Clinics (Sao Paulo, Brazil) · 2026
Association between systemic inflammation and long-term mortality in emergency department patients with severe hypertension.
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Yoo Byungwoo, Kim Byung Sik, Kim Hyun-Jin, Shin Jeong-Hun
Аннотация
BACKGROUND: The prognostic role of systemic inflammatory indicators in patients with severe hypertension remains unclear. This study evaluated the associations between several inflammatory markers, including Neutrophil-to-Lymphocyte Ratio (NLR), Lymphocyte-to-Monocyte Ratio (LMR), Platelet-to-Lymphocyte Ratio (PLR), Systemic Immune-Inflammation Index (SII), C-Reactive Protein (CRP) level, and long-term mortality.
METHODS: This retrospective cohort included 5,320 adult patients presenting to the emergency department with severe hypertension (systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mmHg) between 2016 and 2019. All patients underwent complete blood counts and CRP testing. Patients were categorized into tertiles for each inflammatory marker.
RESULTS: Higher tertiles of NLR, PLR, SII, and CRP were associated with increased 3-year all-cause mortality, while higher LMR was associated with lower mortality. Adjusted hazard ratios (95% Confidence Intervals) comparing the highest to lowest tertiles were: NLR 1.61 (1.35-1.92), LMR 0.71 (0.60-0.85), PLR 1.22 (1.03-1.44), SII 1.57 (1.33-1.86), and CRP 2.21 (1.84-2.65). Dose-response analyses revealed linear associations between NLR and SII, an inverse J-shaped pattern for LMR, a J-shaped curve for PLR, and a nonlinear positive association for CRP. CRP showed the highest discriminatory performance among the evaluated markers.
CONCLUSION: Systemic inflammatory indicators were associated with long-term mortality in patients with severe hypertension. These findings suggest that inflammatory markers may provide prognostic information in this population, although their role in risk stratification and follow-up planning requires further evaluation.
METHODS: This retrospective cohort included 5,320 adult patients presenting to the emergency department with severe hypertension (systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mmHg) between 2016 and 2019. All patients underwent complete blood counts and CRP testing. Patients were categorized into tertiles for each inflammatory marker.
RESULTS: Higher tertiles of NLR, PLR, SII, and CRP were associated with increased 3-year all-cause mortality, while higher LMR was associated with lower mortality. Adjusted hazard ratios (95% Confidence Intervals) comparing the highest to lowest tertiles were: NLR 1.61 (1.35-1.92), LMR 0.71 (0.60-0.85), PLR 1.22 (1.03-1.44), SII 1.57 (1.33-1.86), and CRP 2.21 (1.84-2.65). Dose-response analyses revealed linear associations between NLR and SII, an inverse J-shaped pattern for LMR, a J-shaped curve for PLR, and a nonlinear positive association for CRP. CRP showed the highest discriminatory performance among the evaluated markers.
CONCLUSION: Systemic inflammatory indicators were associated with long-term mortality in patients with severe hypertension. These findings suggest that inflammatory markers may provide prognostic information in this population, although their role in risk stratification and follow-up planning requires further evaluation.