Neutrophil-to-lymphocyte Ratio and 5-year All-cause Mortality in Patients with Heart Failure

doi:10.12114/j.issn.1007-9572.2019.00.632

Abstract

Abstract: Background　The mortality rate of heart failure（HF） remains high.And there are limited clinical studies on the relationship between neutrophil-to-lymphocyte ratio（NLR） and 5-year all-cause mortality in such patients.Objective　To investigate the correlation between NLR and 5-year all-cause mortality in patients with HF.Methods　This study was a single-center retrospective study.418 adult patients with symptomatic HF（NYHA class Ⅲ-Ⅳ） hospitalized in the First Affiliated Hospital of Guangxi Medical University from August，2012 to July，2013 were enrolled.Clinical data and telephone-based follow-up results were collected to understand the 5-year all-cause mortality.The relationship between NLR and 5-year all-cause mortality was analyzed across quartile subgroups stratified by NLR value.Results　The 5-year all-cause mortality in the participants was 55.3%（231/418）．Univariate analysis showed that urea，creatinine，cystatin C，creatine kinase isozyme，plasma N-terminal B-type natriuretic peptide precursor，higher NYHA classes，and elevated NLR increased the risk of 5-year all-cause mortality in HF patients（P<0.05），whereas high weight and triglyceride，the use of β receptor blockers，and women decreased the risk（P<0.05）．After adjusting for other covariates，NLR remained an independent predictor of 5-year all-cause mortality（P<0.05）．Conclusion　NLR is an independent predictor of 5-year all-cause mortality in HF patients.The higher the ratio，the higher the risk.

Key words: Heart failure, Neutrophil, Lymphocyte, Mortality, Neutrophil-to-lymphocyte ratio

摘要：

背景　目前心力衰竭患者的死亡率仍然很高，且国内外关于中性粒细胞与淋巴细胞比值与心力衰竭患者5年全因死亡的相关性临床研究较为缺乏。目的　分析心力衰竭患者中性粒细胞与淋巴细胞比值与5年全因死亡的关系。方法　本研究为单中心回顾性研究，选取2012年8月—2013年7月于广西医科大学第一附属医院住院的成年症状性心力衰竭〔纽约心脏病协会（NYHA）心功能分级Ⅲ~Ⅳ级〕患者418例为研究对象，收集患者的临床资料并电话随访了解心力衰竭患者的5年全因死亡情况。根据患者中性粒细胞与淋巴细胞比值等分为4组，分析中性粒细胞与淋巴细胞比值与心力衰竭患者5年全因死亡率的关系。结果　本研究心力衰竭患者全因死亡率为55.3%（231/418）。单因素分析结果显示，尿素、肌酐、胱抑素C、肌酸激酶同工酶、N末端B型利钠肽前体、心功能分级、中性粒细胞与淋巴细胞比值高是心力衰竭患者5年全因死亡的危险因素（P<0.05），而体质量高、三酰甘油水平高、使用β-受体阻滞剂是心力衰竭患者5年全因死亡的保护因素（P<0.05），女性心力衰竭患者5年全因死亡发生风险低于男性（P<0.05）。在校正了多种混杂因素后，中性粒细胞与淋巴细胞比值仍然是心力衰竭患者5年全因死亡的独立预测因素（P<0.05）。结论　中性粒细胞与淋巴细胞比值是心力衰竭患者5年全因死亡的独立预测因素，比值越高，风险越大。

关键词: 心力衰竭, 中性粒细胞, 淋巴细胞, 死亡率, 中性粒细胞与淋巴细胞比值

LUO Faxin,YE Ziliang,ZHU Jijin. Neutrophil-to-lymphocyte Ratio and 5-year All-cause Mortality in Patients with Heart Failure　[J]. Chinese General Practice, 2019, 22(34): 4213-4219. DOI: 10.12114/j.issn.1007-9572.2019.00.632.
罗发新,叶自亮,朱继金. 心力衰竭患者中性粒细胞与淋巴细胞比值与5年全因死亡的关系研究[J]. 中国全科医学, 2019, 22(34): 4213-4219. DOI: 10.12114/j.issn.1007-9572.2019.00.632.

