Elevated Neutrophil-to-Lymphocyte Ratio Predicts Prognosis in Acute Myocarditis.
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Cannata Antonio, Segev Amitai, Madaudo Cristina, Bobbio Emanuele, Baggio Chiara, Schütze Jonathan, Gentile Piero, Sanguineti Marta, Monzo Luca, Schettino Matteo, Ferone Emma, Elsanhoury Ahmed, Younis Anan, Palazzini Matteo, Ferroni Adriana, Giani Valentina, Sadler Matthew, Di Lisi Daniela, Albarjas Mohammad, Calò Leonardo, Sado Daniel, Polte Christian Lars, Garascia Andrea, Scott Paul A, Shah Ajay M, Giacca Mauro, Sinagra Gianfranco, Bollano Entela, McDonagh Theresa, Tschöpe Carsten, Novo Giuseppina, Ammirati Enrico, Beigel Roy, Gräni Christoph, Merlo Marco, Ameri Pietro, Bromage Daniel I
Аннотация
OBJECTIVES: The present study aimed to investigate the prognostic value of NLR in patients with AM.
METHODS: A total of 1,150 consecutive patients with a diagnosis of AM admitted to 10 international tertiary referral cardiac centers were included in the study. The diagnosis was confirmed using cardiac magnetic resonance or endomyocardial biopsy. The primary outcome measure was a composite of all-cause mortality or heart transplantation. Patients were divided into 2 groups according to an NLR cutoff of 4 derived from spline regression analysis and 70:30 train-test split algorithm.
RESULTS: Patients with an NLR <4 were younger and more likely to present with chest pain, and those with an NLR ≥4 were more likely to present with breathlessness and have other comorbidities. Over a median follow-up of 228 weeks, a NLR ≥4 was associated with a worse prognosis (P < 0.0001). After adjustment for prognostic variables, NLR emerged as an independent predictor of outcome (HR: 3.03 [95% CI: 1.30-7.04]; P = 0.010). Elevated NLR remained associated with worse outcomes among patients with preserved ejection fraction at baseline, who are conventionally considered to be at lower risk of adverse events (P < 0.0001).
CONCLUSIONS: In patients with AM, elevated NLR is associated with worse prognosis and may be valuable for stratifying patients, even those conventionally considered at low risk.