Role of WBC count and neutrophil to lymphocyte ratio in predicting in-hospital outcome after acute myocardial infarction

摘要

Background: Current evidence supports a central role for inflammationin all phases of the atherosclerotic process. Substantialbiological data implicate inflammatory pathways in earlyatherogenesis, in the progression of lesions, and finally in thethrombotic complications of this disease.Aims: To evaluate the role of total WBC count and Neutrophil tolymphocyte ratio as a predictor of in-hospital outcome for adverseevents (death and heart failure) for the patients presented withAMI.Methods: Patients were those who presented with us at least twoof the following increase in the levels of myocardial necrosis(troponin I >1 ng/ml); new ST elevation from the J point in two ormore contiguous leads with an elevation of at least 0.2mV in leadsV1, V2 and V3 or at least 0.1 mV Results on continuous measurementsare presented on Mean ± SD (Min-Max) and results oncategorical measurements are presented in Number (%). Chisquare (2) test was used to determine the association or relationshipbetween 2 categorical variable.Results: In our study, WBC count had statistically significantcorrelation with incidence of heart failure. There was strong statisticallysignificant and strong association between level of tertileand incidence of heart failure with a p value of < 0.001 and averageWBC count being 13329.30 ± 3321.78 in patients with heart failureand 10128.13 ± 2651.14 in those without heart failure. Neutrophilto lymphocyte ratio (NLR) had statistically significant correlationwith incidence of heart failure. There was strong statisticallysignificant, and strong association between level of tertile andincidence of heart failure with a p value of < 0.001 and averageNLR being 4.02 ± 1.56 in patients with heart failure and 1.84 ± 0.63in those without heart failure. WBC count had statistically significantcorrelation with incidence of mortality. There was strongstatistically significant, and strong association between level oftertile and incidence of mortality with a p value of < 0.001 andaverage WBC count being 14588 ± 3384 in patients with mortalityand 11020 ± 2944 in those without mortality. Neutrophil tolymphocyte ratio had statistically significant correlation withincidence of mortality. There was strong statistically significantand strong association between level of tertile and incidence ofmortality with a p value of < 0.001 and average NLR being 4.86 ±1.712 in patients with mortality and 2.45 ± 1.054 in those withoutmortality. In our study we found statistically significant andstrong correlation between the level of Killip class and level oftertile. In our study patients with lower Killip class had lower WBCcounts and those with higher Killip class had higher WBC countsand the difference was strongly statistically significant with a pvalue of < 0.001 with the average WBC count being 10128 ± 2651 inKillip I, 11754 ± 2630 in Killip II , 12727 ± 2790 in Killip III and 15166± 3640 in Killip IV. (table No.13,15). A strong correlation betweenthe level of Killip class and level of NLR tertile.In our study patientswith lower Killip class had lower NLR and those with higherKillip class had higher NLR and the difference was strongly statisticallysignificant with a p value of < 0.001 with the average NLRbeing 1.85 ± 0.626 in Killip I, 2.6 ± 0.607 in Killip II , 3.84 ± 0.952 inKillip III and 5.27 ± 1.642 in Killip IV.Conclusion: The present study was designed to determine predictiverole of WBC count on admission for mortality in patients ofACS; where lack of resources keeps the access of so many to thebest diagnostic methods, WBC count and NLR may become anadditional parameter for the preliminary approach of patientswith AMI. We finally conclude that WBC count and N/L are simpleand cost effective tools of determining in hospital outcome inpatients with acute MI.