The use of Neutrophil Lymphocyte Ratio in Patients Presenting to the Emergency Department with Chest Pain

Abstract

Objective: Objective: In this study, we aimed to determine the roles of neutrophil, MPV, and NLR, in the diagnosis of ACS and the differentiation of ACS subtypes (ST-elevation myocardial infarction and non-ST elevation myocardial infarction), in patients presented to the emergency department with chest pain and were diagnosed with ACS (acute coronary syndrome). Methods: This study was designed as a single-center, cross-sectional, and retrospective. 402 patients who were applied to University Hospital Emergency Department between January 2020 and November 2020; and registered to hospital automation system with chest pain; and underwent further examinations and treatments were included in the study. Ethical approval was obtained from the Local Clinical Research Ethics Committee before the study. Patients who were hospitalized after further examination, who received medical treatment, and did not undergo PCI (Percutaneous coronary intervention) were accepted as NSTMI (n = 202). Patients who were hospitalized after further examination and underwent PCI were accepted as STMI (n = 200). Results: 36.3% of the patients were female (n = 146) and 63.7% (n = 256) were male. The mean age of the cases was detected to be 61.46 ± 14.06. The number of hospitalized ACS patients for NSTMI suspicion and received medical treatment was 202. The number of patients who underwent PCI and accepted as STMI was 200.Mean neutrophils, MPV, NLR, and Troponin values were also significantly higher than those who are not hospitalized (p <0.001). The mean WBC, Neutrophil, NLR, and Troponin values of the patients underwent PCI were also significantly higher than those without PCI (p <0.001). Conclusion: We believe that NLR is a diagnostic valuable that can be used as a biomarker in diagnosing ACS and determining the PCI.

Keywords

• Emergency Department
• Chest Pain
• Acute coronary syndrome
• percutaneous coronary intervention
• Neutrophil lymphocyte ratio

Acil Servise Göğüs Ağrısı ile Başvuran Hastalarda Nötrofil Lenfosit Oranının Kullanımı

Abstract

Amaç: Biz çalışmamızda acil servise göğüs ağrısı şikayeti ile başvuran ve AKS(Akut koroner sendrom) öntanısı alan olgularda; Nötrofil, MPV, NLR, nin AKS tanısı koymada ve AKS subtip ayrımını (ST elevasyonlu myokard enfarktüsüve non St elevasyonlu myokard enfarktüsü) yapabilme durumunu saptamayı amaçlanmıştır. Yöntem: Bu çalışma tek merkezli, kesitsel ve retrospektif olarak yapıldı. Çalışmaya Üniversite hastanesi acil servisinin 2020-Ocak, 2020-Kasım tarihleri arasında hastane otomasyon sistemine göğüs ağrısı tanısı girilip ileri tetkik ve tedavi yapılan 402 hasta dahil edilmiştir. Çalışma için öncesinde Lokal Klinik Araştırmalar Etik Kurulu’ndan etik onay alındı. İleri tetkik sonrasında hastaneye yatışı yapılan, medikal tedavi alan ve PCI (Perkütan koroner girişim) yapılmayan olgular NSTMI olarak (n=202) kabul edilmiştir. İleri tetkik sonrasında hastaneye yatan ve PCI yapılan olgular STMI (n=200) olarak kabul edilmiştir. Bulgular: Hastaların %36.3’ü kadın (n=146), %63.7’si (n=256) erkek olarak saptandı. Olguların yaş ortalaması 61.46±14.06 olarak tespit edildi. Hastaneye yatan AKS düşünülen olgulardan NSTMI düşünülen ve medikal tedavi ile alan hasta sayısı 202 iken, PCI tedavisi uygulanan ve STMI kabul edilen olgu sayısı 200 olarak saptanmıştır. Nötrofil, MPV, NLR ve Troponin ortalamaları da yatış yapmayanlardan anlamlı derecede yüksekti (p<0.001). PCI yapılan hastaların WBC, Nötrofil, NLR ve Troponin ortalamaları da PCI yapılmayanlardan anlamlı derecede yüksekti (p<0.001). Sonuç: AKS tanısı konmasında ve PCI tedavi yönteminin belirlenmesinde NLR’ nin tanı değeri olan bir biyobelirteç olarak kullanılabileceği kanaatindeyiz.

