Akut Koroner Sendromlu Hastalarda Nötrofil/Lenfosit Oranı ve Monosit Sayımının Değerlendirilmesi

Öz

Amaç: Akut koroner sendromlar, dünyada ve ülkemizde tüm ölüm sebepleri içerisinde en üst sırada yer almaktadır. Bu çalışmada tam kan sayımı parametrelerinin akut koroner sendromların klinik seyrinde prediktif açıdan değerli olup olmadığını araştırmak amaçlanmıştır.
Materyal ve Metot: Çalışma, yıllık hasta sayısı 150.000 olan bir Eğitim ve Araştırma Hastanesi Acil Tıp Kliniği’nde 01.02.2017-31.07.2017 tarihleri arasında tek merkezli prospektif olarak gerçekleştirildi. Çalışma için Lokal Klinik Araştırmalar Etik Kurulu’ndan etik onayı alındı. Hastaların demografik özellikleri, tam kan parametreleri, nötrofil / lenfosit oranı (NLR), GRACE risk skorları kayıt altına alındı. Hastaların hastanede kalış süreleri, hastane içi mortaliteleri ve 6 aylık mortaliteleri takip edildi.
Bulgular: Çalışmadaki hastaların %77,27’ ü erkek, %22,73’ si kadındı. Yaş ortalaması 61±12 idi. Tüm gruplar içerisinde NLR değerleri (p=0,009), monosit sayıları (p<0,001) arasında hastane içi mortalite açısından anlamlı fark saptandı. NLR değerleri (p=0,045), monosit sayıları (p=0,026) arasında da 6 aylık mortalite açısından anlamlı fark saptandı. Hastane içi mortalite açısından NLR düzeyi düşük grup ile diğer gruplar arasında anlamlı fark saptanmıştır (p=0,006), Bu çalışmada NLR alt grupları arasında 6 aylık mortalite açısından anlamlı fark saptanmamıştır (p=0,131). GRACE skoru ve NLR arasında zayıf (p<0,001; rho=0,393) korelasyon saptandı.
Sonuç: Akut koroner sendrom nedeniyle acil servislerde takip edilen hastalarda tam kan parametreleri ve NLR gibi parametreler klinik karar verme sürecinde ve hastaların prognozunu ve mortalitelerini öngörmede yardımcı olabilir.

Anahtar Kelimeler

• Akut koroner sendrom,nötrofil,lenfosit,monosit,nötrofil/lenfosit oranı

The Evaluation of Neutrophil/Lymphocyte Rates and Monocyte Counts in Patients with Acute Coronary Syndrome

Abstract

Objectives: Acute coronary syndromes are at the top of all causes of death in the world and in our country. In this study, we aimed to evaluate whether total blood count parameters have predictive value in clinical course of acute coronary syndromes.
Materials and Methods: The study was performed as a single center prospective study between 01.02.2017 and 31.07.2017 at the Emergency Medicine Clinic of a Training and Research Hospital in which the annual number of patients is 150,000. Ethics approval was obtained from the Local Clinical Research Ethics Committee for the study. Demographic feature, total blood count parameter, neutrophil / lymphocyte ratio (NLR), GRACE risk score of the patients were recorded. Length of stay, in-hospital mortality and 6-month mortality of the patients were followed.
Results: In this study, 77.27% of the patients were male and 22.73% were female. The mean age was 61 ± 12. There were significant differences between NLR’s (p = 0.009) and monocyte counts (p <0.001) in all groups in terms of in-hospital mortality. There were also significant differences between NLR’s (p = 0,045) and monocyte counts (p = 0,026) in terms of 6-month mortality. There was a significant difference between the group with low NLR and the other groups in terms of hospital mortality (p = 0,006). There was no significant difference between NLR subgroups in terms of 6-month mortality in this study (p = 0.131). There was a weak correlation between GRACE score and NLR (p <0.001; rho = 0.393).
Conclusion: Parameters such as total blood count and NLR in patients followed up in emergency departments due to acute coronary syndrome may help in the clinical decision making process and predicting the prognosis and mortality of patients.

