Neutrophil-to-lymphocyte ratio as a prognostic factor in patients with acute pulmonary embolism on the background of oncological disease

Background. Current risk stratification methods for patients with pulmonary embolism (PE) in the context of malignancy do not account for all factors influencing disease course and prognosis. This underscores the importance of investigating inflammatory markers, particularly the neutrophil-to-lymphocyte ratio (NLR) as an accessible and informative prognostic tool. Objective: to determine the clinical and prognostic significance of NLR in patients with acute PE and concomitant cancer. Materials and methods. A retrospective analysis of 291 medical records of patients with acute PE treated at Kharkiv City Clinical Hospital 8 from 2018 to 2020 was conducted, including 92 participants with confirmed malignancy. PE diagnosis was verified by computed tomography pulmonary angiography and/or autopsy findings. All patients underwent laboratory and ultrasound examinations, as well as risk assessment for PE and early mortality according to the 2019 ESC guidelines. Data obtained were subjected to statistical analysis. Results. A comparative assessment of clinical, instrumental, and laboratory parameters was performed in patients with PE depending on cancer presence. Participants with malignancy were older (64 vs. 60.4 years), more frequently had a history of venous thrombosis (15.08 vs. 12.68 %), blood transfusions, and central venous catheter use. Elevated NLR (> 3) was more common in elderly patients (p < 0.008), those who had a stroke (p < 0.045), prolonged bed rest (> 3 days; p < 0.065), diabetes mellitus (p < 0.008), obesity (p < 0.089), high early mortality risk (p < 0.0006), PESI class V (p < 0.001), and high-risk sPESI scores (p < 0.0002). In cancer patients, elevated NLR was associated with kidney disease (p < 0.013), extended bed rest (> 3 days), atrial enlargement, increased left ventricular end-systolic diameter, elevated leukocyte count, fibrinogen, and troponin I levels, and inversely correlated with oxygen saturation and ejection fraction. Conclusions. In cancer patients with PE, elevated NLR is associated with more significant oxygen desaturation, cardiac chamber enlargement, increased cardiomyocyte injury markers, and a higher percentage of patients at elevated in-hospital mortality risk based on established criteria.