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Published in: BMC Cardiovascular Disorders 1/2021

Open Access 01-12-2021 | Heart Failure | Research

The association between platelet-to-lymphocyte ratio with mortality among patients suffering from acute decompensated heart failure

Authors: Maryam Heidarpour, Sepideh Bashiri, Mehrbod Vakhshoori, Kiyan Heshmat-Ghahdarijani, Farbod Khanizadeh, Shaghayegh Ferdowsian, Davood Shafie

Published in: BMC Cardiovascular Disorders | Issue 1/2021

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Abstract

Background

Platelet-to-lymphocyte ratio (PLR) is an inflammation index suggested to have the prognostic capability in heart failure (HF). We sought to investigate the association of PLR with cardiovascular disease (CVD) mortality and creatinine (Cr) rise among Iranian individuals suffering from acute decompensated HF (ADHF).

Methods

This retrospective cohort study was in the context of the Persian Registry Of cardioVascular diseasE/Heart Failure (PROVE/HF) study. 405 individuals with ADHF admitted to the emergency department were recruited from April 2019 to March 2020. PLR was calculated by division of platelet to absolute lymphocyte counts and categorized based on quartiles. We utilized the Kaplan–Meier curve to show the difference in mortality based on PLR quartiles. Cr rise was defined as the increment of at least 0.3 mg/dl from baseline. Cox proportional hazard ratio (HR) was used to investigate the association of PLR with CVDs mortality.

Results

Mean age of participants was 65.9 ± 13.49 years (males: 67.7%). The mean follow-up duration was 4.26 ± 2.2 months. CVDs mortality or re-hospitalization was not significantly associated with PLR status. Multivariate analysis of PLR quartiles showed a minimally reduced likelihood of CVDs death in 2nd quartile versus the first one (HR 0.40, 95% confidence interval (CI) 0.16–1.01, P = 0.054). Cr rise had no remarkable relation with PLR status in neither model.

