Clinical Utility of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Systemic Immune-Inflammation Index in Predicting Cardiopulmonary Complications
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Keywords
Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, cardiopulmonary complications, risk stratification
Abstract
Background: Cardiopulmonary complications are major drivers of morbidity and mortality in surgical and critically ill populations. Systemic immune-inflammation markers—including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII)—have emerged as accessible hematological biomarkers for risk stratification. This study evaluated the predictive value of baseline NLR, PLR, and SII for post-procedural and critical care cardiopulmonary events.
Methods: A total of 320 patients admitted for acute medical care were evaluated in this prospective observational study. Pre-treatment complete blood counts were used to calculate NLR (absolute neutrophil count / absolute lymphocyte count), PLR (absolute platelet count / absolute lymphocyte count), and SII (absolute platelet count absolute neutrophil count / absolute lymphocyte count). Patients were monitored for 30 days for primary endpoints, which included acute myocardial injury, heart failure exacerbation, cardiac arrhythmias, acute respiratory distress syndrome (ARDS), severe pneumonia, and pulmonary embolism. Receiver operating characteristic (ROC) curves and multivariable logistic regression analyses were performed to evaluate predictive performance.
Results: Cardiopulmonary complications occurred in 78 patients (24.4 percent). Baseline NLR, PLR, and SII were significantly elevated in patients who developed complications compared to those who did not. Receiver operating characteristic analysis demonstrated that SII had the highest predictive accuracy (area under the curve = 0.84), followed by NLR (area under the curve = 0.79) and PLR (area under the curve = 0.72). An optimal cutoff value of 850 for SII yielded 81 percent sensitivity and 76 percent specificity. Multivariable logistic regression identified high SII (adjusted odds ratio: 3.45, 95 percent confidence interval: 1.82 to 6.54, p less than 0.001) and elevated NLR (adjusted odds ratio: 2.15, 95 percent confidence interval: 1.20 to 3.86, p = 0.010) as independent predictors of adverse cardiopulmonary outcomes.
Conclusions: Pre-treatment SII, NLR, and PLR serve as valuable, low-cost prognostic markers for predicting 30-day cardiopulmonary complications. Incorporating these cellular biomarkers into routine risk assessments can improve early clinical stratification and targeted interventions.
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