Keywords

• Acute coronary syndrome,neutrophil,lymphocyte,monocyte,neutrophil / lymphocyte ratio

References

1. 1. Wilkins E, Wilson L, Wickramasinghe K et al. European Cardiovascular Disease Statistics. 2017 edition. Brussels: Eur Heart Network; 2017:192.
2. 2. Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, et al. 2014 AHA/acc guideline for the management of patients with Non-ST-Elevation acute coronary syndromes: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;64(24):e139–228.
3. 3. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. Eur Heart J 2012;33(20):2551–67.
4. 4. Janota T. Biochemical markers in the diagnosis of myocardial infarction. Cor Vasa 2014;56(4):1–7.
5. 5. Gillum RF, Mussolino ME, Madans JH. Counts of neutrophils, lymphocytes, and monocytes, cause-specific mortality and coronary heart disease: The NHANES-I epidemiologic follow-up study. Ann Epidemiol 2005;15(4):266–71.
6. 6. Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005;45(10):1638–43.
7. 7. Gurm HS, Bhatt DL, Lincoff AM, Tcheng JE, Kereiakes DJ, Kleiman NS, et al. Impact of preprocedural white blood cell count on long term mortality after percutaneous coronary intervention: insights from the EPIC, EPILOG, and EPISTENT trials. Heart 2003;89(10):1200–4.
8. 8. Kirtane AJ, Bui A, Murphy SA, Barron H V., Gibson CM. Association of peripheral neutrophilia with adverse angiographic outcomes in ST-elevation myocardial infarction. Am J Cardiol 2004;93(5):532–6.