Conclusion

PLR could not be used as an independent prognostic factor among ADHF patients. Several studies are required clarifying the exact utility of this index.
Literature
1.
go back to reference McMurray J, Adamopoulos S, Anker S, Auricchio A, Böhm M, Dickstein K, et al. ESC Committee for Practice Guidelines. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787–847.CrossRef McMurray J, Adamopoulos S, Anker S, Auricchio A, Böhm M, Dickstein K, et al. ESC Committee for Practice Guidelines. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787–847.CrossRef
2.
go back to reference Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007;93(9):1137–46.CrossRef Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007;93(9):1137–46.CrossRef
3.
go back to reference Arrigo M, Parissis JT, Akiyama E, Mebazaa A. Understanding acute heart failure: pathophysiology and diagnosis. Eur Heart J Suppl. 2016;18(suppl_G):G11–8.CrossRef Arrigo M, Parissis JT, Akiyama E, Mebazaa A. Understanding acute heart failure: pathophysiology and diagnosis. Eur Heart J Suppl. 2016;18(suppl_G):G11–8.CrossRef
4.
go back to reference Hoseinbor M, Vakhshoori M, Babak A, Givi M, Heidarpour M, Nikouei F, et al. Frequency of readmission in Iranian heart failure patients within six months after discharge and its association with guideline directed medical treatment. Drug Invention Today. 2019;11(11):2737–41. Hoseinbor M, Vakhshoori M, Babak A, Givi M, Heidarpour M, Nikouei F, et al. Frequency of readmission in Iranian heart failure patients within six months after discharge and its association with guideline directed medical treatment. Drug Invention Today. 2019;11(11):2737–41.
5.
go back to reference Gheorghiade M, Zannad F, Sopko G, Klein L, Piña IL, Konstam MA, et al. Acute heart failure syndromes: current state and framework for future research. Circulation. 2005;112(25):3958–68.CrossRef Gheorghiade M, Zannad F, Sopko G, Klein L, Piña IL, Konstam MA, et al. Acute heart failure syndromes: current state and framework for future research. Circulation. 2005;112(25):3958–68.CrossRef
6.
go back to reference Sabbah HN. Pathophysiology of acute heart failure syndrome: a knowledge gap. Heart Fail Rev. 2017;22(6):621–39.CrossRef Sabbah HN. Pathophysiology of acute heart failure syndrome: a knowledge gap. Heart Fail Rev. 2017;22(6):621–39.CrossRef
7.
go back to reference de Boer RA, Daniels LB, Maisel AS, Januzzi JL Jr. State of the art: newer biomarkers in heart failure. Eur J Heart Fail. 2015;17(6):559–69.CrossRef de Boer RA, Daniels LB, Maisel AS, Januzzi JL Jr. State of the art: newer biomarkers in heart failure. Eur J Heart Fail. 2015;17(6):559–69.CrossRef
8.
go back to reference Koosha P, Roohafza H, Sarrafzadegan N, Vakhshoori M, Talaei M, Sheikhbahaei E, et al. High sensitivity C-reactive protein predictive value for cardiovascular disease: a nested case control from Isfahan Cohort Study (ICS). Glob Heart. 2020;15(1):3.CrossRef Koosha P, Roohafza H, Sarrafzadegan N, Vakhshoori M, Talaei M, Sheikhbahaei E, et al. High sensitivity C-reactive protein predictive value for cardiovascular disease: a nested case control from Isfahan Cohort Study (ICS). Glob Heart. 2020;15(1):3.CrossRef
9.
go back to reference Sari I, Sunbul M, Mammadov C, Durmus E, Bozbay M, Kivrak T, et al. Relation of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio with coronary artery disease severity in patients undergoing coronary angiography. Kardiologia Polska (Polish Heart J). 2015;73(12):1310–6.CrossRef Sari I, Sunbul M, Mammadov C, Durmus E, Bozbay M, Kivrak T, et al. Relation of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio with coronary artery disease severity in patients undergoing coronary angiography. Kardiologia Polska (Polish Heart J). 2015;73(12):1310–6.CrossRef
10.
