Higher Neutrophil to Lymphocyte Ratio at Admission is Association with Post-PCI Depressive Symptoms in Patients with ACS

Figures & data

Figure 1 Study recruitment profile.

Abbreviations: ACS, acute coronary syndrome; PCI, percutaneous coronary intervention.

Table 1 Patient Characteristics According to Post-PCI Depressive Symptoms

Variable	ALL (n=224)	Non-Depression (n=172)	Depression (n=52)	P-value
Demographic characteristics
Age (year)	62.34±10.54	53.61±13.09	58.82± 12.89	0.007
BMI (kg/m^2)	22.44±3.59	22.58±3.69	21.95±3.20	0.266
Male, n (%)	165 (73.7)	137 (79.7)	28 (53.8)	<0.001
Married, n (%)	202 (90.2)	161 (93.6)	41 (78.8)	0.002
Education, n (%)				0.375
Below	168 (75.0)	125 (72.7)	43 (82.7)
High school	44 (19.6)	37 (21.5)	7 (13.5)
Above	12 (5.4)	10 (5.8)	2 (3.8)
Medical history
Hypertension, n (%)	132 (58.9)	91 (52.9)	41 (78.8)	0.001
Diabetes, n (%)	46 (20.5)	33 (19.2)	13 (25.0)	0.433
Smoking, n (%)	130 (58.0)	105 (61.0)	25 (48.1)	0.110
Drinking, n (%)	98 (43.8)	79 (45.9)	19 (36.5)	0.266
Laboratory findings
Monocytes, 10^9/L, median (IQR)	0.40 (0.29, 0.51)	0.40 (0.30, 0.50)	0.35 (0.27, 0.55)	0.395
Neutrophils, 10^9/L, median (IQR)	4.52 (3.29, 6.62)	4.37 (3.13, 6.39)	5.60 (3.82, 7.40)	0.006
Lymphocytes, 10^9/L, median (IQR)	1.46 (1.05, 2.04)	1.57 (1.11, 2.32)	1.23 (0.99, 1.76)	0.008
Platelets, 10^9/L, median (IQR)	185.0 (154.25, 231.00)	187.50 (155.25, 230.0)	178.50 (149.25, 238.5)	0.867
NLR	2.84 (1.95, 4.48)	2.57 (1.72, 3.91)	4.33 (3.26, 7.01)	< 0.001
Coronary angiography
Gensini score, median (IQR)	45.50 (32.00, 66.00)	41.0 (30.0, 57.88)	66.5 (48.50, 94.75)	< 0.001
Number of lesion, n (%)				< 0.001
Single-branch	63 (28.1)	56 (32.6)	7 (13.5)
Double-branch	83 (37.1)	69 (40.1)	14 (26.9)
Multi-branch	78 (34.8)	47 (27.3)	31 (59.6)
HAMD score, median (IQR)	10.50 (7.00, 17.00)	9.00 (6.00, 12.75)	24.00 (22.00, 26.00)	< 0.001

Note: Data in bold indicates statistical significance (P<0.05).

Abbreviations: BMI, body mass index; NLR, neutrophil to lymphocyte ratio; IQR, inter-quartile range; HAMD, Hamilton depression scale.

