Combined Predictive Value of Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio for In-hospital Mortality Risk in Patients with Acute Myocardial Infarction

Abstract

Background Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been shown to have significant predictive value for cardiovascular disease in previous studies, however, whether the combination of NLR and PLR can enhance the predictive value for in-hospital mortality risk in patients with acute myocardial infarction (AMI) has not been investigated. Objective To investigate the combined predictive value of NLR and PLR in the short-term prognosis of AMI patients. Methods The case data of 3 246 AMI patients hospitalized in the Department of Cardiology of the Second Hospital of Dalian Medical University from December 2015 to December 2021 were included, with the final outcome of all-cause death during hospitalization, who were divided into in-hospital death and non-death groupsand matched 1∶1 using propensity score matching (PSM). Receiver operating characteristic (ROC) curves were plotted for the predictive value of NLR+PLR, NLR, and PLR for the risk of in-hospital death in AMI patients. In order to better evaluate the predictive value of NLR+PLR for in-hospital mortality risk in patients with different types of AMI, patients were divided into NSTEMI and STEMI groups, and the predictive values of NLR+PLR, NLR, and PLR for in-hospital mortality risk in patients with NSTEMI and STEMI groups were analyzed. Results (1) Patients who died during hospitalization were matched based on PSM in a 1∶1 ratio, with 115 patients in each group. There was no significantly different in matching variables between the two groups after matching (P>0.05). (2) The area under the ROC curve of NLR + PLR for predicting the risk of in-hospital mortality in AMI patients (AUC=0.754) was greater than NLR (AUC=0.731) and PLR (AUC=0.577) (P<0.05). (3) NLR+PLR had a higher predictive ability for in-hospital mortality risk in STEMI patients (AUC=0.797) than in NSTEMI patients (AUC=0.739) . Conclusion Compared with NLR or PLR alone, the combination of NLR and PLR can better predict the risk of in-hospital mortality in AMI patients, especially with better efficacy in STEMI patients.

Keywords

• myocardial infarction|propensity score|propensity score matching|neutrophil-to-lymphocyte ratio|platelet-to-lymphocyte ratio|risk of death