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Vol 13, No 1 (2018)
Original Papers
Published online: 2018-03-22
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The role of neutrophil to lymphocyte ratio as a predictor of left ventricular diastolic dysfunction in chronic kidney disease patients

Leszek Gromadziński, Beata Januszko-Giergielewicz, Rakesh Jalali, Tomasz Arłukowicz, Piotr Pruszczyk
DOI: 10.5603/FC.2018.0001
·
Folia Cardiologica 2018;13(1):1-8.

open access

Vol 13, No 1 (2018)
Original Papers
Published online: 2018-03-22

Abstract

Introduction. Left ventricular diastolic dysfunction (LVDD) occurs very often in patients with chronic kidney disease
(CKD). The neutrophil to lymphocyte ratio (NLR) is a novel inflammatory marker, which has a predictive value in different
cardiovascular diseases. We have evaluated the association between NLR and LVDD among CKD patients.
Material and methods. The study group consisted of 54 ambulatory patients with CKD at stages 3–5 with preserved
left ventricular (LV) systolic function. The CKD patients were divided into two groups, depending on the results of mitral
early diastolic velocity EmLV: the group with LV diastolic dysfunction LVDD(+), when EmLV < 8 cm/s, and the group
with normal LV diastolic function LVDD(–), when EmLV ≥ 8 cm/s. NLR was calculated as the ratio of the neutrophil and
lymphocyte counts.
Results. Patients in LVDD(+) group had significantly higher values of NLR when compared to patients in LVDD(–) group
(2.51 [1.12–9.82] vs. 1.75 [0.99–3.64], p = 0.007). NLR negatively correlated with EmLV (r = –0.311, p = 0.021), while
positively with N-terminal B-type natriuretic propeptide (r = 0.292, p = 0.037). Among the examined parameters, NLR
was an independent predictive factor for LVDD with odds ratio 3.14 (95% confidence interval [CI] 1.05–9.42), p = 0.034.
The area under the receiver operating characteristics curve for NLR was 0.714 (95% CI 0.575–0.828), p = 0.003, and
using a cut point of 1.77, the NLR predicted LVDD with a sensitivity of 92.3% and specificity of 53.6%.
Conclusions. This study suggests that elevated neutrophil to lymphocyte ratio as an indicator of inflammation seems to
be a useful marker of LVDD in CKD patients.

Abstract

Introduction. Left ventricular diastolic dysfunction (LVDD) occurs very often in patients with chronic kidney disease
(CKD). The neutrophil to lymphocyte ratio (NLR) is a novel inflammatory marker, which has a predictive value in different
cardiovascular diseases. We have evaluated the association between NLR and LVDD among CKD patients.
Material and methods. The study group consisted of 54 ambulatory patients with CKD at stages 3–5 with preserved
left ventricular (LV) systolic function. The CKD patients were divided into two groups, depending on the results of mitral
early diastolic velocity EmLV: the group with LV diastolic dysfunction LVDD(+), when EmLV < 8 cm/s, and the group
with normal LV diastolic function LVDD(–), when EmLV ≥ 8 cm/s. NLR was calculated as the ratio of the neutrophil and
lymphocyte counts.
Results. Patients in LVDD(+) group had significantly higher values of NLR when compared to patients in LVDD(–) group
(2.51 [1.12–9.82] vs. 1.75 [0.99–3.64], p = 0.007). NLR negatively correlated with EmLV (r = –0.311, p = 0.021), while
positively with N-terminal B-type natriuretic propeptide (r = 0.292, p = 0.037). Among the examined parameters, NLR
was an independent predictive factor for LVDD with odds ratio 3.14 (95% confidence interval [CI] 1.05–9.42), p = 0.034.
The area under the receiver operating characteristics curve for NLR was 0.714 (95% CI 0.575–0.828), p = 0.003, and
using a cut point of 1.77, the NLR predicted LVDD with a sensitivity of 92.3% and specificity of 53.6%.
Conclusions. This study suggests that elevated neutrophil to lymphocyte ratio as an indicator of inflammation seems to
be a useful marker of LVDD in CKD patients.

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Keywords

neutrophil to lymphocyte ratio, diastolic dysfunction, chronic kidney disease

About this article
Title

The role of neutrophil to lymphocyte ratio as a predictor of left ventricular diastolic dysfunction in chronic kidney disease patients

Journal

Folia Cardiologica

Issue

Vol 13, No 1 (2018)

Pages

1-8

Published online

2018-03-22

DOI

10.5603/FC.2018.0001

Bibliographic record

Folia Cardiologica 2018;13(1):1-8.

Keywords

neutrophil to lymphocyte ratio
diastolic dysfunction
chronic kidney disease

Authors

Leszek Gromadziński
Beata Januszko-Giergielewicz
Rakesh Jalali
Tomasz Arłukowicz
Piotr Pruszczyk

