Generic placeholder image

Reviews on Recent Clinical Trials

Editor-in-Chief

ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

Review Article

Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio as Biomarkers for Cardiovascular Surgery Procedures: A Literature Review

Author(s): Raffaele Serra*, Nicola Ielapi*, Noemi Licastro, Michele Provenzano, Michele Andreucci, Umberto Marcello Bracale, Federica Jiritano, Stefano de Franciscis, Pasquale Mastroroberto and Giuseppe Filiberto Serraino

Volume 16, Issue 2, 2021

Published on: 27 October, 2020

Page: [173 - 179] Pages: 7

DOI: 10.2174/1574887115999201027145406

Price: $65

Abstract

Background: Neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have been studied so far as prognostic factors of cardiovascular diseases. Their role interplayed with endothelial inflammation has emerged as optimal predictors for major cardiovascular disease events and prognostic factors for post-procedural outcomes.

Methods: A review of the current literature was undertaken to investigate the relationship between NLR and PLR with percutaneous, cardiac surgery, and vascular surgery procedures.

Results: Our findings show that perioperative NLR and PLR levels are significantly correlated with patient morbidity and mortality rates.

Conclusion: These biomarkers have several attractive characteristics, as they are inexpensive and quickly available, and they can contribute to the early identification of patients at high risk for periprocedural adverse events.

Keywords: Neutrophil-to-lymphocyte ratio, NLR, platelet-to-lymphocyte ratio, PLR, cardiac surgery, vascular surgery, precision medicine, outcome, surgery, endovascular.

