Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
China Academy of Chinese Medical Sciences, Beijing, China.
Cardiovasc Diabetol. 2024 Apr 2;23(1):117. doi: 10.1186/s12933-024-02191-5.
Identifying reliable prognostic markers is crucial for the effective management of hypertension. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential inflammatory marker linked to cardiovascular outcomes. This study aims to investigate the association of NLR with all-cause and cardiovascular mortality among patients with hypertension.
This study analyzed data from 3067 hypertensive adults in the National Health and Nutritional Examination Surveys (NHANES) from 2009 to 2014. Mortality details were obtained from the National Death Index (NDI). Restricted cubic spline (RCS) was deployed to visualize the association of the NLR with mortality risk. Weighted Cox proportional hazards models were employed to assess the independent association of NLR with mortality risk. Time-dependent receiver operating characteristic curve (ROC) analysis was conducted to access the predictive ability of NLR for survival. Mediation analysis was used to explore the indirect impact of NLR on mortality mediated through eGFR.
Over a median 92.0-months follow-up, 538 deaths occurred, including 114 cardiovascular deaths. RCS analysis revealed a positive association between NLR and both all-cause and cardiovascular mortality. Participants were stratified into higher (> 3.5) and lower (≤ 3.5) NLR groups. Weighted Cox proportional hazards models demonstrated that individuals with higher NLR had a significantly increased risk of all-cause (HR 1.96, 95% confidence interval (CI) 1.52-2.52, p < 0.0001) and cardiovascular mortality (HR 2.33, 95% CI 1.54-3.51, p < 0.0001). Stratified and interaction analysis confirmed the stability of the core results. Notably, eGFR partially mediated the association between NLR and both all-cause and cardiovascular mortality by a 5.4% and 4.7% proportion, respectively. Additionally, the areas under the curve (AUC) of the 3-, 5- and 10- year survival was 0.68, 0.65 and 0.64 for all-cause mortality and 0.68, 0.70 and 0.69 for cardiovascular mortality, respectively.
Elevated NLR independently confers an increased risk for both all-cause and cardiovascular mortality in individuals with hypertension.
识别可靠的预后标志物对于高血压的有效管理至关重要。中性粒细胞与淋巴细胞比值（NLR）已成为与心血管结局相关的潜在炎症标志物。本研究旨在探讨 NLR 与高血压患者全因和心血管死亡率的关系。
本研究分析了 2009 年至 2014 年全国健康和营养检查调查（NHANES）中 3067 名高血压成年人的数据。通过国家死亡指数（NDI）获取死亡率细节。采用受限立方样条（RCS）直观显示 NLR 与死亡率风险的关系。采用加权 Cox 比例风险模型评估 NLR 与死亡率风险的独立相关性。进行时间依赖性接受者操作特征曲线（ROC）分析以评估 NLR 对生存的预测能力。采用中介分析探讨 NLR 通过 eGFR 对死亡率的间接影响。
中位随访 92.0 个月期间，共发生 538 例死亡，包括 114 例心血管死亡。RCS 分析显示 NLR 与全因和心血管死亡率呈正相关。将参与者分为 NLR 较高（>3.5）和较低（≤3.5）组。加权 Cox 比例风险模型显示，NLR 较高的个体全因死亡（HR 1.96，95%置信区间（CI）1.52-2.52，p<0.0001）和心血管死亡（HR 2.33，95%CI 1.54-3.51，p<0.0001）风险显著增加。分层和交互分析证实了核心结果的稳定性。值得注意的是，eGFR 通过分别为 5.4%和 4.7%的比例部分介导了 NLR 与全因和心血管死亡率之间的关联。此外，全因死亡率的 3 年、5 年和 10 年生存率的曲线下面积（AUC）分别为 0.68、0.65 和 0.64，心血管死亡率的 AUC 分别为 0.68、0.70 和 0.69。
在高血压患者中，升高的 NLR 独立增加全因和心血管死亡率的风险。