References

［1］PONIKOWSKI P，VOORS A A，ANKER S D，et al．2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure：the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology（ESC）developed with the special contribution of the Heart Failure Association（HFA）of the ESC［J］．Eur J Heart Fail，2016，18（8）：891-975．DOI：10.1002/ejhf.592.
［2］黄尧，操基玉，程自平．合肥某三甲医院2012—2014年心血管病住院患者流行病学分析［J］．安徽医学，2017，38（2）：144-146．DOI：10.3969/j.issn.1000-0399.2017.02.005.
HUANG Y，CAO J Y，CHENG Z P．Epidemiology analysis of inpatients with cardiovascular diseases in a certain hospital of Hefei in 2012—2014［J］．Anhui Medical Journal，2017，38（5）：144-146．DOI：10.3969/j.issn.1000-0399.2017.02.005.
［3］中华医学会心血管病学分会.中国心力衰竭诊断和治疗指南2014［J］．中华心血管病杂志，2014，42（2）：3-10.https：//wenku.baidu.com/view/3308024b6c85ec3a87c2c585.html.
［4］HE J Y，LI J，WANG Y F，et al．Neutrophil-to-lymphocyte ratio（NLR）predicts mortality and adverse-outcomes after ST-segment elevation myocardial infarction in Chinese people［J］．Int J Clin Exp Pathol，2014，7（7）：4045-4056.
［5］SAWANT A C，ADHIKARI P，NARRA S R，et al．Neutrophil to lymphocyte ratio predicts short- and long-term mortality following revascularization therapy for ST elevation myocardial infarction［J］．Cardiol J，2014，21（5）：500-508．DOI：10.5603/CJ.a2013.0148.
［6］WANG X D，ZHANG G Y，JIANG X J，et al．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［J］．Atherosclerosis，2014，234（1）：206-213．DOI：10.1016/j.atherosclerosis.2014.03.003.
［7］MCMURRAY J J，ADAMOPOULOS S，ANKER S D，et al．ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012：the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology developed in collaboration with the Heart Failure Association（HFA）of the ESC［J］．Eur J Heart Fail，2012，14（8）：803-869．DOI：10.1093/eurjhf/hfs105.
［8］周京敏，崔晓通，葛均波.中国心力衰竭的流行病学概况［J］．中华心血管病杂志，2015，43（12）：1018-1021.http：//www.360doc.com/content/16/0928/18/17155989_594445555.shtml.
［9］ENGSTRO M G，MELANDER O，HEDBLAD B.Leukocyte count and incidence of hospitalizations due to heart failure［J］．Circ Heart Fail，2009，2（3）：217-222．DOI：10.1161/circheartfailure.108.827071.
［10］ARRUDA-OLSON A M，REEDER G S，BELL M R，et al．Neutrophilia predicts death and heart failure after myocardial infarction：a community-based study［J］．Circ Cardiovasc Qual Outcomes，2009，2（6）：656-662．DOI：10.1161/CIRCOUTCOMES.108.831024.
［11］RUDIGER A，BURCKHARDT O A，HARPES P，et al．The relative lymphocyte count on hospital admission is a risk factor for long-term mortality in patients with acute heart failure［J］．Am J Emerg Med，2006，24（4）：451-454．DOI：10.1016/j.ajem.2005.10.010.
［12］YAN W，LIU C L，LI R J，et al．Usefulness of the neutrophil-to-lymphocyte ratio in predicting adverse events in elderly patients with chronic heart failure［J］．Int Heart J，2016，57（5）：615-621．DOI：10.1536/ihj.16-049.
［13］WASILEWSKI J，PYKA L，HAWRANEK M，et al．Prognostic value of neutrophil?to?lymphocyte ratio in predicting long-term mortality in patients with ischemic and nonischemic heart failure［J］．Pol Arch Med Wewn，2016，126（3）：166-173．DOI：10.20452/pamw.3316.
［14］DURMUS E，KIVRAK T，GERIN F，et al．Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are predictors of heart failure［J］．Arq Bras Cardiol，2015，105（6）：606-613．DOI：10.5935/abc.20150126.
