ST Segment Elevasyonlu Miyokart İnfarktüsünde Nötrofil/Lenfosit Oranının Kardiyojenik Şokla İlişkisi

Year 2016, Volume: 19 Issue: 2, 72 - 75, 01.08.2016

Elnur Alizade , Sinan Cerşit Mustafa Bulut Anıl Avcı Mehmet Mustafa Tabakcı Ahmet Güler Uğur Aslantaş Mehmet Yunus Emiroğlu Selçuk Pala

Abstract

Giriş: Nötrofil-lenfosit oranı (NLO) akut koroner sendromların
fizyopatolojisi ile ilişkilidir. ST segment elevasyonlu miyokart infarktüsünde
(STEMİ) gözlenen inflamatuvar süreç NLO’da artışa sebep olabilir. Çalışmamızda,
STEMİ ile hastaneye başvuran hastalarda kardiyojenik şok (KŞ) gelişen ve
gelişmeyen gruplar arasında NLO’da fark olup olmadığı araştırıldı.

Hastalar
ve Yöntem: Çalışmaya akut STEMİ ile başvuran
toplam 203 hasta alındı. Yüz hasta KŞ grubunu oluşturdu. Yüz üç hastada ise
komplikasyonsuz STEMİ mevcuttu. Tüm hastalardan rutin kan örnekleri alındı. NLO
analizi yapıldı.

Bulgular: NLO gruplar arasında anlamlı olarak farklı bulundu (9.9
± 7.9 vs. 6.2 ± 4.3, sırasıyla, p< 0.001). 
“Multiple logistic regression” analizi, KŞ’yle komplike STEMİ’nin şok
izlenmeyen STEMİ hasta grubuna göre daha yüksek NLO değerlerine sahip olduğunu
gösterdi (β= 1.07, %95 CI 1.01-1.15, p= 0.03).

Sonuç: Çalışmamızda hastaneye başvuruda ölçülen NLO’nun  KŞ gelişen STEMİ hastalarında anlamlı olarak
daha yüksek olduğu bulundu. Artmış NLO oranı KŞ gelişecek hastaları predikte
etmede kullanılabilir.

Keywords

Nötrofil/lenfosit oranı, karsinojenik şok, ST segment elevasyonlu miyokart infarktüsü, inflamasyon, ateroskleroz

Relationship Between Admission Neutrophil to Lymphocyte Ratio and ST-Elevation Myocardial İnfarction Complicated by Cardiogenic Shock

Abstract

Introduction: Neutrophil
to lymphocyte ratio (NLR) is related to the pathogenesis of acute coronary
syndromes. The inflammatory process in ST-elevation myocardial infarction
(STEMI) may cause an increase in NLR. In this study, we aimed to investigate
whether admission NLR is associated with STEMI complicated by cardiogenic
shock.

Patients and Methods: The
study population comprised patients who had presented with acute STEMI. All
patients referred underwent routine blood tests, including common blood cell
counts, and NLR analysis.

Results: STEMI
showed characteristics of cardiogenic shock in 100 patients and was
uncomplicated in 103 patients. NLR was significantly different between the two
groups (9.9 ± 7.9 vs. 6.2 ± 4.3, respectively, p< 0.001). Multiple logistic
regression analyses showed that NLR was significantly associated with STEMI
complicated by cardiogenic shock (β= 1.07, 95% CI 1.01-1.15, p= 0.03).

Conclusion: Our results demonstrated that
admission NLR was higher in patients with STEMI complicated by cardiogenic
shock. To prove this relationship between NLR and cardiogenic shock, further
investigations are needed.

Keywords

Neutrophil to lymphocyte ratio, cardiogenic shock, myocardial infarction, inflammation, atherosclerosis

