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. 2022 Aug 13;21(1):156.
doi: 10.1186/s12933-022-01583-9.

High neutrophil to lymphocyte ratio with type 2 diabetes mellitus predicts poor prognosis in patients undergoing percutaneous coronary intervention: a large-scale cohort study

Jining He #  1   2 , Xiaohui Bian #  1   2 , Chenxi Song  1   2 , Rui Zhang  1   2 , Sheng Yuan  1   2 , Dong Yin  3 , Kefei Dou  4   5
Affiliations

High neutrophil to lymphocyte ratio with type 2 diabetes mellitus predicts poor prognosis in patients undergoing percutaneous coronary intervention: a large-scale cohort study

Jining He et al. Cardiovasc Diabetol. .

Abstract

Background: Inflammation plays a crucial role in the pathogenesis and progression of coronary artery disease (CAD). The neutrophil to lymphocyte ratio (NLR) is a novel inflammatory biomarker and its association with clinical outcomes in CAD patients with different glycemic metabolism after percutaneous coronary intervention (PCI) remains undetermined. Therefore, this study aimed to investigate the effect of NLR on the prognosis of patients undergoing PCI with or without type 2 diabetes mellitus (T2DM).

Methods: We consecutively enrolled 8,835 patients with CAD hospitalized for PCI at Fuwai hospital. NLR was calculated using the following formula: neutrophil (*109/L)/lymphocyte (*109/L). According to optimal cut-off value, study patients were categorized as higher level of NLR (NLR-H) and lower level of NLR (NLR-L) and were further stratified as NLR-H with T2DM and non-T2DM, and NLR-L with T2DM and non-T2DM. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), defined as all-cause mortality, myocardial infarction (MI), stroke and target vessel revascularization.

Results: A total of 674 (7.6%) MACCEs were recorded during a median follow-up of 2.4 years. The optimal cut-off value of NLR was 2.85 determined by the surv_cutpoint function. Compared to those in the NLR-H/T2DM groups, patients in the NLR-L/non-T2DM, NLR-H/non-T2DM and NLR-L/T2DM groups were at significantly lower risk of 2-year MACCEs [adjusted hazard ratio (HR): 0.67, 95% confidence interval (CI): 0.52 to 0.87, P = 0.003; adjusted HR: 0.62, 95%CI: 0.45 to 0.85, P = 0.003; adjusted HR: 0.77, 95%CI: 0.61 to 0.97, P = 0.025; respectively]. Remarkably, patients in the NLR-L/non-T2DM group also had significantly lower risk of a composite of all-cause mortality and MI than those in the NLR-H/T2DM group (adjusted HR: 0.57, 95%CI: 0.35 to 0.93, P = 0.024). Multivariable Cox proportional hazards model also indicated the highest risk of MACCEs in diabetic patients with higher level of NLR than others (P for trend = 0.009). Additionally, subgroup analysis indicated consistent impact of NLR on MACCEs across different subgroups.

Conclusions: Presence of T2DM with elevated NLR is associated with worse clinical outcomes in CAD patients undergoing PCI. Categorization of patients with elevated NLR and T2DM could provide valuable information for risk stratification of CAD patients.

Keywords: Coronary artery disease; Diabetes; Neutrophil‑to‑lymphocyte ratio; Percutaneous coronary intervention; Prognosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study flowchart. *A total of 708 patients with missing neutrophil or lymphocyte count and 845 patients with missing FBG or HbA1c levels were excluded. PCI, percutaneous coronary intervention; DES, drug-eluting stent; other abbreviations as in Table 1
Fig. 2
Fig. 2
Kaplan–Meier curves for cumulative incidence of MACCEs according to different NLR levels in the T2DM (A) and non-T2DM (B) groups. Abbreviations as in Table 1
Fig. 3
Fig. 3
Kaplan–Meier curves for cumulative incidence of MACCE according to different NLR levels (A), glycemic metabolism status (B), and status of both NLR levels and glycemic metabolism (C). Abbreviations as in Table 1
Fig. 4
Fig. 4
Forest Plot of MACCE According to Various Subgroups. Adjusted for age, male sex, hypertension, dyslipidemia, smoking history, previous MI, previous PCI, previous stroke, Previous PAD, ACS, HbA1c, TG, LDL-C, hsCRP, eGFR, LVEF, DAPT, β blocker, LM/three-vessel disease, CTO, moderate to severe calcification, number of treated vessels, number of stents, IABP use and SYNTAX score. Abbreviations as in Table 1
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