Keywords

• Acil Servis
• Göğüs Ağrısı
• Akut koroner sendrom
• Perkütan koroner girişim
• Nötrofil lenfozit oranı

References

1. 1. Collet J-P, Thiele H, Barbato E, Barthélémy O, Bauersachs J, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2020;1–79.
2. 2. DUYGU İ. ST elevasyonlu akut myokard infarktüsü hastalarının tedaviye ulaşma sürelerini etkileyen faktörlerin değerlendirilmesi Dokuz Eylül Üniversitesi Hastanesi çalışması. 2012; Available from: http://acikerisim.deu.edu.tr/xmlui/handle/20.500.12397/12984
3. 3. Chen X, Meng Y, Shao M, Zhang T, Han L, Zhang W, et al. Prognostic value of pre-infarction angina combined with mean platelet volume to lymphocyte count ratio for no-reflow and short-term mortality in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. Med Sci Monit. 2020;26:1–13.
4. 4. Özen M, Serinken M, Yilmaz A, Özen Ş. Acil Servise Başvuran Akut Koroner Sendrom Tanili Hastalarin Sosyodemografik ve Klinik Özellikleri. Turkiye Acil Tip Derg. 2012;12(3):117–22. 5. Rencüzoğulları İ, Karabağ Y, Çağdaş M, Karakoyun S, Yesin M, Artaç İ, et al. Assessment of Relationship Between SYNTAX and SYNTAX II Scores and Neutrophil/Lymphocyte Ratio in Patients with Non-ST Segment Elevation Myocardial Infarction. Kafkas J Med Sci. 2017;7(2):117–23.
5. 6. Yelgeç NS, Karataş MB, Çanga Y, Güzelburç Ö, Öz D, Zengin A, et al. The neutrophil-to-lymphocyte ratio is associated with acute chest pain in patients with mitral valve prolapse. Kocaeli Med J. 2019;8(3):125–31.
6. 7. Wang H, Liu Z, Shao J, Lin L, Jiang M, Wang L, et al. Immune and Inflammation in Acute Coronary Syndrome: Molecular Mechanisms and Therapeutic Implications. J Immunol Res. 2020;2020.
7. 8. Aydın İE, Gökhan Ş, Şener A, Tanrıverdi F, Pamukçu Günaydın G, Kurtoğlu Çelik G. The Evaluation of Neutrophil/Lymphocyte Rates and Monocyte Counts in Patients with Acute Coronary Syndrome. Ankara Med J. 2018;18(3).
8. 9. Li Y, Chen X, Huang L, Lu J. Association between neutrophil–lymphocyte ratio and arterial stiffness in patients with acute coronary syndrome. Biosci Rep. 2019;39(5):1–7. 10. Karagün E. Psoriazis Hastalarında Sistemik Tedavinin Hematolojik Parametreler Üzerine Etkisi. Konuralp Tıp Derg. 2019;11(1):95–100.

9. 11. Önmez A, Bilir E, Torun S. Akut pankreatit şiddeti ile trombosit lenfosit oranı, nötrofil lenfosit oranı, eritrosit dağılım genişliği ve ortalama platelet volümü arasındaki ilişki. Konuralp Tıp Derg. 2019;11(1):24–9.
10. 12. Şahinkuş S, Aksoy M, Aydın E, Eynel E, Akçay Ç, Kocayiğit İ, et al. 2018 Yılında Tek Merkezde Primer Perkutan Koroner Girişim Yapılan Hastaların Klinik Özellikleri, Anjiyografi İşleminin ve Hastane İçi Klinik Sonuçların Analizi. Sak Med J. 2020;
11. 13. Li YH, Wang YC, Wang YC, Liu JC, Lee CH, Chen CC, et al. 2018 Guidelines of the Taiwan Society of Cardiology, Taiwan Society of Emergency Medicine and Taiwan Society of Cardiovascular Interventions for the management of non ST-segment elevation acute coronary syndrome. J Formos Med Assoc [Internet]. 2018;117(9):766–90. Available from: https://doi.org/10.1016/j.jfma.2018.06.002
12. 14. 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.
13. 15. 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. 16. 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.
14. 17. 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 NonST-elevation myocardial infarction. Am J Cardiol [Internet]. 2010;106(4):470–6. Available from: http://dx.doi.org/10.1016/j.amjcard.2010.03.062