［15］BENITES-ZAPATA V A，HERNANDEZ A V，NAGARAJAN V，et al．Usefulness of neutrophil-to-lymphocyte ratio in risk stratification of patients with advanced heart failure［J］．Am J Cardiol，2015，115（1）：57-61．DOI：10.1016/j.amjcard.2014.10.008.
［16］TASAL A，ERTURK M，UYAREL H，et al．Utility of the neutrophil to lymphocyte ratio for predicting in-hospital mortality after levosimendan infusion in patients with acute decompensated heart failure［J］．J Cardiol，2014，63（6）：418-423．DOI：10.1016/j.jjcc.2013.10.009.
［17］ROSS R.Atherosclerosis：an inflammatory disease［J］．N Engl J Med，1999，340（2）：115-126．DOI：10.1056/nejm199901143400207.
［18］TOUSOULIS D，ANTONIADES C，KOUMALLOS N，et al．Pro-inflammatory cytokines in acute coronary syndromes：from bench to bedside［J］．Cytokine Growth Factor Rev，2006，17（4）：225-233．DOI：10.1016/j.cytogfr.2006.04.003.
［19］TANG W H，TONG W，TROUGHTON R W，et al．Prognostic value and echocardiographic determinants of plasma myeloperoxidase levels in chronic heart failure［J］．J Am Coll Cardiol，2007，49（24）：2364-2370．DOI：10.1016/j.jacc.2007.02.053.
［20］CHEN W，FRANGOGIANNIS N G.The role of inflammatory and fibrogenic pathways in heart failure associated with aging［J］．Heart Fail Rev，2010，15（5）：415-422．DOI：10.1007/s10741-010-9161-y.
［21］CAK C M，CETIN M，DOGAN A，et al．Neutrophil to lymphocyte ratio predicts poor functional capacity in patients with heart failure［J］．Turk Kardiyol Dern Ars，2014，42（7）：612-620．DOI：10.5543/tkda.2014.16363.
［22］AZAB B，ZAHER M，WEISERBS K F，et al．Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction［J］．Am J Cardiol，2010，106（4）：470-476．DOI：10.1016/j.amjcard.2010.03.062.
［23］HOTCHKISS R S，KARL I E．The pathophysiology and treatment of Sepsis［J］．N Engl J Med，2003，348（2）：138-150．DOI：10.1056/NEJMra021333.
［24］YüCEL H，REFIKEROEGE M，ZORLU A，et al．Lymphocytopenia is associated with poor NYHA functional class in chronic heart failure patients with reduced ejection fraction［J］．Turk Kardiyol Dern Ars，2015，43（5）：427-433．DOI：10.5543/tkda.2015.89439.
［25］PI?A I L，LIN L，WEINFURT K P，et al．Hemoglobin，exercise training，and health status in patients with chronic heart failure（from the HF-ACTION randomized controlled trial）［J］．Am J Cardiol，2013，112（7）：971-976．DOI：10.1016/j.amjcard.2013.05.033.
［26］徐帅，王莉．外周血中性粒细胞/淋巴细胞比值与急性ST段抬高型心肌梗死患者急性肾损伤的关系研究［J］．实用心脑肺血管病杂志，2017，25（11）：26-29．DOI：10.3969/j.issn.1008-5971.2017.11.007.
XU S，WANG L．Relationship between neutrophilia/lymphocyte ratio and acute kidney injury in patients with acute ST segment elevation myocardial infarction［J］．Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease，2017，25（11）：26-29．DOI：10.3969/j.issn.1008-5971.2017.11.007.
［27］SMITH G L，RADFORD M J，RATHORE S S，et al．Elevated serum creatinine and increased mortality in women and elderly heart failure patients［J］．J Am Coll Cardiol，2002，39：441．DOI：10.1016/S0735-1097（02）81983-0.
［28］ALEHAGEN U，DAHLSTR?M U，LINDAHL T L.Cystatin C and NT-proBNP，a powerful combination of biomarkers for predicting cardiovascular mortality in elderly patients with heart failure：results from a 10-year study in primary care［J］．European Journal of Heart Failure，2014，11（4）：354-360．DOI.org/10.1093/eurjhf/hfp024.

