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Neutrophil-to-Lymphocyte Ratio in Acute Decompensated Heart Failure: can it predict the prognosis?
Session:
Painel 1 - Insuficiencia cardiaca 1
Speaker:
Gustavo M. Campos
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Gustavo M. Campos; Patrícia M. Alves; João Borges Rosa; José Paulo Almeida; Sofia S. Martinho; Ana Vera Marinho; Rui Baptista; Susana Costa; Fátima Franco Silva; Isabel Fonseca; Luís Candal Leite; Lino Gonçalves
Abstract
<p><strong>Introduction:</strong> Inflammation plays an important role in the pathogenesis and progression of heart failure. Raised inflammatory cytokines are associated with adverse outcomes, but these are not routinely assessed in clinical practice. Neutrophil-to-lymphocyte ratio (NLR) has been proposed as reliable indicator of immune activation, inflammation and oxidative stress injury, and its measurement has been considered a valuable tool for predicting mortality in patients with cardiovascular disease.</p> <p><strong>Objectives:</strong> To assess the value of the NLR in predicting in-hospital and mid-term outcomes in Acute Decompensated Heart Failure (ADHF).</p> <p><strong>Methods:</strong> Retrospective, observational study including ADHF patients hospitalized in a tertiary hospital, between November 2016 and December 2017. Exclusion criteria were patients with active cancer, hematopoietic diseases, chronic inflammatory conditions, chronic glucocorticoid therapy, or patients in whom a complete blood cell count was not performed within 24h from hospital admission. The endpoints were all-cause in-hospital and follow-up mortality. Median follow-up time was 5 [IQR 3-11] months. A receiver operating characteristics (ROC) curve was used to test NLR as a predictor of mortality and to obtain the best cut-off point. We transformed NLR into a categorical variable with 2 groups: group 1 (NLR < 7.27, n= 253) and group 2 (NLR >= 7.27, n = 147). Multivariate models were elaborated including all clinically relevant significant variables identified in univariate analysis: a logistic regression model was used to analyze in-hospital mortality and a Cox regression model for long-term mortality.</p> <p><strong>Results:</strong> We included 400 patients (age 77.5 ± 10.9; 224 males). AUC was 0.644. We considered the best cut off point to be 7.27 (sensitivity 64%, specificity 68%). In-hospital mortality was 13.4% (n = 53): group 2 had an increase rate of death (23.6% [n = 34]) compared to those in group 1 (7.5% [n = 19]) (p < 0.001). In the multivariate logistic regression analysis NLR >= 7.27 was found to be associated to worst outcome (adjusted OR: 4.64, CI 1.56 to 13.77, p = 0.006). During follow up, group 2 had higher mortality rates (23.6% vs 12.8% in group 1, log rank <0.001 – figure 1). In the multivariate Cox regression NLR >= 7.27 was an independent predictor of mid-term mortality (HR: 2,68, CI 1.39 to 5.19, p = 0,003).</p> <p><strong>Conclusion:</strong> RNL may be used as a predictor of both in-hospital and follow-up mortality after an episode of ADHF.</p>
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