The Association of Neutrophil to Lymphocyte Ratio and Other Complete Blood Count Parameters with Global Registry of Acute Coronary Events Risk Score in Patients with Non-ST Segment Elevation - Acute Coronary Syndrome: A Single-Center Study.

Abstract

Background: The involvement of inflammation in the start and advancement of atherosclerotic plaques in acute coronary syndrome has been clarified. White blood cell count and its differential are key inflammatory markers in cardiovascular disease, with the neutrophil-to-lymphocyte ratio (NLR) emerging as a marker of inflammation and a predictor of mortality in patients with acute coronary syndrome. The study aims to investigate the utility of neutrophil to lymphocyte ratio and other complete blood count parameters as a risk stratification tool and independent predictor of Global Registry for Acute Coronary Events (GRACE) risk score in Non-ST segment elevation acute coronary syndrome (NSTE-ACS).

Methods: This was a cross-sectional retrospective single-center study conducted in Baghdad Teaching Hospital. A total of 110 patients diagnosed with NSTE-ACS were enrolled in this study. Demographic data and components that determine the GRACE risk score were recorded at admission to the emergency department alongside risk factors for coronary artery disease. Venous blood for relevant laboratory analysis was obtained from all patients. Patients were categorized into three risk groups according to the GRACE risk score. The study results were statistically analyzed using the one-way Analysis of Variance (ANOVA) test and the Kruskal Wallis test. Spearman test and multiple linear regression analysis were used for correlation and identification of independent predictors respectively.

Results: The mean age of patients was 59.4 years with a standard deviation of 21.1 years. The majority of them were males (61.8%). The predominant portion (102) had non-ST elevation myocardial infarction (NSTEMI). The mean total white blood cell count, absolute neutrophil count, absolute lymphocyte count, and neutrophil to lymphocyte ratio of the patients were 11.1 ×103/ml, 8.7 ×103/ml, 1.7 ×103/ml, and 5.9 respectively. The mean admission left ventricle ejection fraction (LV EF) of the patients was 52.5 % with a standard deviation of 9.6 %. There is a significant positive correlation between NLR and GRACE risk score (r = 0.339, P < 0.001) and a statistically significant negative correlation between NLR and LV EF (r = -0.385, P = 0.005).

Conclusion: This study showed a statistically significant association and positive correlation between neutrophil-to-lymphocyte ratio (NLR) and Global Registry of Acute Coronary Events (GRACE) risk score, so neutrophil-to-lymphocyte ratio (NLR) is a valuable marker for risk stratification and prognosis in NSTE-ACS patients, serving as an independent predictor of the GRACE risk score.