil to lymphocyte ratio (NLR) is a non-specific inflammatory marker in HF and known to be high pre-ventricular assist device (VAD) implantation. We sought to determine if NLR normalizes post-VAD implantation and its impact on survival.
Methods: We retrospectively reviewed patients who received an LVAD or BiVAD at our institution 1/1/2008–7/1/2015. We recorded pre-VAD blood results and other key variables. NLR was recorded pre-VAD and at 14, 30, 60, 90, 120, 150, 180 and 365 days on VAD support. The mean and median NLRs were graphed; pre-VAD vs 90-day NLR was compared by Wilcoxon matched-paired signed rank test. Cox proportional hazards models were constructed to study the impact of NLR pre-VAD and 90 days post-VAD on mortality during VAD support (covariates selected from univariate screen of high/low NLR).
Results: The median WBC pre-VAD was 8.9 (IQR 6.9-11.3) 109/L and NLR 4.8 (3.0-8.0), n=194. Post-VAD implantation the NLR rose initially and then decreased towards a lower median plateau at 4.1 (Fig 1; pre-VAD vs day 90 p=0.018). Pre-VAD NLR was associated with mortality on VAD support (unadjusted hazard ratio, HR, 1.031, 95% CI 1.008-1.055 per 1 unit NLR, p=0.008, n=190; adjusted HR 1.043, 95% CI 1.014-1.073, p=0.004, adjusted for age, BMI, WBC, hemoglobin, sodium, BUN). Patients with lower pre-VAD NLR reached their median plateau sooner (by 60 d) than those with higher baseline NLR (by 90 d). Despite the decrease, 90-day post-VAD NLR remained significantly associated with mortality (unadjusted, HR, 1.102, 95% CI 1.039-1.168, p=0.001, n=141; adjusted HR 1.102, 95% CI 1.027-1.182, p=0.007, covariates include 90 d WBC).
Conclusion: NLR improves on VAD support, but a higher NLR at day 90 remains an independent predictor of mortality. This underscores the extent of ongoing systemic inflammatory activity during VAD support and presents a potential target for future novel interventions.
Author Disclosures: S.K. Sundararajan: None. M.S. Kiernan: Other Research Support; Significant; Thoratec. Speakers Bureau; Modest; Heartware. D. DeNofrio: Consultant/Advisory Board; Modest; Thoratec, Heartware. A.R. Vest: Consultant/Advisory Board; Modest; Sunshine Heart, Inc..
- © 2016 by American Heart Association, Inc.