DIAGNOSTIC UTILITY OF LEUKOCYTE PARAMETERS IN THE PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
DOI:
https://doi.org/10.11603/ijmmr.2413-6077.2020.2.11693Keywords:
inflammation, acute myocardial infarction, complete blood count, leukocytesAbstract
Background. Inflammation is one of the key players in acute myocardial infarction (AMI). One of the ways to evaluate it indirectly is to analyze leukocyte parameters of complete blood count (CBC), which is a routine and affordable method of diagnosis. Leukocyte counts can provide additional information about the course, as well as a potential prognosis for complications of AMI. We suggest that the dynamic changes of CBC during the treatment of the patients with AMI may be of value to assess the prognosis of the course of the disease, and therefore require further study.
Objective. The aim of the study to evaluate the diagnostic and prognostic potential of leukocyte indexes of CBC, in particular the levels of leukocytes, lymphocytes, neutrophils and N/L, WBC/MPV, PLT/L ratios in the patients with AMI at the time of hospitalization and on the 7th day of hospital stay.
Methods. The study involved 204 individuals: 152 patients with AMI (Group 1), 30 patients with stable coronary heart disease (Group 2) and 24 healthy volunteers (Group 3). Hemogram parameters and their ratios, in particular the levels of leukocytes, lymphocytes, neutrophils, ESR, as well as the ratios of N/L and PLT/L were studied.
Results. Levels of leukocytes, neutrophils, lymphocytes, as well as N/L, WBC/MPV, MPV/L ratios were significantly higher in the patients with AMI compared to other groups. The best diagnostic value had such indicators as the total number of leukocytes (sensitivity 71.7%, specificity 69.7%, AUC 0.794), the absolute number of granulocytes (sensitivity 81.7%, specificity 77.4%, AUC 0.803), the N/L ratio (sensitivity 75.0%, specificity 71.7%, AUC 0.791) and the WBC/MPV ratio (sensitivity 76.7%, specificity 62.3%, AUC 0.760). The PLT/L ratio calculated on the 7th day of hospital stay correlated with the risk of in-hospital (r=0.369, p=0.002) and 6-month mortality (r=0.338, p=0.004) according to the GRACE score.
Conclusions. Leukocytes, granulocytes, N/L and WBC/MPV ratios had a fairly high diagnostic value for the patients with AMI. Regarding the prognostic potential assessment, only the PLT/L ratio on the 7th day of hospitalization correlated with the risk of in-hospital and 6-month mortality. This proves the importance of assessing CBC parameters not only at the time of hospitalization, but also in the dynamics of AMI.
References
Frangogiannis NG, Smith CW, Entman ML. The inflammatory response in myocardial infarction. Cardiovasc Res. 2002;53:31–47.
Ferrari JP, Lueneberg ME, da Silva RL, Fattah T, Gottschall CAM, Moreira DM. Correlation between leukocyte count and infarct size in ST segment elevation myocardial infarction. Arch Med Sci Atheroscler Dis. 2016;1:e44–e48.
Italiano JE, Hartwig JH. Chapter 2 – Megakaryocyte Development and Platelet Formation. In: Michelson ADBT-P (Third E (ed). Academic Press; 2013. p. 27-49.
Korniluk A, Koper-Lenkiewicz OM, Kamińska J, Kemona H, Dymicka-Piekarska V. Mean platelet volume (MPV): new perspectives for an old marker in the course and prognosis of inflammatory conditions. Mediators of inflammation. 2019 Oct;2019.
DOI: https://doi.org/10.1155/2019/9213074
Lassale C, Curtis A, Abete I, van der Schouw YT, Verschuren WMM, Lu Y, Bueno-de-Mesquita HB. Elements of the complete blood count associated with cardiovascular disease incidence: Findings from the EPIC-NL cohort study. Sci Rep. 2018;8:3290.
Li J, Wu J, Zhang M, Zheng Y. Dynamic changes of innate lymphoid cells in acute ST-segment elevation myocardial infarction and its association with clinical outcomes. Sci Rep. 2020;10:5099.
Khode V, Sindhur J, Kanbur D, Ruikar K, Nallulwar S. Mean platelet volume and other platelet volume indices in patients with stable coronary artery disease and acute myocardial infarction: A case control study. J Cardiovasc Dis Res. 2012;3:272–75.
Collet J-P, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2020.
DOI: https://doi.org/10.1093/eurheartj/ehaa575
Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39:119–77.
Granger CB, Goldberg RJ, Dabbous O, et al. Predictors of Hospital Mortality in the Global Registry of Acute Coronary Events. Arch Intern Med. 2003;163:2345–53.
Eagle KA, Lim MJ, Dabbous OH, et al. A Validated Prediction Model for All Forms of Acute Coronary SyndromeEstimating the Risk of 6-Month Postdischarge Death in an International Registry. JAMA. 2004;291:2727–33.
Hofmann U, Frantz S. Role of lymphocytes in myocardial injury, healing, and remodeling after myocardial infarction. Circ Res. 2015;116:354–67.
Kalay N, Dogdu O, Koc F, Yarlioglues M, Ardic I, Akpek M, Cicek D, Oguzhan A, Ergin A, Kaya MG. Hematologic parameters and angiographic progression of coronary atherosclerosis. Angiology. 2012;63:213–17.
Azab B, Shah N, Akerman M, McGinn JT. Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction. J Thromb Thrombolysis. 2012;34:326–34.
Alexandrakis MG, Passam FH, Moschandrea IA, Christophoridou A V, Pappa CA, Coulocheri SA, Kyriakou DS. Levels of serum cytokines and acute phase proteins in patients with essential and cancer-related thrombocytosis. Am J Clin Oncol. 2003;26:135–40.
Zhang Q, Si D, Zhang Z, Wang C, Zheng H, Li S, Huang S, Zhang W. Value of the platelet-to-lymphocyte ratio in the prediction of left ventricular thrombus in anterior ST-elevation myocardial infarction with left ventricular dysfunction. BMC Cardiovasc Disord. 2020;20:1–8
Bekler A, Gazi E, Yılmaz M, Temiz A, Altun B, Barutçu A, Peker T. Could elevated platelet-lymphocyte ratio predict left ventricular systolic dysfunction in patients with non-ST elevated acute coronary syndrome? Anatol J Cardiol. 2015;15:385–90.
Akdag S, Akyol A, Asker M, Ozturk F, Gumrukcuoglu HA. The relation of platelet-lymphocyte ratio and coronary collateral circulation in patients with non-ST segment elevation myocardial infarction. Postep w Kardiol Interwencyjnej. 2016;12:224–30.
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