go back to reference Mueller C, Laule-Kilian K, Christ A, Brunner-La Rocca HP, Perruchoud AP. Inflammation and long-term mortality in acute congestive heart failure. Am Heart J. 2006;151(4):845–50.CrossRef Mueller C, Laule-Kilian K, Christ A, Brunner-La Rocca HP, Perruchoud AP. Inflammation and long-term mortality in acute congestive heart failure. Am Heart J. 2006;151(4):845–50.CrossRef
11.
go back to reference Milo O, Cotter G, Kaluski E, Brill A, Blatt A, Krakover R, et al. Comparison of inflammatory and neurohormonal activation in cardiogenic pulmonary edema secondary to ischemic versus nonischemic causes. Am J Cardiol. 2003;92(2):222–6.CrossRef Milo O, Cotter G, Kaluski E, Brill A, Blatt A, Krakover R, et al. Comparison of inflammatory and neurohormonal activation in cardiogenic pulmonary edema secondary to ischemic versus nonischemic causes. Am J Cardiol. 2003;92(2):222–6.CrossRef
12.
go back to reference Briasoulis A, Androulakis E, Christophides T, Tousoulis D. The role of inflammation and cell death in the pathogenesis, progression and treatment of heart failure. Heart Fail Rev. 2016;21(2):169–76.CrossRef Briasoulis A, Androulakis E, Christophides T, Tousoulis D. The role of inflammation and cell death in the pathogenesis, progression and treatment of heart failure. Heart Fail Rev. 2016;21(2):169–76.CrossRef
13.
go back to reference Zhang Y, Bauersachs J, Langer HF. Immune mechanisms in heart failure. Eur J Heart Fail. 2017;19(11):1379–89.CrossRef Zhang Y, Bauersachs J, Langer HF. Immune mechanisms in heart failure. Eur J Heart Fail. 2017;19(11):1379–89.CrossRef
14.
go back to reference Rabb H, Griffin MD, McKay DB, Swaminathan S, Pickkers P, Rosner MH, et al. Inflammation in AKI: current understanding, key questions, and knowledge gaps. J Am Soc Nephrol. 2016;27(2):371–9.CrossRef Rabb H, Griffin MD, McKay DB, Swaminathan S, Pickkers P, Rosner MH, et al. Inflammation in AKI: current understanding, key questions, and knowledge gaps. J Am Soc Nephrol. 2016;27(2):371–9.CrossRef
15.
16.
go back to reference Templeton AJ, Ace O, McNamara MG, Al-Mubarak M, Vera-Badillo FE, Hermanns T, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Prev Biomark. 2014;23(7):1204–12.CrossRef Templeton AJ, Ace O, McNamara MG, Al-Mubarak M, Vera-Badillo FE, Hermanns T, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Prev Biomark. 2014;23(7):1204–12.CrossRef
17.
go back to reference Balta S, Ozturk C. The platelet-lymphocyte ratio: a simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets. 2015;26(7):680–1.CrossRef Balta S, Ozturk C. The platelet-lymphocyte ratio: a simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets. 2015;26(7):680–1.CrossRef
18.
go back to reference Zheng C-F, Liu W-Y, Zeng F-F, Zheng M-H, Shi H-Y, Zhou Y, et al. Prognostic value of platelet-to-lymphocyte ratios among critically ill patients with acute kidney injury. Crit Care. 2017;21(1):238.CrossRef Zheng C-F, Liu W-Y, Zeng F-F, Zheng M-H, Shi H-Y, Zhou Y, et al. Prognostic value of platelet-to-lymphocyte ratios among critically ill patients with acute kidney injury. Crit Care. 2017;21(1):238.CrossRef
19.
go back to reference Szyguła-Jurkiewicz B, Szczurek W, Niedziela J, Gąsior M. Mortality risk factors in patients with advanced heart failure and diabetes mellitus. Kardiol Pol. 2019;77(6):604–9.CrossRef Szyguła-Jurkiewicz B, Szczurek W, Niedziela J, Gąsior M. Mortality risk factors in patients with advanced heart failure and diabetes mellitus. Kardiol Pol. 2019;77(6):604–9.CrossRef
20.
go back to reference Huang W-M, Cheng H-M, Huang C-J, Guo C-Y, Lu D-Y, Lee C-W, et al. Hemographic indices are associated with mortality in acute heart failure. Sci Rep. 2017;7(1):1–9.CrossRef Huang W-M, Cheng H-M, Huang C-J, Guo C-Y, Lu D-Y, Lee C-W, et al. Hemographic indices are associated with mortality in acute heart failure. Sci Rep. 2017;7(1):1–9.CrossRef
21.
go back to reference Durmus E, Kivrak T, Gerin F, Sunbul M, Sari I, Erdogan O. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are predictors of heart failure. Arq Bras Cardiol. 2015;105(6):606–13.PubMedPubMedCentral Durmus E, Kivrak T, Gerin F, Sunbul M, Sari I, Erdogan O. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are predictors of heart failure. Arq Bras Cardiol. 2015;105(6):606–13.PubMedPubMedCentral
