Soler-Espejo Eva, Marín Francisco, López-Gálvez Raquel, Ramos-Bratos María Pilar, Sánchez-Villalobos María, Esteve-Pastor María Asunción, Lip Gregory Y H, Rivera-Caravaca José Miguel, Roldán Vanessa
Department of Hematology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.
Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain.
Clin Cardiol. 2025 Feb;48(2):e70102. doi: 10.1002/clc.70102.
Systemic inflammation plays a central role in atrial fibrillation (AF). The neutrophil-to-lymphocyte ratio (NLR) is a simple hematological index that has been shown to be associated with prognosis in different pathologies.
The NLR is associated with an increased risk of adverse events in patients with AF.
We included a prospective cohort of AF patients who started vitamin K antagonists (VKAs) therapy between July 2016 and June 2018. NLR was assessed at baseline and classified into three categories: low (< 3), moderate (3-5), and high (> 5). During a 2-year follow-up period, all cardiovascular deaths, all-cause deaths, and net clinical outcomes (NCO; either ischemic stroke/transient ischemic attack, major bleeding or all-cause death), were recorded.
A total of 1050 patients were included (51.4% women; median age 77 years). NLR was available in 936 patients: 507 (54.2%) had low NLR (< 3), 239 (25.5%) had moderate NLR (3-5), and 190 (20.3%) had high NLR (> 5). The primary endpoint was significantly increased in the high NLR category (p = 0.002 for cardiovascular death; p < 0.001 for all-cause mortality, and p < 0.001 for NCO), with higher IRRs (all p < 0.001). Multivariate Cox regression analyses showed that high NLR was independently associated with an increased risk of cardiovascular death (aHR: 2.02; 95% CI: 1.04-3.92), all-cause mortality (aHR: 2.51; 95% CI: 1.58-3.97), and NCO (aHR: 1.99; 95% CI: 1.37-2.87), compared to low NLR.
In this prospective AF cohort receiving VKAs, elevated NLR was significantly associated with an increased risk of adverse clinical outcomes. NLR has independent prognostic value beyond other classical risk factors.
全身炎症在心房颤动（AF）中起核心作用。中性粒细胞与淋巴细胞比值（NLR）是一项简单的血液学指标，已被证明与不同疾病的预后相关。
NLR与AF患者不良事件风险增加有关。
我们纳入了一个前瞻性队列，该队列中的AF患者在2016年7月至2018年6月期间开始使用维生素K拮抗剂（VKA）治疗。在基线时评估NLR，并将其分为三类：低（<3）、中（3 - 5）和高（>5）。在2年的随访期内，记录所有心血管死亡、全因死亡和净临床结局（NCO；即缺血性卒中/短暂性脑缺血发作、大出血或全因死亡）。
共纳入1050例患者（51.4%为女性；中位年龄77岁）。936例患者有NLR数据：507例（54.2%）NLR低（<3），239例（25.5%）NLR中等（3 - 5），190例（20.3%）NLR高（>5）。高NLR组的主要终点显著增加（心血管死亡p = 0.002；全因死亡率p < 0.001，NCO p < 0.001），风险比更高（所有p < 0.001）。多变量Cox回归分析显示，与低NLR相比，高NLR与心血管死亡风险增加（调整后风险比：2.02；95%置信区间：1.04 - 3.92）、全因死亡率增加（调整后风险比：2.51；95%置信区间：1.58 - 3.97）和NCO增加（调整后风险比：1.99；95%置信区间：1.37 - 2.87）独立相关。
在这个接受VKA治疗的前瞻性AF队列中，NLR升高与不良临床结局风险增加显著相关。NLR具有超越其他经典危险因素的独立预后价值。
