Clinical Research
Usefulness of Neutrophil-to-Lymphocyte Ratio to Predict In-hospital Outcomes in Infective Endocarditis

https://doi.org/10.1016/j.cjca.2013.05.005Get rights and content

Abstract

Background

The neutrophil-to-lymphocyte ratio is an independent predictor of worse prognosis in both infectious and cardiovascular disease. We hypothesized that an increased neutrophil-to-lymphocyte ratio at admission would predict in-hospital unfavourable outcomes in patients with infective endocarditis (IE).

Methods

We retrospectively analyzed clinical, laboratory, and echocardiographic data in a total of 121 consecutive adult patients (64 men; mean age, 54.7 ± 14.2 years) with definite IE.

Results

Among all patients, the prespecified clinical outcomes were experienced in 46 patients (38%). In-hospital mortality and central nervous system (CNS) events occurred in 29 (24%) and 21 patients (17%), respectively. The neutrophil-to-lymphocyte ratio at admission was found to be significantly higher for either composite end point. On using multiple Cox regression analysis, vegetation size ≥ 10 mm, end-stage renal disease, Staphylococcus aureus infection, low hemoglobin level, increased C-reactive protein (CRP) level, and high neutrophil-to-lymphocyte ratio at admission emerged as independent predictors of in-hospital unfavourable outcomes. In the receiver operating characteristics (ROC) curve analysis, a neutrophil-to-lymphocyte ratio > 7.1 had 80% sensitivity and 83% specificity in predicting adverse outcomes.

Conclusion

High neutrophil-to-lymphocyte ratio at admission is an independent predictor of in-hospital mortality and CNS events in patients with IE. However, prospective validation of these findings is required.

Résumé

Introduction

Le rapport neutrophiles/lymphocytes est un prédicteur indépendant vers un pronostic plus mauvais de maladie cardiovasculaire et de maladie infectieuse. Nous avons posé l’hypothèse qu'une augmentation du rapport neutrophiles/lymphocytes à l'admission pourrait prédire une évolution intrahospitalière défavorable chez les patients ayant une endocardite infectieuse (EI).

Méthodes

Nous avons analysé de manière rétrospective les données cliniques, de laboratoire et échocardiographiques chez un total de 121 patients adultes consécutifs (64 hommes; âge moyen de 54,7 ± 14,2 ans) ayant une EI établie.

Résultats

Parmi tous les patients, les résultats cliniques préspécifiés ont été subis par 46 patients (38 %). La mortalité intrahospitalière et les événements liés au système nerveux central (SNC) sont apparus respectivement chez 29 patients (24 %) et 21 patients (17 %). Le rapport neutrophiles/lymphocytes à l'admission s'est révélé significativement plus élevé pour chacun des critères de jugement combinés. En utilisant l'analyse de régression multiple de Cox, une taille des végétations ≥ 10 mm, une insuffisance rénale terminale, une infection à staphylocoque doré, une faible concentration en hémoglobine, une augmentation de la concentration de protéine C réactive et un rapport neutrophiles/lymphocytes élevé à l'admission se sont révélés être des prédicteurs indépendants d'une évolution intrahospitalière défavorable. Dans l'analyse de la courbe caractéristique d'efficacité du récepteur (ROC: receiver operating characteristic), un rapport neutrophiles/lymphocytes > 7,1 a eu une sensibilité à 80 % et une spécificité à 83 % dans la prédiction d'une évolution indésirable.

Conclusion

Un rapport élevé neutrophiles/lymphocytes à l’admission est un prédicteur indépendant de la mortalité intrahospitalière et des événements liés au SNC chez les patients ayant une EI. Cependant, une validation prospective de ces résultats est nécessaire.

Section snippets

Methods

We retrospectively analyzed clinical, laboratory, and echocardiographic data from a total of 122 consecutive adult patients with definite IE between January 2009 and December 2011 at Turkey Yuksek Ihtisas Educational and Research Hospital (Ankara, Turkey). All patients met the modified Duke criteria18 for the definitive diagnosis of IE. One patient was excluded from the study because of unexplained pancytopenia, thus leaving 121 patients to analyze.

Each participant underwent a comprehensive

Results

A total of 121 patients (64 men; mean age, 54.7 ± 14.2 years; range, 21-78 years) with a definitive diagnosis of IE were analyzed. Patients were assigned to 2 groups according to the presence of prespecified clinical outcomes. Among all patients, the prespecified clinical outcomes were experienced by 46 patients (38%). In-hospital mortality occurred in 29 patients (24%) and clinically overt CNS events in 21 patients (17%). The composite clinical outcomes and details of CNS events are presented

Discussion

In the present study, we investigated the accuracy of the neutrophil-to-lymphocyte ratio at admission for predicting in-hospital prognosis in participants with definite IE. At least 1 unfavourable outcome was identified during hospitalization in 38% of the study population. The neutrophil-to-lymphocyte ratio at admission was calculated to be significantly higher for either composite end points—namely, mortality and CNS events—during hospitalization (Fig. 3). High neutrophil-to-lymphocyte ratio

Disclosures

The authors have no conflicts of interest to disclose.

References (29)

Cited by (57)

  • Evolving Spectrum of Prognostic Inflammatory Markers in Infective Endocarditis

    2020, Journal of Cardiothoracic and Vascular Anesthesia
  • The utility of peripheral blood leucocyte ratios as biomarkers in infectious diseases: A systematic review and meta-analysis

    2019, Journal of Infection
    Citation Excerpt :

    The initial mean FGSI did not differ between groups. In a case control study of patients with infective endocarditis diagnosed using the modified Duke Criteria,49 NLR was examined as a predictor of adverse in-hospital outcomes.50 These were defined as in-hospital mortality or an intra-cerebral event (cerebrovascular event, meningitis, embolism, or brain haemorrhage).

View all citing articles on Scopus

See page 1678 for disclosure information.

View full text