Graphical Abstract
[1]
Ridker PM, Lüscher TF. Anti-inflammatory therapies for cardiovascular disease. Eur Heart J 2014; 35(27): 1782-91.
[http://dx.doi.org/10.1093/eurheartj/ehu203] [PMID: 24864079]
[2]
Shen XH, Chen Q, Shi Y, Li HW. Association of neutrophil/lymphocyte ratio with long-term mortality after ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Chin Med J (Engl) 2010; 123(23): 3438-43.
[PMID: 22166528]
[3]
Spark JI, Sarveswaran J, Blest N, Charalabidis P, Asthana S. An elevated neutrophil-lymphocyte ratio independently predicts mortality in chronic critical limb ischemia. J Vasc Surg 2010; 52(3): 632-6.
[http://dx.doi.org/10.1016/j.jvs.2010.03.067] [PMID: 20573475]
[4]
Ates AH, Canpolat U, Yorgun H, et al. Total white blood cell count is associated with the presence, severity and extent of coronary atherosclerosis detected by dual-source multislice computed tomographic coronary angiography. Cardiol J 2011; 18(4): 371-7.
[PMID: 21769817]
[5]
Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA 1998; 279(18): 1477-82.
[http://dx.doi.org/10.1001/jama.279.18.1477] [PMID: 9600484]
[6]
Lee CD, Folsom AR, Nieto FJ, Chambless LE, Shahar E, Wolfe DA. White blood cell count and incidence of coronary heart disease and ischemic stroke and mortality from cardiovascular disease in African-American and White men and women: atherosclerosis risk in communities study. Am J Epidemiol 2001; 154(8): 758-64.
[http://dx.doi.org/10.1093/aje/154.8.758] [PMID: 11590089]
[7]
Guasti L, Dentali F, Castiglioni L, et al. Neutrophils and clinical outcomes in patients with acute coronary syndromes and/or cardiac revascularisation. A systematic review on more than 34,000 subjects. Thromb Haemost 2011; 106(4): 591-9.
[http://dx.doi.org/10.1160/TH11-02-0096] [PMID: 21866299]
[8]
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.
[http://dx.doi.org/10.1016/j.amjcard.2008.05.006] [PMID: 18773982]
[9]
Mach F, Schönbeck U, Bonnefoy JY, Pober JS, Libby P. Activation of monocyte/macrophage functions related to acute atheroma complication by ligation of CD40: induction of collagenase, stromelysin, and tissue factor. Circulation 1997; 96(2): 396-9.
[http://dx.doi.org/10.1161/01.CIR.96.2.396] [PMID: 9244201]
[10]
Wang X, Zhang G, Jiang X, Zhu H, Lu Z, Xu L. Neutrophil to lymphocyte ratio in relation to risk of all-cause mortality and cardiovascular events among patients undergoing angiography or cardiac revascularization: a meta-analysis of observational studies. Atherosclerosis 2014; 234(1): 206-13.
[http://dx.doi.org/10.1016/j.atherosclerosis.2014.03.003] [PMID: 24681815]
[11]
Zernecke A, Bot I, Djalali-Talab Y, et al. Protective role of CXC receptor 4/CXC ligand 12 unveils the importance of neutrophils in atherosclerosis. Circ Res 2008; 102(2): 209-17.
[http://dx.doi.org/10.1161/CIRCRESAHA.107.160697] [PMID: 17991882]
[12]
Ikeda U, Ikeda M, Oohara T, Kano S, Yaginuma T. Mitogenic action of interleukin-1 α on vascular smooth muscle cells mediated by PDGF. Atherosclerosis 1990; 84(2-3): 183-8.
[http://dx.doi.org/10.1016/0021-9150(90)90089-2] [PMID: 2282097]
[13]
Azab B, Zaher M, Weiserbs KF, et al. Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction. Am J Cardiol 2010; 106(4): 470-6.
[http://dx.doi.org/10.1016/j.amjcard.2010.03.062] [PMID: 20691303]
[14]
Biolik G, Gajniak D, Kubicz M, Ziaja D, Ziaja K, Kuczmik W. The Influence of Inflammation on Fibrinogen Turnover and Redistribution of the Hemostatic Balance to a Prothrombotic State in High On-Treatment Platelet Reactivity-Dual Poor Responder (HTPR-DPR) Patients. Patients Mediators Inflamm 2019; 20193767128
[http://dx.doi.org/10.1155/2019/3767128] [PMID: 31396017]
[15]
Nikolsky E, Grines CL, Cox DA, et al. Impact of baseline platelet count in patients undergoing primary percutaneous coronary intervention in acute myocardial infarction (from the CADILLAC trial). Am J Cardiol 2007; 99(8): 1055-61.
[http://dx.doi.org/10.1016/j.amjcard.2006.11.066] [PMID: 17437727]
[16]
Waehre T, Damås JK, Yndestad A, et al. Effect of activated platelets on expression of cytokines in peripheral blood mononuclear cells - potential role of prostaglandin E2. Thromb Haemost 2004; 92(6): 1358-67.
[http://dx.doi.org/10.1160/TH04-03-0146] [PMID: 15583745]
[17]
Fowler AJ, Agha RA. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography--the growing versatility of NLR. Atherosclerosis 2013; 228(1): 44-5.
