Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Important Indicators for Predicting in-Hospital Death in Elderly AMI Patients

Figures & data

Table 1 Basic Characteristics of Enrolling Patients

Variables	Total Study Population	Without Death	with Death	P value
	N=1550	N=1418	N=132
Male, n(%)	926(59.7)	855(39.7)	71(46.2)	0.145
BMI(kg/m^2)	24.97 ± 3.48	25.08 ± 3.51	24.07 ± 3.04	<0.001
Age(years)	73.10 ± 8.57	72.50 ± 8.30	79.55 ± 8.78	0.818
SBP(mmHg)	138(120,156)	139(121,157)	132(109,141)	0.001
Diabetes, n(%)	671(43.3)	603(42.5)	68(51.5)	0.046
Heart failure, n(%)	1082(69.8)	959(67.6)	123(93.2)	<0.001
Type of AMI				0.048
NSTEMI, n(%)	1102(71.1)	1018(71.8)	84(63.6)
STEMI, n(%)	448(28.9)	400(28.2)	48(36.4)
Previous stroke, n(%)	125(8.1)	108(7.7)	16(12.1)	0.068
Hypertension, n(%)	1079(69.6)	994(70.1)	85(64.3)	0.173
eGFR class				<0.001
>60, n(%)	1099(70.9)	1054(74.3)	45(34.1)
30~60, n(%)	228(14.7)	188(13.3)	40(30.3)
<30, n(%)	223(14.4)	176(12.4)	47(35.6)
Blood routine examination
Neutrophils(10^9/L)	5.18(3.93,7.04)	5.01(3.85,6.63)	8.96(5.87,12.34)	<0.001
Lymphocytes(10^9/L)	1.40(1.05,1.87)	1.42(1.08,1.89)	1.07(0.65,1.70)	<0.001
WBC(10^9/L)	7.50(0.5.93,9.36)	7.32(5.86,9.02)	10.85(8.14,14.39)	<0.001
PLT(10^9/L)	205(170,244)	204.50(170.00,244.00)	208.50(168.00,252.50)	0.969
Hb(g/L)	130(116,142)	131.00(117.75,142.00)	117.50(103.25,132.75)	<0.001
NLR	3.61(2.43,5.83)	3.43(2.37,5.29)	7.74(4.71,14.66)	<0.001
PLR	143.02(107.28,196.92)	140.07(106.06,189.93)	185.85(122.81,284.66)	<0.001
Laboratory data
Na(mmol/L)	140(137.89,141.90)	140.10(138.02,141.92)	138.90(135.52,141.00)	<0.001
K(mmol/L)	3.95(3.66,4.26)	3.93(3.65,4.23)	4.12(3.71,4.58)	<0.001
ALT(U/L)	23.07(15.00,37.29)	22.57(14.96,36.34)	28.77(16.28,62.95)	<0.001
AST(U/L)	29.16(19.56,75.73)	27.83(19.26,66.00)	75.40(29.04,206.57)	<0.001
Triglycerides(mmol/L)	1.31(0.96,1.83)	1.33(0.96,1.85)	1.17(0.93,1.71)	0.048
Total cholesterol(mmol/L)	4.36(3.64,5.20)	4.38(3.65,5.20)	4.31(3.45,5.23)	0.715
LDL-C(mmol/L)	2.41(1.85,3.04)	2.42(1.86,3.04)	2.27(1.73,3.09)	0.331
HDL-C(mmol/L)	1.04(0.90,1.21)	1.03(0.90,1.21)	1.08(0.84,1.29)	0.547
CTNI(ug/L)	1.05(0.55,3.46)	0.98(0.52,2.58)	5.26(0.85,20.22)	<0.001
CK-MB(ug/L)	19.76(14.84,43.05)	19.59(15.00,40.13)	22.25(6.10,96.19)	0.867
Inpatient medication
Aspirin, n(%)	1437(92.7)	1324(93.4)	113(85.6)	0.001
Statins, n(%)	1512(97.5)	1391(98.1)	121(91.7)	<0.001
β-blockers, n(%)	896(57.8)	833(58.7)	63(47.7)	0.014
ACEI/ARBs, n(%)	685(44.2)	653(46.1)	32(24.2)	<0.001

Abbreviations: BMI, body mass index; SBP, systolic blood press; NSTEMI, non-ST segment elevation myocardial infarction; STEMI, ST segment elevation myocardial infarction; eGFR, estimated glomerular filtration rate; WBC, white blood cell; PLT, platelet; Hb, hemoglobin; NLR, neutrophil-lymphocyte ratio; PLR, platelet-lymphocyte ratio; ALT, alanine aminotransferase; AST, aspartate aminotransferase; LDL-C, low-density lipoprotein-cholesterol; HDL-C, high-density lipoprotein-cholesterol; CTNI, cardiac troponin I; CK-MB creatine kinase-MB; ACEIs, angiotensin-converting enzyme inhibitors; ARBs, angiotensin receptor blockers.