22.
go back to reference Givi M, Heshmat-Ghahdarijani K, Garakyaraghi M, Yadegarfar G, Vakhshoori M, Heidarpour M, et al. Design and methodology of heart failure registry: results of the Persian registry of cardiovascular disease. Arya Atherosclerosis. 2019;15(5):228.PubMedPubMedCentral Givi M, Heshmat-Ghahdarijani K, Garakyaraghi M, Yadegarfar G, Vakhshoori M, Heidarpour M, et al. Design and methodology of heart failure registry: results of the Persian registry of cardiovascular disease. Arya Atherosclerosis. 2019;15(5):228.PubMedPubMedCentral
23.
go back to reference Reichlin T, Socrates T, Egli P, Potocki M, Breidthardt T, Arenja N, et al. Use of myeloperoxidase for risk stratification in acute heart failure. Clin Chem. 2010;56(6):944–51.CrossRef Reichlin T, Socrates T, Egli P, Potocki M, Breidthardt T, Arenja N, et al. Use of myeloperoxidase for risk stratification in acute heart failure. Clin Chem. 2010;56(6):944–51.CrossRef
24.
go back to reference Yndestad A, Damås JK, Øie E, Ueland T, Gullestad L, Aukrust P. Systemic inflammation in heart failure–the whys and wherefores. Heart Fail Rev. 2006;11(1):83–92.CrossRef Yndestad A, Damås JK, Øie E, Ueland T, Gullestad L, Aukrust P. Systemic inflammation in heart failure–the whys and wherefores. Heart Fail Rev. 2006;11(1):83–92.CrossRef
25.
go back to reference Anker SD, Von Haehling S. Inflammatory mediators in chronic heart failure: an overview. Heart. 2004;90(4):464–70.CrossRef Anker SD, Von Haehling S. Inflammatory mediators in chronic heart failure: an overview. Heart. 2004;90(4):464–70.CrossRef
26.
go back to reference Baldus S, Heeschen C, Meinertz T, Zeiher AM, Eiserich JP, Münzel T, et al. Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes. Circulation. 2003;108(12):1440–5.CrossRef Baldus S, Heeschen C, Meinertz T, Zeiher AM, Eiserich JP, Münzel T, et al. Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes. Circulation. 2003;108(12):1440–5.CrossRef
27.
go back to reference Frangogiannis NG, Smith CW, Entman ML. The inflammatory response in myocardial infarction. Cardiovasc Res. 2002;53(1):31–47.CrossRef Frangogiannis NG, Smith CW, Entman ML. The inflammatory response in myocardial infarction. Cardiovasc Res. 2002;53(1):31–47.CrossRef
28.
go back to reference Rudiger A, Burckhardt OA, Harpes P, Müller SA, Follath F. The relative lymphocyte count on hospital admission is a risk factor for long-term mortality in patients with acute heart failure. Am J Emerg Med. 2006;24(4):451–4.CrossRef Rudiger A, Burckhardt OA, Harpes P, Müller SA, Follath F. The relative lymphocyte count on hospital admission is a risk factor for long-term mortality in patients with acute heart failure. Am J Emerg Med. 2006;24(4):451–4.CrossRef
29.
go back to reference Pourafkari L, Wang CK, Tajlil A, Afshar AH, Schwartz M, Nader ND. platelet–lymphocyte ratio in prediction of outcome of acute heart failure. Biomark Med. 2018;12(1):63–70.CrossRef Pourafkari L, Wang CK, Tajlil A, Afshar AH, Schwartz M, Nader ND. platelet–lymphocyte ratio in prediction of outcome of acute heart failure. Biomark Med. 2018;12(1):63–70.CrossRef
30.
go back to reference Nagarajan V, Cauthen C, Tang WH. Lack of prognostic value of platelet markers in patients with advanced heart failure. J Am Coll Cardiol. 2013;61(10 Supplement):E747.CrossRef Nagarajan V, Cauthen C, Tang WH. Lack of prognostic value of platelet markers in patients with advanced heart failure. J Am Coll Cardiol. 2013;61(10 Supplement):E747.CrossRef
31.
go back to reference Ye G-l, Chen Q, Chen X, Liu Y, Yin T, Meng Q, et al. The prognostic role of platelet-to-lymphocyte ratio in patients with acute heart failure: a cohort study. Sci Rep. 2019;9(1):1–8. Ye G-l, Chen Q, Chen X, Liu Y, Yin T, Meng Q, et al. The prognostic role of platelet-to-lymphocyte ratio in patients with acute heart failure: a cohort study. Sci Rep. 2019;9(1):1–8.