[http://dx.doi.org/10.1016/j.atherosclerosis.2013.02.008] [PMID: 23474126]
[18]
Poludasu S, Cavusoglu E, Khan W, Marmur JD. Neutrophil to lymphocyte ratio as a predictor of long-term mortality in African Americans undergoing percutaneous coronary intervention. Clin Cardiol 2009; 32(12): E6-E10.
[http://dx.doi.org/10.1002/clc.20503] [PMID: 20014207]
[19]
Li XT, Fang H, Li D, et al. Association of platelet to lymphocyte ratio with in-hospital major adverse cardiovascular events and the severity of coronary artery disease assessed by the Gensini score in patients with acute myocardial infarction. Chin Med J (Engl) 2020; 133(4): 415-23.
[http://dx.doi.org/10.1097/CM9.0000000000000650] [PMID: 31977557]
[20]
Muhmmed Suliman MA, Bahnacy Juma AA, Ali Almadhani AA, Pathare AV, Alkindi SS, Uwe Werner F. Predictive value of neutrophil to lymphocyte ratio in outcomes of patients with acute coronary syndrome. Arch Med Res 2010; 41(8): 618-22.
[http://dx.doi.org/10.1016/j.arcmed.2010.11.006] [PMID: 21199731]
[21]
Park JJ, Jang HJ, Oh IY, et al. Prognostic value of neutrophil to lymphocyte ratio in patients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2013; 111(5): 636-42.
[http://dx.doi.org/10.1016/j.amjcard.2012.11.012] [PMID: 23273716]
[22]
Han YC, Yang TH, Kim DI, et al. Neutrophil to lymphocyte ratio predicts long-term clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Korean Circ J 2013; 43(2): 93-9.
[http://dx.doi.org/10.4070/kcj.2013.43.2.93] [PMID: 23508782]
[23]
Cutlip DE, Windecker S, Mehran R, et al. Academic Research Consortium. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 2007; 115(17): 2344-51.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.106.685313] [PMID: 17470709]
[24]
Cho KI, Ann SH, Singh GB, Her AY, Shin ES. Combined Usefulness of the Platelet-to-Lymphocyte Ratio and the Neutrophil-to-Lymphocyte Ratio in Predicting the Long-Term Adverse Events in Patients Who Have Undergone Percutaneous Coronary Intervention with a Drug-Eluting Stent. PLoS One 2015; 10(7): 0133934.
[25]
Arbel Y, Finkelstein A, Halkin A, et al. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis 2012; 225(2): 456-60.
[http://dx.doi.org/10.1016/j.atherosclerosis.2012.09.009] [PMID: 23040448]
[26]
Iijima R, Ndrepepa G, Mehilli J, et al. Relationship between platelet count and 30-day clinical outcomes after percutaneous coronary interventions. Pooled analysis of four ISAR trials. Thromb Haemost 2007; 98(4): 852-7.
[PMID: 17938811]
[27]
Hudzik B, Szkodzinski J, Gorol J, et al. Platelet-to-lymphocyte ratio is a marker of poor prognosis in patients with diabetes mellitus and ST-elevation myocardial infarction. Biomarkers Med 2015; 9(3): 199-207.
[http://dx.doi.org/10.2217/bmm.14.100] [PMID: 25731207]
[28]
Verdoia M, Schaffer A, Barbieri L, et al. Impact of neutrophil-to-lymphocyte ratio on periprocedural myocardial infarction in patients undergoing non-urgent percutaneous coronary revascularisation. Neth Heart J 2016; 24(7-8): 462-74.
[http://dx.doi.org/10.1007/s12471-016-0850-6] [PMID: 27277659]
[29]
Soylu K, Yuksel S, Gulel O, et al. The relationship of coronary flow to neutrophil/lymphocyte ratio in patients undergoing primary percutaneous coronary intervention. J Thorac Dis 2013; 5(3): 258-64.
[PMID: 23825756]
[30]
Yilmaz M, Tenekecioglu E, Arslan B, et al. White Blood Cell Subtypes and Neutrophil-Lymphocyte Ratio in Prediction of Coronary Thrombus Formation in Non-ST-Segment Elevated Acute Coronary Syndrome. Clin Appl Thromb Hemost 2015; 21(5): 446-52.
[http://dx.doi.org/10.1177/1076029613507337] [PMID: 24203350]
[31]
Falk V, Baumgartner H, Bax JJ, et al. ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2017; 52(4): 616-64.
[http://dx.doi.org/10.1093/ejcts/ezx324] [PMID: 29156023]
[32]
Khalil C, Pham M, Sawant AC, et al. Neutrophil-to-lymphocyte ratio predicts heart failure readmissions and outcomes in patients undergoing transcatheter aortic valve replacement. Indian Heart J 2018; 70(Suppl. 3): S313-8.
[http://dx.doi.org/10.1016/j.ihj.2018.08.002] [PMID: 30595282]
[33]
Suh B, Shin DW, Kwon HM, et al. Elevated neutrophil to lymphocyte ratio and ischemic stroke risk in generally healthy adults. PLoS One 2017; 12(8)e0183706
[http://dx.doi.org/10.1371/journal.pone.0183706] [PMID: 28829826]
[34]
Xue J, Huang W, Chen X, Li Q, Cai Z, Yu T, et al. Neutrophil-to-Lymphocyte ratio is a prognostic marker in acute ischemic stroke. J Stroke Cerebrovasc Dis 2017; 26: 650-7.
[35]
Jiritano F, Santarpino G, Serraino GF, et al. Peri-procedural thrombocytopenia after aortic bioprosthesis implant: A systematic review and meta-analysis comparison among conventional, stentless, rapid-deployment, and transcatheter valves. Int J Cardiol 2019; 296: 43-50.
[http://dx.doi.org/10.1016/j.ijcard.2019.07.056] [PMID: 31351790]
[36]
Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg 2002; 21(2): 232-44.
[http://dx.doi.org/10.1016/S1010-7940(01)01099-5] [PMID: 11825729]
[37]
Bronicki RA, Hall M. Cardiopulmonary Bypass-Induced Inflammatory Response: Pathophysiology and Treatment. Pediatr Crit Care Med 2016; 17(8)(Suppl. 1): S272-8.
[http://dx.doi.org/10.1097/PCC.0000000000000759] [PMID: 27490610]
[38]
Ng KT, Van Paassen J, Langan C, et al. The efficacy and safety of prophylactic corticosteroids for the prevention of adverse outcomes in patients undergoing heart surgery using cardiopulmonary bypass: a systematic review and meta-analysis of randomized controlled trials. Eur J Cardiothorac Surg 2020; 57(4): 620-7.
[http://dx.doi.org/10.1093/ejcts/ezz325] [PMID: 31972000]
[39]
Xu H, Sun Y, Zhang S. The Relationship Between Neutrophil to Lymphocyte Ratio and Clinical Outcome in Pediatric Patients After Cardiopulmonary Bypass Surgery: A Retrospective Study. Front Pediatr 2019; 7: 308.
[http://dx.doi.org/10.3389/fped.2019.00308]
[40]
Silberman S, Abu-Yunis U, Tauber R, et al. Neutrophil-Lymphocyte Ratio: Prognostic Impact in Heart Surgery. Early Outcomes and Late Survival. Ann Thorac Surg 2018; 105(2): 581-6.
[http://dx.doi.org/10.1016/j.athoracsur.2017.07.033] [PMID: 29132702]
[41]
Cho JH, Cho HJ, Lee HY, et al. Neutrophil-Lymphocyte Ratio in Patients with Acute Heart Failure Predicts In-Hospital and Long-Term Mortality. J Clin Med 2020; 9(2): 557.
[http://dx.doi.org/10.3390/jcm9020557] [PMID: 32085596]
[42]
Tan TP, Arekapudi A, Metha J, Prasad A, Venkatraghavan L. Neutrophil-lymphocyte ratio as predictor of mortality and morbidity in cardiovascular surgery: a systematic review. ANZ J Surg 2015; 85(6): 414-9.
[http://dx.doi.org/10.1111/ans.13036] [PMID: 25781147]
[43]
Giakoumidakis K, Fotos NV, Patelarou A, et al. Perioperative neutrophil to lymphocyte ratio as a predictor of poor cardiac surgery patient outcomes. Pragmat Obs Res 2017; 8: 9-14.
[http://dx.doi.org/10.2147/POR.S130560] [PMID: 28243161]
[44]
Choi JH, Cho DK, Song YB, et al. Preoperative NT-proBNP and CRP predict perioperative major cardiovascular events in non-cardiac surgery. Heart 2010; 96(1): 56-62.
[http://dx.doi.org/10.1136/hrt.2009.181388] [PMID: 19861299]
[45]
Forget P, Dinant V, De Kock M. Is the Neutrophil-to-Lymphocyte Ratio more correlated than C-reactive protein with postoperative complications after major abdominal surgery? PeerJ 2015; 3e713
[http://dx.doi.org/10.7717/peerj.713] [PMID: 25653901]
[46]
Gibson PH, Croal BL, Cuthbertson BH, et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J 2007; 154(5): 995-1002.
[http://dx.doi.org/10.1016/j.ahj.2007.06.043] [PMID: 17967611]
[47]
Gibson PH, Cuthbertson BH, Croal BL, et al. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 2010; 105(2): 186-91.
[http://dx.doi.org/10.1016/j.amjcard.2009.09.007] [PMID: 20102916]
[48]
Weedle RC, Da Costa M, Veerasingam D, Soo AWS. The use of neutrophil lymphocyte ratio to predict complications post cardiac surgery. Ann Transl Med 2019; 7(23): 778.
[http://dx.doi.org/10.21037/atm.2019.11.17] [PMID: 32042794]
[49]
Ferguson JF, Patel PN, Shah RY, et al. Race and gender variation in response to evoked inflammation. J Transl Med 2013; 11: 63.
[http://dx.doi.org/10.1186/1479-5876-11-63] [PMID: 23497455]
[50]
Laurson KR, McCann DA, Senchina DS. Age, sex, and ethnicity may modify the influence of obesity on inflammation. J Investig Med 2011; 59(1): 27-31.
[http://dx.doi.org/10.2310/JIM.0b013e318200151a] [PMID: 21060285]
[51]
Kim WH, Park JY, Ok SH, Shin IW, Sohn JT. Association Between the Neutrophil/Lymphocyte Ratio and Acute Kidney Injury After Cardiovascular Surgery: A Retrospective Observational Study. Medicine (Baltimore) 2015; 94(43)e1867
[http://dx.doi.org/10.1097/MD.0000000000001867] [PMID: 26512598]
[52]
Kotfis K, Ślozowska J, Safranow K, Szylińska A, Listewnik M. The Practical Use of White Cell Inflammatory Biomarkers in Prediction of Postoperative Delirium after Cardiac Surgery. Brain Sci 2019; 9(11): 308.