Figure 1 The ROC analysis of NLR and PLR predicting in-hospital death in elderly AMI patients. (A) The ROC analysis of NLR predicting in-hospital death in elderly AMI patients; (B) The ROC analysis of PLR predicting in-hospital death in elderly AMI patients.

Abbreviations: ROC curve, receiver operating characteristic curve; NLR, neutrophil-to-Lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; AMI acute myocardial infarction.

Table 2 Univariate Cox Regression Analysis of NLR and PLR for Predicting in-Hospital Mortality in Elderly AMI Patients

Variables	HR	95% CI	P value
Male	0.794	0.563–1.121	0.19
BMI	0.943	0.899–0.989	0.016
Diabetes	1.375	0.977–1.936	0.068
History of stroke	0.190	0.840–2.396	1.419
Type of AMI	1.378	0.966–1.966	0.077
Heart failure	4.640	2.352–9.151	<0.001
Hypertension	0.896	0.625–1.823	0.547
CTNI	1.016	1.013–1.019	<0.001
CK-MB	1.002	1.001–1.003	0.005
Aspirin	0.544	0.333–0.887	0.015
Statins	0.248	0.133–0.460	<0.001
High NLR	5.327	3.720–7.628	<0.001
High PLR	2.064	1.462–2.915	<0.001
eGFR>60(REF)
30~60	3.465	2.256–5.320	<0.001
<30	4.461	2.959–6.724	<0.001

Notes: High NLR = NLR > 6.69; High PLR = PLR >187.6; Type of AMI includes NSTEMI and STEMI, Non-ST-segment elevation myocardial infarction was used as a reference.

Abbreviations: NLR, neutrophil-lymphocyte ratio; PLR, platelet-lymphocyte ratio; AMI, acute myocardial infarction; BMI, body mass index; CTNI, cardiac troponin I; CK-MB creatine kinase-MB; eGFR, estimated glomerular filtration rate.

Table 3 Multivariable Cox Regression of in-Hospital Mortality for Old Patients with AMI

Variables		High NLR			High PLR
	HR	95% CI	P value	HR	95% CI	P value
Model 1	5.327	3.720–7.628	<0.001	2.064	1.462–2.915	<0.001
Model 2	3.654	2.514–5.312	<0.001	1.430	1.006–2.035	0.047
Model 3	3.091	2.097–4.557	<0.001	1.366	0.955–1.953	0.088

Notes: Model 1: we adjusted none; Model 2: we adjusted sex, BMI, diabetes, type of AMI(NSTEMI, STEMI), heart failure and eGFR; Model 3: Model 2 + CTNI, CK-MB, Aspirin use and Statins use. High NLR = NLR > 6.69; High PLR = PLR >187.6.

Abbreviations: AMI, acute myocardial infarction; NLR, neutrophil-lymphocyte ratio; PLR, platelet-lymphocyte ratio; BMI, body mass index; NSTEMI non-ST segment elevation myocardial infarction; STEMI, ST segment elevation myocardial infarction, eGFR, estimated glomerular filtration rate; CTNI, cardiac troponin I; CK-MB creatine kinase-MB.

Figure 2 Dose-response relationship between NLR, PLR and in-hospital mortality in elderly patients with AMI from RCS analysis. (A) Unadjusted dose-response relationship between NLR and in-hospital mortality in elderly patients with AMI; (B) Adjusted dose-response relationship between NLR and in-hospital mortality in elderly patients with AMI; (C) Unadjusted dose-response relationship between PLR and in-hospital mortality in elderly patients with AMI; (D) Adjusted dose-response relationship between PLR and in-hospital mortality in elderly patients with AMI. Adjusted factors include: sex, BMI, diabetes, type of AMI, heart failure, eGFR, CTNI, CK-MB, Aspirin use and Statins use.

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; AMI acute myocardial infarction. RCS, restricted cubic splines; BMI, body mass index; eGFR, estimated glomerular filtration rate; CTNI, cardiac troponin I; CK-MB creatine kinase-MB.

Figure 3 Hazard ratios of the high NLR for predicting in-hospital death in the subgroup analysis.

Abbreviations: AMI, acute myocardial infarction; NSTEMI, non-ST segment elevation myocardial infarction; STEMI, ST segment elevation myocardial infarction; eGFR, estimated glomerular filtration rate.