6 / 61
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 4, July/August 2021
178
AFRICA
Cardiovascular Topics
Value of peripheral blood neutrophil-to-lymphocyte ratio
for clinical diagnosis and prognosis of elderly patients
with chronic heart failure and atrial fibrillation
Chentao Yang, Hua Yang, Sufang Feng, Jie Qin
Abstract
Aim:
We aimed to explore the value of peripheral blood
neutrophil-to-lymphocyte ratio (NLR) for the clinical diagno-
sis and prognosis of elderly patients with chronic heart failure
(CHF) and atrial fibrillation (AF).
Methods:
A total of 248 eligible patients were followed up
for five years, and divided into major adverse cardiovascular
event (MACE) and non-MACE groups. The independent
predictive factors for MACE were explored by multivariate
logistic regression analysis. Based on quartile of NLR, they
were divided into groups A to D. The duration of MACE was
analysed using Kaplan–Meier survival curves. The diagnostic
value of NLR for MACE was evaluated by receiver operating
characteristic curves.
Results:
Higher age, low-density lipoprotein cholesterol and
NLR, lower left ventricular ejection fraction, diabetes and
NYHA heart function class III and IV were independent
predictive factors for MACE. The incidence of MACE rose
with increasing NLR. Groups A to D had significantly differ-
ent rates of acute myocardial infarction, severe arrhythmia
and cardiac death (
p
< 0.05). The average duration of MACE
in groups A to D were 49.31, 45.27, 43.63 and 40.34 months,
respectively.
Conclusion:
The sensitivity and specificity of NLR for diag-
nosis of MACE were 72.39 and 86.18%, respectively. NLR
was an independent predictive factor for MACE in these
elderly patients with CHF and AF.
Keywords:
neutrophil-to-lymphocyte ratio, chronic heart failure,
atrial fibrillation, prognosis
Submitted 14/10/20, accepted 11/2/21
Published online 2/3/21
Cardiovasc J Afr
2021;
32
: 178–181
www.cvja.co.zaDOI: 10.5830/CVJA-2021-004
Chronic heart failure (CHF) refers to changes in cardiac
structure and function due to various pathogenic factors, leading
to ventricular filling, or impairment of the ejection function,
pulmonary oedema, cardiogenic shock and other symptoms.
Patients are prone to cardiovascular lesions during prognosis.
1
With increasing age, the incidence of cardiovascular disease
rises significantly, so elderly people are a high-risk group of
HF patients. The incidence of HF in elderly patients above 65
years of age is five to 10 times that in younger adults, therefore
seriously threatening the life and health of the elderly.
2
The incidence of atrial fibrillation (AF) is significantly
elevated with increasing severity of HF. AF then further
reduces stroke volume and cardiac output in patients with CHF,
significantly increasing the risk of major adverse cardiovascular
events (MACE). Therefore, early diagnosis and therapeutic
measures have important clinical significance for patients with
CHF and AF.
Neutrophil-to-lymphocyte ratio (NLR) can directly reflect
the inflammatory state and immune level of the patient, and
it rises with myocardial ischaemia.
3
In recent years, NLR has
been widely used in the diagnosis of cardiovascular diseases, and
when it is elevated, it has been confirmed in many studies to be
an independent risk factor for coronary heart disease.
4
However,
the association between NLR and the prognosis of patients with
CHF and AF is rarely reported. Therefore, this study aimed
to explore the value of NLR in evaluation of disease risk and
prognosis in patients with CHF and AF.
Methods
A total of 248 patients with CHF and AF, admitted to our hospital
from October 2013 to June 2014, were selected. According to the
New York Heart Association (NYHA) functional classification,
5
there were 58 cases in class I, 62 in class II, 68 in class III, and 60 in
class IV. Among the patients, there were 156 males (62.90%) and
92 females (37.10%), aged on average 72.04 ± 10.87 years (65–88).
Inclusion criteria were: (1) patients aged ≥ 65 years, (2)
those meeting the relevant criteria in the
Guideline for the
Management of Heart Failure
(2014) developed by the Society
Department of Laboratory, Xingtai Medical College, Xingtai
054000, Hebei Province, PR China
Chentao Yang, MD
Jie Qin, MD,
faridik92@yahoo.comDepartment of Clinical Laboratory, Xingtai Third Hospital/
Xingtai Cardiovascular Hospital, Xingtai 054000, Hebei
Province, PR China
Hua Yang, MD
Department of Clinical Laboratory, Xingtai People’s
Hospital, Xingtai 054000, Hebei Province, PR China
Sufang Feng, MD