Laboratory Parameters Predicting Mortality in Heart Failure Patients treated with Implantable Cardioverter Defibrillator: Single Centre, Long-term Results

Abstract

Objectives: Neutrophil/lymphocyte (NLR), Monocyte/HDL (MHR), lymphocyte/monocyte (LMR) and platelet/lymphocyte ratios (PLR) are inflammation markers with proven prognostic values in various cardiovascular diseases. However, a clinical study demonstrating the prognostic value of these markers in heart failure (HF) patients treated with an implantable cardioverter-defibrillator (ICD) is not yet available. It is aimed to demonstrate the relationship between NLR, MHR, LMR, PLR and mortality development in patients with HF with ICD. Materials and Methods: One hundred and ninety-four patients who underwent ICD implantation due to systolic HF between January 2015 and December 2019 were included in the study. Results: The mean age was 59.84±13.26 years. The female gender ratio was 25.3%. Death developed in 16 patients (8%) after a median follow-up of 27 months. While basal urea, uric acid, gamma-glutamyl transferase, C-reactive protein and neutrophil levels were found to be high, hemoglobin and lymphocyte levels were found to be low in the exitus developing group. While the rates of NLR, MHR and PLR were statistically significantly higher in the group with death during follow-up (p=0.001, p=0.049, p=0.020, respectively ), LMR was significantly lower (p<0.001). In ROC analyses, mortality was predicted with 81% sensitivity and 61% specificity (p=0.001 AUC=0.76) of values of NLR and above 3.06; 86% sensitivity and 61% specificity [p=0.046 Area under curve (AUC)=0.723] of values of MHR and above 0,0196; 81% sensitivity and 55% specificity (p<0.001 AUC=0.784) of values of LMR 3.22 and 113.59 and above of PLR with 75% sensitivity and 51% specificity (p=0.020 AUC=0.68). Multiple logistic regression analysis showed LMR was an independent factor for mortality (p=0.027). Conclusion: In our study, it has been shown that NLR, MHR, PLR and LMR, which are inflammation markers, can predict mortality in patients with ICD implanted HF. In the multivariate analysis, LMR value has been found to be significant. This is the first study demonstrating the predictive power of these parameters in this patient group. Key Words: Heart Failure, Neutrophil Lymphocyte Ratio, Monocyte HDL Ratio, Platelet Lymphocyte Ratio, Lymphocyte Monocyte Ratio

Keywords

• Heart Failure
• Neutrophil Lymphocyte Ratio
• Monocyte HDL Ratio
• Platelet Lymphocyte Ratio
• Lymphocyte Monocyte Ratio

Takılabilir Kardiyoverter Defibrilatör ile Tedavi Edilen Kalp Yetersizliği Hastalarında Mortaliteyi Belirleyen Laboratuvar Paramaterleri: Tek Merkezli, Uzun Dönemli Sonuçlar

Abstract

Amaç: Nötrofil/lenfosit oranı (NLR), Monosit/HDL oranı (MHR), lenfosit/monosit oranı (LMR) ve platelet/lenfosit oranı (PLR) kardiyovasküler hastalıklarda prognostik değerleri kanıtlanmış olan enflamasyon belirteçleridir. Fakat bu belirteçlerin takılabilir kardiyoverter defibrillator (ICD) ile tedavi edilen kalp yetersizliği hastalarında prognostik değerini gösteren klinik çalışma henüz mevcut değildir. Bu çalışmada NLR, MHR, LMR, PLR oranları ile ICD’si olan kalp yetersizliği hastalarında mortalite gelişimi arasındaki ilişkinin gösterilmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmaya, Ocak 2015-Aralık 2019 tarihleri arasında sistolik kalp yetersizliği nedeniyle ICD implantasyonu yapılmış 194 hasta dahil edildi Bulgular: Hastaların ortalama yaşı 59,84±13,26 idi. Kadın cinsiyet oranı %25,3 idi. Medyan 27 aylık izlem sonrasında 16 hastada ölüm gelişti (%8). Exitus gelişen grupta bazal üre, ürik asit, gama-glutamil transferaz, C-reaktif protein, nötrofil düzeyleri yüksek saptanırken; hemoglobin ve lenfosit düzeyleri ise düşük saptandı. Takiplerde ölüm gelişen grupta NLR, MHR ve PLR oranları istatistiksel olarak anlamlı şekilde yüksek saptanırken (p=0,001, p=0,049, p=0,020, sırasıyla) LMR belirgin derecede düşük saptanmıştır (p<0,001). Yapılan ROC analizlerinde mortaliteyi NLR’nin 3,06 ve üzerindeki değerlerinin %81 sensitive ve % 61 spesifite [p=0,001 Eğri altında kalan alan (AUC)=0,76]; MHR’nin 0,0196 ve üzerindeki değerlerinin %86 sensitive ve %61 spesifite (p=0,046 AUC=0,723); LMR’nin 3,22 ve altındaki değerlerinin %81 sensitive ve %55 spesifite (p<0,001 AUC=0,784); PLR’nin 113,59 ve üzerindeki değerlerinin %75 sensitive ve %51 spesifite (p=0,020 AUC=0,68) ile öngördüğü saptandı. Bu oranların dahil edildiği multipl lojistik regresyon analizinde LMR değeri istatistiksel olarak anlamlı saptanmıştır (p=0,027). Sonuç: Çalışmamızda enflamasyon belirteçleri olan NLR, MHR, PLR ve LMR oranlarının ICD implante edilmiş kalp yetersizliği hastalarında mortaliteyi predikte edebileceği gösterilmiştir. Yapılan çok değişkenli analizde LMR değeri anlamlı bulunmuştur. Bu çalışma bu hasta grubunda bu parametrelerin prediktör gücünü gösteren ilk çalışmadır. Anahtar Kelimeler: Kalp Yetersizliği, Nötrofil Lenfosit Oranı, Monosit HDL Oranı, Trombosit Lenfosit Oranı, Lensofit Monosit Oranı

Keywords

• Kalp Yetersizliği
• Nötrofil Lenfosit Oranı
• Monosit HDL Oranı
• Trombosit Lenfosit Oranı
• Lensofit Monosit Oranı

References

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