References (30)
  1. McAlister FA, Ezekowitz J, Tonelli M, et al. Renal insufficiency and heart failure: prognostic and therapeutic implications from a prospective cohort study. Circulation. 2004; 109(8): 1004–1009.
  2. Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998; 32(5 Suppl 3): S112–S119.
  3. Nardi E, Cottone S, Mulè G, et al. Influence of chronic renal insufficiency on left ventricular diastolic function in hypertensives without left ventricular hypertrophy. J Nephrol. 2007; 20(3): 320–328.
  4. Otsuka T, Suzuki M, Yoshikawa H, et al. Left ventricular diastolic dysfunction in the early stage of chronic kidney disease. J Cardiol. 2009; 54(2): 199–204.
  5. Bruch C, Rothenburger M, Gotzmann M, et al. Chronic kidney disease in patients with chronic heart failure--impact on intracardiac conduction, diastolic function and prognosis. Int J Cardiol. 2007; 118(3): 375–380.
  6. Glassock RJ, Pecoits-Filho R, Barberato SH. Left ventricular mass in chronic kidney disease and ESRD. Clin J Am Soc Nephrol. 2009; 4 Suppl 1: S79–S91.
  7. Foley RN, Parfrey PS, Harnett JD, et al. The impact of anemia on cardiomyopathy, morbidity, and and mortality in end-stage renal disease. Am J Kidney Dis. 1996; 28(1): 53–61.
  8. Honda H, Qureshi AR, Heimbürger O, et al. Serum albumin, C-reactive protein, interleukin 6, and fetuin a as predictors of malnutrition, cardiovascular disease, and mortality in patients with ESRD. Am J Kidney Dis. 2006; 47(1): 139–148.
  9. Lang RM, Bierig M, Devereux RB, et al. Chamber Quantification Writing Group, American Society of Echocardiography's Guidelines and Standards Committee, European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005; 18(12): 1440–1463.
  10. Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986; 57(6): 450–458.
  11. Isaaz K, Thompson A, Ethevenot G, et al. Doppler echocardiographic measurement of low velocity motion of the left ventricular posterior wall. Am J Cardiol. 1989; 64(1): 66–75.
  12. Garcia MJ, Thomas JD, Klein AL. New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol. 1998; 32(4): 865–875.
  13. Arruda-Olson AM, Reeder GS, Bell MR, et al. Neutrophilia predicts death and heart failure after myocardial infarction: a community-based study. Circ Cardiovasc Qual Outcomes. 2009; 2(6): 656–662.
  14. Karabinos I, Koulouris S, Kranidis A, et al. Neutrophil count on admission predicts major in-hospital events in patients with a non-ST-segment elevation acute coronary syndrome. Clin Cardiol. 2009; 32(10): 561–568.
  15. Soylu K, Gedikli Ö, Ekşi A, et al. Neutrophil-to-lymphocyte ratio for the assessment of hospital mortality in patients with acute pulmonary embolism. Arch Med Sci. 2016; 12(1): 95–100.
  16. Shah N, Parikh V, Patel N, et al. Neutrophil lymphocyte ratio significantly improves the Framingham risk score in prediction of coronary heart disease mortality: insights from the National Health and Nutrition Examination Survey-III. Int J Cardiol. 2014; 171(3): 390–397.
  17. Park JJ, Jang HJ, Oh IY, et al. Prognostic value of neutrophil to lymphocyte ratio in patients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol. 2013; 111(5): 636–642.
  18. Börekçi A, Gür M, Türkoğlu C, et al. Neutrophil to Lymphocyte Ratio Predicts Left Ventricular Remodeling in Patients with ST Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention. Korean Circ J. 2016; 46(1): 15–22.
  19. Wasilewski J, Pyka Ł, Hawranek M, et al. Prognostic value of neutrophil‑to‑lymphocyte ratio in predicting long-term mortality in patients with ischemic and nonischemic heart failure. Pol Arch Med Wewn. 2016; 126(3): 166–173.
  20. Yıldız A, Yüksel M, Oylumlu M, et al. The association between the neutrophil/lymphocyte ratio and functional capacity in patients with idiopathic dilated cardiomyopathy. Anatol J Cardiol. 2015; 15(1): 13–17.
  21. Varol E, Aksoy F, Ozaydin M, et al. Association between neutrophil-lymphocyte ratio and mitral annular calcification. Blood Coagul Fibrinolysis. 2014; 25(6): 557–560.
  22. Turak O, Özcan F, Işleyen A, et al. Usefulness of neutrophil-to-lymphocyte ratio to predict in-hospital outcomes in infective endocarditis. Can J Cardiol. 2013; 29(12): 1672–1678.
  23. Demir M, Demir C. Neutrophil/lymphocyte ratio in patients with atrial septal aneurysm. Vasc Health Risk Manag. 2013; 9: 365–368.
  24. Kılıçaslan B, Dursun H, Kaymak S, et al. The relationship between neutrophil to lymphocyte ratio and blood pressure variability in hypertensive and normotensive subjecs. Turk Kardiyol Dern Ars. 2015; 43(1): 18–24.
  25. Anker SD, von Haehling S. Inflammatory mediators in chronic heart failure: an overview. Heart. 2004; 90(4): 464–470.
  26. Akchurin OM, Kaskel F. Update on inflammation in chronic kidney disease. Blood Purif. 2015; 39(1-3): 84–92.
  27. Mann DL, Young JB. Basic mechanisms in congestive heart failure. Recognizing the role of proinflammatory cytokines. Chest. 1994; 105(3): 897–904.
  28. Torre-Amione G, Kapadia S, Benedict C, et al. Proinflammatory cytokine levels in patients with depressed left ventricular ejection fraction: a report from the Studies of Left Ventricular Dysfunction (SOLVD). J Am Coll Cardiol. 1996; 27(5): 1201–1206.
  29. Prabhu SD. Cytokine-induced modulation of cardiac function. Circ Res. 2004; 95(12): 1140–1153.
  30. Karagöz A, Vural A, Günaydın ZY, et al. The role of neutrophil to lymphocyte ratio as a predictor of diastolic dysfunction in hypertensive patients. Eur Rev Med Pharmacol Sci. 2015; 19(3): 433–440.

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