32.
go back to reference Demir M, Duyuler PT, Guray U, Celik MC. Platelet to lymphocyte ratio on admission and prognosis in patients with acute cardiogenic pulmonary edema. J Emerg Med. 2018;55(4):465–71.CrossRef Demir M, Duyuler PT, Guray U, Celik MC. Platelet to lymphocyte ratio on admission and prognosis in patients with acute cardiogenic pulmonary edema. J Emerg Med. 2018;55(4):465–71.CrossRef
33.
go back to reference Turcato G, Sanchis-Gomar F, Cervellin G, Zorzi E, Sivero V, Salvagno GL, et al. Evaluation of neutrophil-lymphocyte and platelet-lymphocyte ratios as predictors of 30-day mortality in patients hospitalized for an episode of acute decompensated heart failure. J Med Biochem. 2019;38(4):452–60.CrossRef Turcato G, Sanchis-Gomar F, Cervellin G, Zorzi E, Sivero V, Salvagno GL, et al. Evaluation of neutrophil-lymphocyte and platelet-lymphocyte ratios as predictors of 30-day mortality in patients hospitalized for an episode of acute decompensated heart failure. J Med Biochem. 2019;38(4):452–60.CrossRef
34.
go back to reference Bock JS, Gottlieb SS. Cardiorenal syndrome: new perspectives. Circulation. 2010;121(23):2592–600.CrossRef Bock JS, Gottlieb SS. Cardiorenal syndrome: new perspectives. Circulation. 2010;121(23):2592–600.CrossRef
35.
go back to reference Oishi Y, Manabe I. Organ system crosstalk in cardiometabolic disease in the age of multimorbidity. Front Cardiovasc Med. 2020;7:64.CrossRef Oishi Y, Manabe I. Organ system crosstalk in cardiometabolic disease in the age of multimorbidity. Front Cardiovasc Med. 2020;7:64.CrossRef
36.
go back to reference Rangaswami J, Bhalla V, Blair JE, Chang TI, Costa S, Lentine KL, et al. Cardiorenal syndrome: classification, pathophysiology, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation. 2019;139(16):e840–78.CrossRef Rangaswami J, Bhalla V, Blair JE, Chang TI, Costa S, Lentine KL, et al. Cardiorenal syndrome: classification, pathophysiology, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation. 2019;139(16):e840–78.CrossRef
37.
go back to reference Bongartz LG, Cramer MJ, Doevendans PA, Joles JA, Braam B. The severe cardiorenal syndrome:‘Guyton revisited.’ Eur Heart J. 2005;26(1):11–7.CrossRef Bongartz LG, Cramer MJ, Doevendans PA, Joles JA, Braam B. The severe cardiorenal syndrome:‘Guyton revisited.’ Eur Heart J. 2005;26(1):11–7.CrossRef
38.
go back to reference Ter Maaten JM, Damman K, Verhaar MC, Paulus WJ, Duncker DJ, Cheng C, et al. Connecting heart failure with preserved ejection fraction and renal dysfunction: the role of endothelial dysfunction and inflammation. Eur J Heart Fail. 2016;18(6):588–98.CrossRef Ter Maaten JM, Damman K, Verhaar MC, Paulus WJ, Duncker DJ, Cheng C, et al. Connecting heart failure with preserved ejection fraction and renal dysfunction: the role of endothelial dysfunction and inflammation. Eur J Heart Fail. 2016;18(6):588–98.CrossRef
39.
go back to reference Duan S, Sun L, Zhang C, Wu L, Nie G, Huang Z, et al. Association of platelet-to-lymphocyte ratio with kidney clinicopathologic features and renal outcomes in patients with diabetic kidney disease. Int Immunopharmacol. 2021;93:107413.CrossRef Duan S, Sun L, Zhang C, Wu L, Nie G, Huang Z, et al. Association of platelet-to-lymphocyte ratio with kidney clinicopathologic features and renal outcomes in patients with diabetic kidney disease. Int Immunopharmacol. 2021;93:107413.CrossRef
Metadata
Title
The association between platelet-to-lymphocyte ratio with mortality among patients suffering from acute decompensated heart failure
Authors
Maryam Heidarpour
Sepideh Bashiri
Mehrbod Vakhshoori
Kiyan Heshmat-Ghahdarijani
Farbod Khanizadeh
Shaghayegh Ferdowsian
Davood Shafie
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Heart Failure
Published in
BMC Cardiovascular Disorders / Issue 1/2021
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-021-02260-7

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