Cannata Antonio, Segev Amitai, Madaudo Cristina, Bobbio Emanuele, Baggio Chiara, Schütze Jonathan, Gentile Piero, Sanguineti Marta, Monzo Luca, Schettino Matteo, Ferone Emma, Elsanhoury Ahmed, Younis Anan, Palazzini Matteo, Ferroni Adriana, Giani Valentina, Sadler Matthew, Di Lisi Daniela, Albarjas Mohammad, Calò Leonardo, Sado Daniel, Polte Christian Lars, Garascia Andrea, Scott Paul A, Shah Ajay M, Giacca Mauro, Sinagra Gianfranco, Bollano Entela, McDonagh Theresa, Tschöpe Carsten, Novo Giuseppina, Ammirati Enrico, Beigel Roy, Gräni Christoph, Merlo Marco, Ameri Pietro, Bromage Daniel I
King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom.
Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel; The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
JACC Heart Fail. 2025 May;13(5):770-780. doi: 10.1016/j.jchf.2024.11.003. Epub 2025 Jan 22.
Neutrophil-to-lymphocyte ratio (NLR) is an easy-to-use inflammatory biomarker. Baseline NLR is independently associated with incident cardiovascular events and all-cause mortality. However, whether this applies to acute myocarditis (AM) has not been evaluated.
The present study aimed to investigate the prognostic value of NLR in patients with AM.
A total of 1,150 consecutive patients with a diagnosis of AM admitted to 10 international tertiary referral cardiac centers were included in the study. The diagnosis was confirmed using cardiac magnetic resonance or endomyocardial biopsy. The primary outcome measure was a composite of all-cause mortality or heart transplantation. Patients were divided into 2 groups according to an NLR cutoff of 4 derived from spline regression analysis and 70:30 train-test split algorithm.
Patients with an NLR <4 were younger and more likely to present with chest pain, and those with an NLR ≥4 were more likely to present with breathlessness and have other comorbidities. Over a median follow-up of 228 weeks, a NLR ≥4 was associated with a worse prognosis (P < 0.0001). After adjustment for prognostic variables, NLR emerged as an independent predictor of outcome (HR: 3.03 [95% CI: 1.30-7.04]; P = 0.010). Elevated NLR remained associated with worse outcomes among patients with preserved ejection fraction at baseline, who are conventionally considered to be at lower risk of adverse events (P < 0.0001).
In patients with AM, elevated NLR is associated with worse prognosis and may be valuable for stratifying patients, even those conventionally considered at low risk.
中性粒细胞与淋巴细胞比值（NLR）是一种易于使用的炎症生物标志物。基线NLR与心血管事件的发生及全因死亡率独立相关。然而，这是否适用于急性心肌炎（AM）尚未得到评估。
本研究旨在探讨NLR在AM患者中的预后价值。
本研究纳入了10个国际三级转诊心脏中心收治的1150例连续诊断为AM的患者。诊断通过心脏磁共振成像或心内膜心肌活检得以证实。主要结局指标为全因死亡率或心脏移植的综合指标。根据样条回归分析和70:30训练-测试分割算法得出的NLR临界值4，将患者分为两组。
NLR<4的患者更年轻，更易出现胸痛，而NLR≥4的患者更易出现呼吸困难且有其他合并症。在中位随访228周期间，NLR≥4与较差的预后相关（P<0.0001）。在对预后变量进行调整后，NLR成为结局的独立预测因子（HR：3.03[95%CI：1.30-7.04]；P=0.010）。在基线射血分数保留的患者中，NLR升高仍与较差的结局相关，这些患者通常被认为不良事件风险较低（P<0.0001）。
在AM患者中，NLR升高与较差的预后相关，可能对患者分层有价值，即使是那些通常被认为低风险的患者。