9. 9. Dogan I, Karaman K, Sonmez B, Celik S, Turker O. Relationship between serum neutrophil count and infarct size in patients with acute myocardial infarction. Nucl Med Commun 2009;30(10):797–801.
10. 10. Ommen SR, Gibbons RJ, Hodge DO, Thomson SP. Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. Am J Cardiol 1997;79(6):812–4.
11. 11. Aghdaii N, Ferasatkish R, Mohammadzadeh Jouryabi A, Hamidi SH. Significance of preoperative total lymphocyte count as a prognostic criterion in adult cardiac surgery. Anesthesiol Pain Med 2014;4(3):e20331.
12. 12. Núñez J, Sanchis J, Bodí V, et al. Therapeutic implications of low lymphocyte count in non-ST segment elevation acute coronary syndromes. Eur J Intern Med 2009;20(8):768–74.
13. 13. Muhmmed Suliman MAR, Bahnacy Juma AA, Ali Almadhani AA, Pathare AV, Alkindi SSA, Uwe Werner F. Predictive Value of Neutrophil to Lymphocyte Ratio in Outcomes of Patients with Acute Coronary Syndrome. Arch Med Res 2010;41(8):618–22.
14. 14. André P, Srinivasa Prasad KS, Denis C V, et al. CD40L stabilizes arterial thrombi by a β3 integrin-dependent mechanism. Nat Med 2002;8(3):247–52.
15. 15. Balta S, Ozturk C. The platelet-lymphocyte ratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets 2015;26(7):680–1.
16. 16. Takahashi T, Hiasa Y, Ohara Y, et al. Relation between neutrophil counts on admission, microvascular injury, and left ventricular functional recovery in patients with an anterior wall first acute myocardial infarction treated with primary coronary angioplasty. Am J Cardiol 2007;100(1):35–40.
17. 17. Kaya MG, Akpek M, Lam YY, et al. Prognostic value of neutrophil/lymphocyte ratio in patients with ST-elevated myocardial infarction undergoing primary coronary intervention: A prospective, multicenter study. Vol. 168, International Journal of Cardiology 2013;168(2):1154–9.
18. 18. Elbasan Z, Gür M, Şahin DY, et al. Association of mean platelet volume and pre- and postinterventional flow with infarct-related artery in ST-segment elevation myocardial infarction. Angiology 2013;64(6):440–6.
19. 19. Uyarel H, Ergelen M, Cicek G, et al. Red cell distribution width as a novel prognostic marker in patients undergoing primary angioplasty for acute myocardial infarction. Coron Artery Dis 2011;22(3):138–44.
20. 20.. Granger C, Goldberg R, Dabbous O, et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 2003;163(19):2345–53.
21. 21. Lee BK, Durairaj A, Mehra A, Wenby RB, Meiselman HJ, Alexy T. Hemorheological abnormalities in stable angina and acute coronary syndromes. Clinical Hemorheology and Microcirculation 2008:39(1-4):43–51.
22. 22. Chia S, Nagurney JT, Brown DFM, et al. Association of leukocyte and neutrophil counts with infarct size, left ventricular function and outcomes after percutaneous coronary intervention for ST-elevation myocardial infarction. Am J Cardiol 2009;103(3):333–7.
23. 23. Chan D, Ng LL. Biomarkers in acute myocardial infarction. BMC Medicine. 2010;8:34.
24. 24. Bagge U, Karlsson R. Maintenance of white blood cell margination at the passage through small venular junctions. Microvasc Res 1980;20(1):92–5.
25. 25. Kawaguchi H, Mori T, Kawano T, Kono S, Sasaki J, Arakawa K. Band neutrophil count and the presence and severity of coronary atherosclerosis. Am Heart J 1996;132(1 I):9–12.
26. 26. Maugeri N, Manfredi AA, Maseri A. Clinical and experimental evidences on the prothrombotic properties of neutrophils. Srpski arhiv za celokupno lekarstvo 2010; 138:50–2.
27. 27. Karabinos I, Koulouris S, Kranidis A, Pastromas S, Exadaktylos N, Kalofoutis A. Neutrophil count on admission predicts major in-hospital events in patients with a non-ST-segment elevation acute coronary syndrome. Clin Cardiol 2009;32(10):561–8.
28. 28. Sun X-P, Li J, Zhu W-W, Li D-B, et al. Impact of Platelet-to-Lymphocyte Ratio on Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction. Angiology 2016;(45):331971665725.
29. 29. Nozawa N, Hibi K, Endo M, et al. Association Between Circulating Monocytes and Coronary Plaque Progression in Patients With Acute Myocardial Infarction. Circ J 2010;74(7):1384–91.
30. 30. Afiune Neto A, Mansur A de P, Avakian SD, Gomes EPSG, Ramires JAF. Monocytosis is an independent risk marker for coronary artery disease. Arq Bras Cardiol 2006;86(3):240–4.
31. 31. Liu CW, Liao PC, Chen KC, et al. Baseline hemoglobin levels associated with one-year mortality in ST-segment elevation myocardial infarction patients. Acta Cardiol Sin 2016;32:656–66.
32. 32. Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association Between Admission Neutrophil to Lymphocyte Ratio and Outcomes in Patients With Acute Coronary Syndrome. Am J Cardiol 2008;102(6):653–7.
33. 33. Azab B, Zaher M, Weiserbs KF, et al. Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction. Am J Cardiol 2010;106(4):470–6.
34. 34. Duffy BK, Gurm HS, Rajagopal V, Gupta R, Ellis SG, Bhatt DL. Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol 2006;97(7):993–6.
35. 35. Muhmmed Suliman MAR, Bahnacy Juma AA, Ali Almadhani AA, Pathare AV, Alkindi SSA, Uwe Werner F. Predictive Value of Neutrophil to Lymphocyte Ratio in Outcomes of Patients with Acute Coronary Syndrome. Arch Med Res 2010;41(8):618–22.
36. 36. Bekler A, Erbag G, Sen H, Gazi E, Ozcan S. Predictive value of elevated neutrophil-lymphocyte ratio for left ventricular systolic dysfunction in patients with non ST-elevated acute coronary syndrome. Pakistan J Med Sci 2015;31(1):159–63.
37. 37. Soylu K, Gedikli Ö, Dagasan G, et al. Neutrophil-to-lymphocyte ratio predicts coronary artery lesion complexity and mortality after non-ST-segment elevation acute coronary syndrome. Rev Port Cardiol 2015;34(7–8):465–71.
38. 38. Gibson PH, Croal BL, Cuthbertson BH, et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J 2007;154(5):995–1002.