THE PROGNOSTIC VALUE OF NEUTROPHIL-TO-LYMPHOCYTE RATIO IN PREDICTING IN-HOSPITAL OUTCOMES FOR PATIENTS WITH NON-ST-ELEVATION ACUTE CORONARY SYNDROME
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Keywords
Neutrophil-to-lymphocyte ratio (NLR), Non-ST-elevation acute coronary syndrome, Inflammatory biomarkers, In-hospital outcomes
Abstract
Objective: To investigate the association between admission neutrophil-to-lymphocyte ratio (NLR) and clinical outcomes during hospitalization in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) at a major cardiac center in Pakistan.
Study Design: A cross-sectional study
Place and Duration: This study was conducted at Peoples University of Medical and Health Sciences for Women Shaheed Benazirabad Nawabshah from November 2023 to November 2024
Methods: This study enrolled 156 patients aged 18–80 years with NSTE-ACS (unstable angina or non-ST-elevation myocardial infarction [NSTEMI]) after ethical approval and informed consent. NLR was calculated from admission blood samples and stratified as low-risk (<3.0), intermediate-risk (3.0–6.0), and high-risk (>6.0). Outcomes included symptom profiles, ejection fraction, arrhythmias, contrast-induced nephropathy (CIN), and mortality. Data were analyzed using IBM SPSS version 21, with statistical significance at p<0.05.
Results: Of 156 patients (60.3% male, mean age 51–60 years), 51.3% (n=80) were low-risk, 32.1% (n=50) intermediate-risk, and 16.6% (n=26) high-risk. Significant differences included shortness of breath prevalence (19.4% low-risk vs. 42.3% high-risk; p=0.004), ejection fraction (20–40%: 28.8% low-risk vs. 53.8% high-risk; p=0.019), neutrophils (60±8.90% low-risk vs. 85±3.00% high-risk; p<0.001), and lymphocytes (33.5±7.02% low-risk vs. 9.5±2.25% high-risk; p<0.001). In-hospital trends showed arrhythmias (3.8% low-risk vs. 12.5% high-risk; p=0.073), CIN (2.5% low-risk vs. 9.6% high-risk; p=0.078), and mortality (1.3% low-risk vs. 3.8% high-risk; p=0.263), with uniform hospital stays (median 3 days; p=0.311).
Conclusion: Elevated NLR is associated with worse symptom severity, reduced ejection fraction, and trends toward increased complications in NSTE-ACS, supporting its prognostic value in resource-limited settings. Larger studies are needed for validation.
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Altaf Hussain
Altaf Hussain, Associate Professor Cardiology, Sindh Institute of Cardiovascular diseases Hyderabad Pakistan
Rizwan Khan
Rizwan Khan, Assistant Professor Adult Cardiology, Sindh Institute of Cardiovascular diseases Baldia. Pakistan.
Muhammad Hassan
Muhammad Hassan, Associate Professor Adult Cardiology, Sindh Institute of Cardiovascular diseases Sukkur Pakistan
Javed Khurshed Shaikh
Javed Khurshed Shaikh, Associate Professor Adult Cardiology, Sindh Institute of Cardiovascular diseases Sukkur Pakistan
Muhammad Waqas
Muhammad Waqas, Assistant Professor Adult Cardiology, Sindh Institute of Cardiovascular diseases Karachi Pakistan
Imran Ellahi Soomro
Imran Ellahi Soomro, Associate Professor Cardiology, Peoples University of Medical and Health Sciences for Women Shaheed Benazirabad Nawabshah.