[1]	YUAN Yujuan, TAO Jing, WANG Ying, PENG Hui, YANG Yining. Elevated Neutrophil Percentage to Albumin Ratio is Associated with In-hospital Outcomes in Patients with Acute Myocardial Infarction [J]. Chinese General Practice, 2026, 29(18): 2489-2497.
[2]	MA Xiaoyu, MA Xiaomei, WU Guozhi, ZHENG Ya, GUO Qinghong. Research Progress of Neutrophil Extracellular Traps in Gastric Cancer [J]. Chinese General Practice, 2026, 29(17): 2425-2432.
[3]	LI Shilong, WANG He, ZHOU Xiaoyu, FU Lei, ZHAO Zhuo, HUA Chengjun, SI Chunying. Advances in the Study of Cardiac Macrophages in Heart Failure with Preserved Ejection Fraction [J]. Chinese General Practice, 2026, 29(15): 2084-2091.
[4]	LI Jiali, LIU Fan, KE Lixin, LI Huijuan, WANG Haibo, ZHAO Xiaoxiao, ZHAO Xinke, LU Cuncun. Disease Burden of Obesity among Individuals Aged 60 and above Globally and in China from 1990 to 2021: Trend Analysis and Model-based Projection [J]. Chinese General Practice, 2026, 29(15): 2067-2076.
[5]	ZHEN Rui, GU Xufang, GAO Shengwei, ZHANG Bowen, REN Zhenjuan, YANG Ruixuan. Burden of Cardiovascular Diseases Attributable to Metabolic Risk Factors in China 1990—2021 and Projected Trends from 2022 to 2035 [J]. Chinese General Practice, 2026, 29(15): 2077-2083.
[6]	QIU Yanli, GAO Yongyin, BIAN Xueyan, WANG Xue, LI Yue. The Predictive Value of Estimated Pulse Wave Velocity for All-cause and Cardiovascular-related Mortality in Cancer Patients [J]. Chinese General Practice, 2026, 29(14): 1890-1897.
[7]	LI Zhen, WANG Chengyong. Association of Neutrophil-to-lymphocyte Ratio, Systemic Immune-inflammation Index, and Monocyte-to-lymphocyte Ratio with Disease Prognosis in Patients with Advanced Prostate Cancer [J]. Chinese General Practice, 2026, 29(14): 1878-1882.
[8]	WANG Yiheng, XU Xiaoming, XIA Yunlong, XIA Linying, HAN Xue, GUO Yongzhen, LIU Quanchi, YAN Wenjun. Progress in Pharmacotherapy of Heart Failure with Preserved Ejection Fraction [J]. Chinese General Practice, 2026, 29(03): 403-408.
[9]	JIANG Xiaorui, YAN Yuyao, WEI Jingjing, QIAO Lijie, PENG Guangcao, ZHU Mingjun. Systematic Review of Risk Prediction Models for Concurrent Heart Failure with Coronary Heart Disease [J]. Chinese General Practice, 2026, 29(03): 393-402.
[10]	CHEN Xueqin, WANG Shihong, LAI Fengxia, ZHANG Jingjing, CHEN Hao, KONG Danli, DING Yuanlin. Study on Trend Analysis and Forecast of Incidence, Disease and Mortality of Chronic Obstructive Pulmonary Disease in China, 1990-2021 [J]. Chinese General Practice, 2026, 29(02): 264-272.
[11]	YANG Qinghui, HU Yingxue, NI Pingwei, LIU Xiao. Analysis of the Incidence and Mortality Trends of Lung Cancer in China from 1990 to 2021 and Prediction for 2035 [J]. Chinese General Practice, 2026, 29(02): 256-263.
[12]	MI Lingyu, CHEN Lianxin, GAO Hengbo, WANG Bincheng. Predictive Value of Triglyceride-glucose Index for Prognosis in Patients with Pulmonary Embolism [J]. Chinese General Practice, 2025, 28(35): 4421-4429.
[13]	LIU Yongcheng, LIU Siyu, LIANG Xiaoyu, HAO Xiaopeng, WEI Yue, DONG Guoju. Analysis of Echocardiographic Outcome Measures in Randomized Controlled Trials in Heart Failure with Preserved Ejection Fraction [J]. Chinese General Practice, 2025, 28(33): 4140-4147.
[14]	LIU Mingbo, HE Xinye, YANG Xiaohong, WANG Zengwu. Interpretation of Report on Cardiovascular Health and Diseases in China 2024 [J]. Chinese General Practice, 2025, 28(32): 3989-4008.
[15]	ZHANG Ji, ZHOU Jie, LI Ling, WU Yanli, JI Wei, LIU Tao. Associations of Fasting Blood Glucose with All-cause Mortality and Specific-cause Mortality in a Prospective Cohort Study [J]. Chinese General Practice, 2025, 28(31): 3924-3931.