References

• 1. O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013;61:e78-140. doi: 10.1016/j.jacc.2012.11.019.
• 2. Niccoli G, Lanza GA, Spaziani C, Altamura L, Romagnoli E, Leone AM, et al. Baseline systemic inþammatory status and no-reþow phenomenon after percutaneous coronary angioplasty for acute myocardial infarction. Int J Cardiol 2007;3:306-11.
• 3. Akpek M, Kaya MG, Lam YY, Sahin O, Elcik D, Celik T, et al. Relation of neutrophil/lymphocyte ratio to coronary þow to in-hospital major adverse cardiac events in patients with st-elevated myocardial infarction undergoing primary coronary intervention. Am J Cardiol 2012;110:621-7.
• 4. Ustündağ M, Orak M, Güloğlu C, Sayhan MB, Alyan O, Kale E. Comparative diagnostic accuracy of serum levels of neutrophil activating peptide-2 and pentraxin-3 versus troponin-I in acute coronary syndrome. Anadolu Kardiyol Derg 2011;7:588-94.
• 5. Núñez J, Núñez E, Bodí V, Sanchis J, Miñana G, Mainar L, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol 2008;6:747-52.
• 6. Bodi V, Sanchis J, Nunez J, Mainar L, Minana G, Benet I, et al. Uncontrolled immune response in acute miyocardial infarction: Unraveling the thread. Am Heart J 2008;156:1065-73.
• 7. Papa A, Emdin M, Passino C, Michelassi C, Battaglia D, Cocci F. Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta 2008;395:27-31.
• 8. Sönmez O, Ertaş G, Bacaksız A, Tasal A, Erdoğan E, Asoğlu E, et al. Relation of neutrophil -to- lymphocyte ratio with the presence and complexity of coronary artery disease: an observational study. Anadolu Kardiyol Derg 2013;13:662-7.
• 9. Madjid M, Awan I, Willerson JT, Casscells SW. Leukocyte count and coronary heart disease: implications for risk assessment. J Am Coll Cardiol 2004;44:1945-56.
• 10. Dragu R, Khoury S, Zuckerman R, Suleiman M, Mutlak D, Agmon Y, et al. Predictive value of white blood cell subtypes for long-term outcome following myocardial infarction. Atherosclerosis 2012;221:605.
• 11. Davies MJ. The pathophysiology of acute coronary syndromes. Heart 2000;83:361-6.
• 12. Gürsoy OM, Karakoyun S, Kalçık M, Gökdeniz T, Yesin M, Gündüz S, et al. Usefulness of novel hematologic inflammatory parameters to predict prosthetic mitral valve thrombosis. Am J Cardiol 2014;113:860-4.
• 13. Uthamalingam S, Patvardhan EA, Subramanian S, Ahmed W, Martin W, Daley M, et al. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol 2011;107:433-8.
• 14. Mariani M, Fetiveau R, Rossetti E, Poli A, Poletti F, Vandoni P, et al. Significance of total and differential leucocyte count in patients with acute myocardial infarction treated with primary coronary angioplasty Eur Heart J 2006;27:2511-5.
• 15. 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;102:653-7.
• 16. Szmitko PE, Wang CH, Weisel RD, de Almeida JR, Anderson TJ, Verma S. New markers of inflammation and endothelial cell activation. Circulation 2003;108:1917-23.
• 17. Fuster V, Moreno PR, Fayad ZA, Corti R, Badimon JJ. Atherothrombosis and highrisk plaque: part I: evolving concepts. J Am Coll Cardiol 2005;46:937-54.
• 18. Núñez J, Núñez E, Bodí V, Sanchis J, Miñana G, Mainar L, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol 2008;6:747-52.
• 19. 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;45:1638-43.
• 20. Sanchis J, Bodí V, Núñez J, Bertomeu V, Consuegra L, Bosch MJ, et al. Prognostic usefulness of white-blood cell count on admission and one-year outcome in patients with non-ST elevation acute chest pain. Am J Cardiol 2006;98:885-9.
• 21. Supel K, Salska A, Jaskiewicz F, Kacprzak M, Zielinska M. Mean platelet volume and its prognostic value in acute coronary syndrome complicated by cardiogenic shock Cardiol J 2013;20:254-60.
• 22. Chia S, Nagurney JT, Brown DF, Raffel OC, Bamberg F, Senatore F, 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;103:333-7.
• 23. Azab B, Zaher M, Weiserbs KF, Torbey E, Lacossiere K, Gaddam S, 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;106:470-6.
• 24. Stone PH. Triggering myocardial infarction. N Eng J Med 2004;351:1716-8.
• 25. 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;97:993-6.
• 26. JJ Park, Jang HJ, Oh IY, Yoon CH, Suh JW, Coh YS, et al. Prognostic value of netrophil to lymphocyte ratio in patients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2013;111:636-42.
• 27. Kaya MG, Akpek M, Lam YY, Yarlioglues M, Celik T, Gunebakmaz O, et al. Prognostic value of neutrophil/lymphocyte ratio in patients with ST-elevated myocardial infarction undergoing primary coronary intervention: a prospective, multicenter study. Int J Cardiol 2013;168:1154-9.
• 28. Steppich BA, Moog P, Matissek C, Wisniowski N, Kühle J, Joghetaei N, et al. Cytokine profiles and T cell function in acute coronary syndromes. Atherosclerosis 2007;190:443-51.