Abduljabbar Ali Safaa, Fawzi Hussein Muataz
College of Medicine, University of Baghdad, Baghdad, Iraq.
Med J Islam Repub Iran. 2024 Sep 23;38:109. doi: 10.47176/mjiri.38.109. eCollection 2024.
The involvement of inflammation in the start and advancement of atherosclerotic plaques in acute coronary syndrome has been clarified. White blood cell count and its differential are key inflammatory markers in cardiovascular disease, with the neutrophil-to-lymphocyte ratio (NLR) emerging as a marker of inflammation and a predictor of mortality in patients with acute coronary syndrome. The study aims to investigate the utility of neutrophil to lymphocyte ratio and other complete blood count parameters as a risk stratification tool and independent predictor of Global Registry for Acute Coronary Events (GRACE) risk score in Non-ST segment elevation acute coronary syndrome (NSTE-ACS).
This was a cross-sectional retrospective single-center study conducted in Baghdad Teaching Hospital. A total of 110 patients diagnosed with NSTE-ACS were enrolled in this study. Demographic data and components that determine the GRACE risk score were recorded at admission to the emergency department alongside risk factors for coronary artery disease. Venous blood for relevant laboratory analysis was obtained from all patients. Patients were categorized into three risk groups according to the GRACE risk score. The study results were statistically analyzed using the one-way Analysis of Variance (ANOVA) test and the Kruskal Wallis test. Spearman test and multiple linear regression analysis were used for correlation and identification of independent predictors respectively.
The mean age of patients was 59.4 years with a standard deviation of 21.1 years. The majority of them were males (61.8%). The predominant portion (102) had non-ST elevation myocardial infarction (NSTEMI). The mean total white blood cell count, absolute neutrophil count, absolute lymphocyte count, and neutrophil to lymphocyte ratio of the patients were 11.1 ×103/ml, 8.7 ×103/ml, 1.7 ×103/ml, and 5.9 respectively. The mean admission left ventricle ejection fraction (LV EF) of the patients was 52.5 % with a standard deviation of 9.6 %. There is a significant positive correlation between NLR and GRACE risk score (r = 0.339, < 0.001) and a statistically significant negative correlation between NLR and LV EF (r = -0.385, = 0.005).
This study showed a statistically significant association and positive correlation between neutrophil-to-lymphocyte ratio (NLR) and Global Registry of Acute Coronary Events (GRACE) risk score, so neutrophil-to-lymphocyte ratio (NLR) is a valuable marker for risk stratification and prognosis in NSTE-ACS patients, serving as an independent predictor of the GRACE risk score.
炎症在急性冠状动脉综合征中动脉粥样硬化斑块的起始和进展中的作用已得到阐明。白细胞计数及其分类是心血管疾病中的关键炎症标志物，中性粒细胞与淋巴细胞比值（NLR）已成为炎症标志物及急性冠状动脉综合征患者死亡率的预测指标。本研究旨在探讨中性粒细胞与淋巴细胞比值及其他全血细胞计数参数作为非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者风险分层工具及全球急性冠状动脉事件注册研究（GRACE）风险评分独立预测指标的效用。
这是一项在巴格达教学医院进行的横断面回顾性单中心研究。本研究共纳入110例诊断为NSTE-ACS的患者。在急诊科入院时记录人口统计学数据及决定GRACE风险评分的各项指标以及冠状动脉疾病的危险因素。采集所有患者的静脉血进行相关实验室分析。根据GRACE风险评分将患者分为三个风险组。采用单因素方差分析（ANOVA）检验和Kruskal Wallis检验对研究结果进行统计学分析。分别使用Spearman检验和多元线性回归分析进行相关性分析及独立预测指标的识别。
患者的平均年龄为59.4岁，标准差为21.1岁。其中大多数为男性（61.8%）。主要部分（102例）为非ST段抬高型心肌梗死（NSTEMI）。患者的平均总白细胞计数、绝对中性粒细胞计数、绝对淋巴细胞计数及中性粒细胞与淋巴细胞比值分别为11.1×10³/ml、8.7×10³/ml、1.7×10³/ml和5.9。患者入院时左心室射血分数（LV EF）的平均值为52.5%，标准差为9.6%。NLR与GRACE风险评分之间存在显著正相关（r = 0.339，P<0.001），NLR与LV EF之间存在统计学显著负相关（r = -0.385，P = 0.005）。
本研究表明中性粒细胞与淋巴细胞比值（NLR）与全球急性冠状动脉事件注册研究（GRACE）风险评分之间存在统计学显著关联及正相关，因此中性粒细胞与淋巴细胞比值（NLR）是NSTE-ACS患者风险分层和预后的有价值标志物，可作为GRACE风险评分的独立预测指标。