Table 2 Baseline Characteristics of Post-PCI Patients in NLR Quartiles

Variables	All Patients	NLR Quartiles
		Quartile 1 (≤ 1.95)	Quartile 2 (1.96–2.84)	Quartile 3 (2.85–4.46)	Quartile 4 (≥4.47)	P-value
Demographic characteristics
Age (year)	62.34±10.54	60.81±11.11	60.98±11.07	65.47±8.18	62.18±11.05	0.070
BMI (kg/m^2)	22.44±3.59	22.64±3.30	22.48±3.57	22.12±3.57	22.49±3.96	0.892
Male, n (%)	165 (73.7)	43 (75.4)	39 (69.6)	42 (76.4)	41 (73.2)	0.858
Married, n (%)	202 (90.2)	56 (98.2)	51 (91.1)	45 (81.8)	50 (89.3)	0.032
Education, n (%)						0.069
Below	168 (75.0)	43 (75.4)	36 (64.3)	40 (72.7)	49 (87.5)
High school	44 (19.6)	12 (21.1)	15 (26.8)	13 (23.6)	4 (7.1)
Above	12 (5.4)	2 (3.5)	5 (8.9)	2 (3.6)	3 (5.4)
Medical history
Hypertension, n (%)	132 (58.9)	31 (54.4)	36 (64.3)	36 (65.5)	29 (51.8)	0.348
Diabetes, n (%)	46 (20.5)	9 (15.8)	13 (23.2)	10 (18.2)	14 (25.0)	0.319
Smoking, n (%)	130 (58.0)	36 (63.2)	32 (57.1)	35 (63.6)	27 (48.2)	0.313
Drinking, n (%)	98 (43.8)	25 (43.9)	26 (46.4)	29 (52.7)	18 (32.1)	0.171
Laboratory findings
Monocytes, 10^9/L, median (IQR)	0.40 (0.29, 0.51)	0.41 (0.33, 0.55)	0.38 (0.27, 0.48)	0.41 (0.32, 0.51)	0.35 (0.27, 0.54)	0.148
Neutrophils, 10^9/L, median (IQR)	4.52 (3.29, 6.62)	3.17 (2.56, 4.63)	3.87 (3.19, 4.61)	4.66 (3.61, 6.13)	7.27 (5.45, 8.49)	< 0.001
Lymphocytes, 10^9/L, median (IQR)	1.46 (1.05, 2.04)	2.5 (1.85, 3.55)	1.58 (1.39, 2.02)	1.27 (1.00, 1.74)	1.00 (0.68, 1.29)	< 0.001
Platelets, 10^9/L, median (IQR)	185.0 (154.25, 231.00)	177.0 (150.0, 224.0)	191.0 (157.25, 223.75)	193.0 (140.0, 242.0)	182.0 (155.50, 235.25)	0.878
NLR, median (IQR)	2.84 (1.95, 4.48)	1.42 (1.21, 1.70)	2.31 (2.13, 2.66)	3.65 (3.22, 3.95)	7.12 (5.53, 9.66)	< 0.001
Coronary angiography
Gensini score, median (IQR)	45.50 (32.00, 66.00)	44.0 (32.0, 61.5)	42.0 (29.75, 59.38)	46.0 (32.00, 65.00)	56.0 (32.75, 76.00)	0.195
Number of lesion, n (%)						0.302
Single-branch	63 (28.1)	16 (28.1)	17 (30.4)	13 (23.6)	17 (30.4)
Double-branch	83 (37.1)	26 (45.6)	22 (39.3)	21 (38.2)	14 (25.0)
Multi-branch	78 (34.8)	15 (26.3)	17 (30.4)	21 (38.2)	25 (44.6)
HAMD score, median (IQR)	10.50 (7.00, 17.00)	7.00 (5.00, 10.00)	8.00 (6.00, 11.75)	14.00 (8.00, 20.00)	17.00 (13.00, 24.00)	< 0.001

Note: Data in bold indicates statistical significance (P<0.05).

Abbreviations: BMI, body mass index; NLR, neutrophil to lymphocyte ratio; HAMD, Hamilton Depression Scale; IQR, inter-quartile range.

Figure 2 The proportion of post-PCI depressive symptoms for the quartiles of NLR at admission.

Abbreviations: NLR, neutrophil to lymphocyte ratio; PCI, percutaneous coronary intervention.

Table 3 Multivariate Adjusted Odds Ratios for the Association Between NLR Levels and Post-PCI Depressive Symptoms

	OR (95% CI)^a				P-value for Trend^b
	Quartile 1	Quartile 2	Quartile 3	Quartile 4
Unadjusted	1.000 (reference)	2.208 (0.625, 7.802)	6.446 (2.017, 20.602)	8.574 (2.717, 27.053)	<0.001
P-value		0.219	0.002	<0.001
Model 1^c	1.000 (reference)	2.102 (0.575, 7.685)	6.826 (2.039, 22.852)	9.633 (2.915, 31.838)	<0.001
P-value		0.262	0.002	<0.001
Model 2^d	1.000 (reference)	2.310 (0.482, 11.063)	8.420 (1.868, 37.950)	12.208 (2.698, 55.241)	<0.001
P-value		0.295	0.006	0.001
Model 3^e	1.000 (reference)	2.255 (0.466, 10.920)	8.580 (1.882, 39.118)	12.028 (2.642, 54.752)	<0.001
P-value		0.312	0.005	0.001

Notes: ^aReference OR (1.000) is the Quartile 4 of NLR. ^bTest for trend based on variable containing median value for each quartile. ^cModel 1: adjusted for age, sex. ^dModel 2: adjusted for covariates from Model 1 and further adjusted for variables with P < 0.05 in univariate analysis (married, Hypertension, Gensini score, Number of lesion). ^eModel 3: adjusted for covariates from Model 2 and further adjusted for conventional confounding factors (smoking, diabetes).

Abbreviations: OR, odds radio; CI, confidence level.

Figure 3 ROC curves for predicting of post-PCI depressive symptoms.

Abbreviations: NLR, neutrophil to lymphocyte ratio; ROC, receiver operating characteristic.