Introduction Systemic Inflammation may play an important role in the development and progression of Chronic Heart Failure (CHF). Neutrophil-to-lymphocyte ratio (NLR) and reactive thrombocytosis are cellular components of systemic inflammation that are regulated by cytokines especially IL-6. In this study, we investigated the whether a novel inflammation-based system for CHF, collectively named the CPNR (combination of platelet count and NLR), provides additive prognostic value in predicting outcome in CHF patients.
Methods After excluding CHF patients with medical conditions known to affect the total and differential WBC counts, a total of 1557 patients with CHF (mean age 76 ± 11, 34% females, 65% IHD; 57% in NYHA III/IV) were evaluated prospectively from the BIOSTAT-CHF Scotland cohort. Routine laboratory measurements including full blood count was performed at baseline from which NLR and platelet count was determined. The cut-off values of NLR and platelet count were chosen at 3 and 275 respectively so as to maximise model fit, backed up by receiver operating characteristic curve analysis. A patient with both elevated NLR (>3) and platelet count (>275) was allocated a score of 2 (CPNR 2), and a patient shown one or neither was allocated a score of 1 (CPNR 1) or 0 (CPNR 0), respectively. Cox proportional hazard models were used to assess the prognostic impact of CPNR, adjusting for significant covariates.
Results During a median follow-up period of 1.4 years (IQR 0.6,2.2), there were 23% all-cause deaths, 10% CHF deaths and 12% CVD deaths. Mortality rates (95% CI) were higher in CPNR 2 (all-cause: 251, CHF: 129, and CVD: 116 deaths per 1000 person years) as compared to CPNR 1 (all-cause: 189, CHF: 86, and CVD: 99 deaths per 1000 person years) and CPNR 0 (all-cause: 76, CHF: 28 and CVD: 42 deaths per 1000 person years). A Cox proportional hazard model, adjusted for relevant covariates, showed that CPNR was a significant risk factor for mortality [all-cause, HR=1.5 CI=1.3–1.8; CHF, HR=1.65 CI=1.3–2.2; CVD, HR=1.5 CI=1.2–1.9] and CHF hospitalisation (HR=1.3 CI=1.1–1.5).
Conclusion An elevated platelet count and NLR (CPNR 2) is associated with worse clinical outcome in CHF patients. CPNR is a novel and readily available biomarker of inflammation that could potentially help in risk stratification of CHF patients.
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