Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Feb 21;8(2):9-17.
doi: 10.5492/wjccm.v8.i2.9.

Neutrophil-lymphocyte ratio: A prognostic tool in patients with in-hospital cardiac arrest

Vishal H Patel  1 , Philip Vendittelli  2 , Rajat Garg  3 , Susan Szpunar  4 , Thomas LaLonde  2 , John Lee  5 , Howard Rosman  2 , Rajendra H Mehta  6 , Hussein Othman  2
Affiliations

Neutrophil-lymphocyte ratio: A prognostic tool in patients with in-hospital cardiac arrest

Vishal H Patel et al. World J Crit Care Med. .

Abstract

Background: In-hospital cardiac arrest (IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation (ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient's prognosis. The neutrophil-lymphocyte ratio (NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis. We hypothesize that an elevated NLR is associated with poor outcomes including mortality at discharge in patients with IHCA.

Aim: To determine the prognostic significance of NLR in patients suffering IHCA who achieve ROSC.

Methods: A retrospective study was performed on all patients who had IHCA with the advanced cardiac life support protocol administered in a large urban community United States hospital over a one-year period. Patients were divided into two groups based on their NLR value (NLR < 4.5 or NLR ≥ 4.5). This cutpoint was derived from receiving operator characteristic curve analysis (area under the curve = 0.66) and provided 73% positive predictive value, 82% sensitivity and 42% specificity for predicting in-hospital death after IHCA. The primary outcome was death or discharge at 30 d, whichever came first.

Results: We reviewed 153 patients with a mean age of 66.1 ± 16.3 years; 48% were female. In-hospital mortality occurred in 65%. The median NLR in survivors was 4.9 (range 0.6-46.5) compared with 8.9 (0.28-96) in non-survivors (P = 0.001). A multivariable logistic regression model demonstrated that an NLR above 4.55 [odds ratio (OR) = 5.20, confidence interval (CI): 1.5-18.3, P = 0.01], older age (OR = 1.03, CI: 1.00-1.07, P = 0.05), and elevated serum lactate level (OR = 1.20, CI: 1.03-1.40, P = 0.02) were independent predictors of death.

Conclusion: An NLR ≥ 4.5 may be a useful marker of increased risk of death in patients with IHCA.

Keywords: Asystole; In-hospital cardiac arrest; Lactate; Neutrophil-lymphocyte ratio; Prognosis; Pulseless electrical alternans; Pulseless ventricular tachycardia; Ventricular fibrillation.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: All authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Receiver operating characteristic curve of neutrophil-lymphocyte ratio in in-hospital cardiac arrest showing the true positive rate plotted against the false positive rate. The area under the curve value was 0.66 and cut off point of the neutrophil-lymphocyte ratio was determined to be 4.55 with a 73% positive predictive value, sensitivity of 82% and specificity of 42%. ROC: Receiver operating characteristic.
Figure 2
Figure 2
Initial cardiac rhythm and neutrophil lymphocyte ratio in survivors (solid black) and non-survivors (checker-board) of in-hospital cardiac arrest alongside with P-values for interaction. pVtach: Pulseless ventricular tachycardia; Vfib: Ventricular fibrillation; PEA: Pulseless electrical alternans.
See this image and copyright information in PMC

References

    1. Sandroni C, Nolan J, Cavallaro F, Antonelli M. In-hospital cardiac arrest: Incidence, prognosis and possible measures to improve survival. Intensive Care Med. 2007;33:237–245. - PubMed
    1. Morrison LJ, Neumar RW, Zimmerman JL, Link MS, Newby LK, McMullan PW, Jr, Hoek TV, Halverson CC, Doering L, Peberdy MA, Edelson DP American Heart Association Emergency Cardiovascular Care Committee, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on P. Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: A consensus statement from the American Heart Association. Circulation. 2013;127:1538–1563. - PubMed
    1. Nadkarni VM, Larkin GL, Peberdy MA, Carey SM, Kaye W, Mancini ME, Nichol G, Lane-Truitt T, Potts J, Ornato JP, Berg RA National Registry of Cardiopulmonary Resuscitation Investigators. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA. 2006;295:50–57. - PubMed
    1. Booth CM, Boone RH, Tomlinson G, Detsky AS. Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA. 2004;291:870–879. - PubMed
    1. Garcia S, Drexel T, Bekwelem W, Raveendran G, Caldwell E, