Role of Neutrophil to Lymphocyte Ratio as a predictor in Risk Stratifying Patients with NSTE-ACS

Background: Acute myocardial infarction is known to be accompanied by elevated leukocyte count. The differentiation of leukocyte types gives an added benefit of judging the severity of A.C.S. & predicting its clinical outcomes. Aim: To test the significance of Neutrophil to Lymphocyte ratio in risk stratifying patients with acute coronary syndromes and its early outcomes.Methods: One hundred patients with UAP and NSTEMI were prospectively evaluated at Ain Shams University Hospital (63% UAP and 37% NSTEMI). The patients were followed-up for clinical outcomes for 48 hours in-hospital & for one month after discharge.Results: The median (IQR) NLR was 8.4 (5.3 to 9.7) in NSTEMI group versus 1.8 (1.2 to 2.8) in unstable angina group, NLR > 3.9 had a sensitivity of 100%, & specificity of 92% as a diagnostic value. The patients were categorized into three groups: low risk, intermediate risk, & high risk, according to TIMI score. In unstable angina patients, the quartiles of NLR in “low risk”, “intermediate risk” and “high risk” groups were 3 (2.0, 4.3), 3.4 (2.4, 5.1) and 5.5 (3.4, 9.65). In NSTEMI patients, the quartiles of NLR in “low risk”, “intermediate risk”, and “high risk” groups were 5.1 (3.1, 8.1), 5.2 (3.0, 9.0) and 6.5 (3.9, 11.7). NLR values were found to be significantly elevated in high-risk groups.Conclusion: NLR on presentation, is a powerful & independent predictor of cardiovascular outcomes in patients with NSTE-ACS. It appears to have the chance of revitalization as a practical biomarker with high clinical predictability and prognostication.