[http://dx.doi.org/10.3390/brainsci9110308] [PMID: 31684066]
[53]
Parlar H, Şaşkın H. Are Pre and Postoperative Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio Associated with Early Postoperative AKI Following CABG? Rev Bras Cir Cardiovasc 2018; 33(3): 233-41.
[http://dx.doi.org/10.21470/1678-9741-2017-0164] [PMID: 30043915]
[54]
Egberts A, Fekkes D, Wijnbeld EH, et al. Disturbed serotonergic neurotransmission and oxidative stress in elderly patients with delirium. Dement Geriatr Cogn Disord Extra 2015; 5(3): 450-8.
[http://dx.doi.org/10.1159/000440696] [PMID: 26955379]
[55]
Maldonado JR. Neuropathogenesis of delirium: review of current etiologic theories and common pathways. Am J Geriatr Psychiatry 2013; 21(12): 1190-222.
[http://dx.doi.org/10.1016/j.jagp.2013.09.005] [PMID: 24206937]
[56]
Theologou S, Giakoumidakis K, Charitos C. Perioperative predictors of delirium and incidence factors in adult patients post cardiac surgery. Pragmat Obs Res 2018; 9: 11-9.
[http://dx.doi.org/10.2147/POR.S157909] [PMID: 29773957]
[57]
Massiot N, Lareyre F, Voury-Pons A, et al. High Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio are Associated with Symptomatic Internal Carotid Artery Stenosis. J Stroke Cerebrovasc Dis 2019; 28(1): 76-83.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2018.09.001] [PMID: 30268367]
[58]
Bao X, Zhou G, Xu W, Liu X, Ye Z, Jiang F. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio: novel markers for the diagnosis and prognosis in patients with restenosis following CAS. Biomarkers Med 2020; 14(4): 271-82.
[http://dx.doi.org/10.2217/bmm-2019-0155] [PMID: 32134328]
[59]
King AH, Schmaier AH, Harth KC, et al. Elevated neutrophil-lymphocyte ratio predicts mortality following elective endovascular aneurysm repair. J Vasc Surg 2020; 72(1): 129-37.
[http://dx.doi.org/10.1016/j.jvs.2019.10.058] [PMID: 32037083]
[60]
Bath J, Smith JB, Kruse RL, Vogel TR. Association of neutrophil-to-lymphocyte ratio with outcomes after elective abdominal aortic aneurysm repair. J Vasc Nurs 2019; 37(3): 213-20.
[http://dx.doi.org/10.1016/j.jvn.2019.06.001] [PMID: 31727313]
[61]
Wang S, Liu H, Wang Q, et al. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Are Effective Predictors of Prognosis in Patients with Acute Mesenteric Arterial Embolism and Thrombosis. Ann Vasc Surg 2018; 49: 115-22.
[http://dx.doi.org/10.1016/j.avsg.2018.01.059] [PMID: 29428537]
[62]
Ye M, Qian X, Guo X, et al. Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio Predict Severity and Prognosis of Lower Limb Arteriosclerosis Obliterans. Ann Vasc Surg 2020; 64: 221-7.
[http://dx.doi.org/10.1016/j.avsg.2019.09.005] [PMID: 31655109]
[63]
Demirdal T, Sen P. The significance of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and lymphocyte-monocyte ratio in predicting peripheral arterial disease, peripheral neuropathy, osteomyelitis and amputation in diabetic foot infection. Diabetes Res Clin Pract 2018; 144: 118-25.
[http://dx.doi.org/10.1016/j.diabres.2018.08.009] [PMID: 30176260]
[64]
Huguet E, Maccallini G, Pardini P, et al. Reference Values for Neutrophil to Lymphocyte Ratio (NLR), a Biomarker of Cardiovascular Risk, According to Age and Sex in a Latin American Population. Curr Probl Cardiol 2019; 46(3)100422
[http://dx.doi.org/10.1016/j.cpcardiol.2019.04.002] [PMID: 31103219]
[65]
Ye GL, Chen Q, Chen X, et al. The prognostic role of platelet-to-lymphocyte ratio in patients with acute heart failure: A cohort study. Sci Rep 2019; 9(1): 10639.
[http://dx.doi.org/10.1038/s41598-019-47143-2] [PMID: 31337846]
[66]
Valga F, Monzón T, Henriquez F, Antón-Pérez G. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as biological markers of interest in kidney disease. Nefrologia 2019; 39(3): 243-9.
[http://dx.doi.org/10.1016/j.nefro.2018.11.005] [PMID: 30782498]
[67]
Serra R, Ielapi N, Barbetta A, Buffone G, Bevacqua E, Andreucci M, et al. Biomarkers for precision medicine in phlebology and wound care: A systematic review. Acta Phlebol 2017; 18(2): 52-6.
[68]
Serra R, Ielapi N, Barbetta A, Andreucci M, de Franciscis S. Novel biomarkers for cardiovascular risk. Biomarkers Med 2018; 12(9): 1015-24.
[http://dx.doi.org/10.2217/bmm-2018-0056] [PMID: 30126290]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy