PROGNOSTIC VALUE OF NEUTROPHIL-TO-LYMPHOCYTE RATIO IN ACUTE CORONARY SYNDROME PATIENTS: A META-ANALYSIS OF HAZARD RATIOS

Xiao-Qing Quan^{1, #}, Zhong-Hui Jiang^{2, #}, Zhong-Bin Yang², Hong-Tao Liu^{3, *} 

¹Department of Geriatrics, Department of General Pratice,  Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen 518110, China - ²Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China - ³Department of Cardiology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen 518110, China

Background: Previous meta-analyses have revealed the prognostic significance of neutrophil-lymphocyte ratio (NLR) in acute coronary syndrome (ACS) by combining the odds ratios (ORs) or risk ratio (RRs).  This study aims to supplement the previous meta-analysis by including only adjusted hazard ratios (HRs). We have investigated the value of NLR in predicting mortality and major adverse cardiovascular events (MACEs) in ACS patients.

Methods: Relevant articles published were systematically searched from PubMed, the Cochrane Library, EMBASE and Web of before May 18, 2019. HRs with associated 95% confidence intervals (CIs) were calculated to estimate the effects. 

Results: A total of 8 articles of 4877 patients were included in the meta-analysis. Our analysis for patients with recent ACS indicated that higher NLR was a prognostic marker in predicting long-term mortality (HR=1.19, 95% CI=1.03–1.39 P=0.022), long-term MACEs (HR=1.41, 95% CI=0.81–2.46, P=0.222), in-hospital mortality (HR=1.27, 95% CI=1.15–1.40, P<0.001). Pretreatment NLR predicted long-term mortality/MACEs in ACS patients (HR=1.17, 95% CI=1.07–1.28, P<0.001). 

Conclusion: In conclusion, the updated meta-analysis of pooled adjusted HRs provided evidence that ACS patients with higher preconditioning NLR value have a higher risk of mortality.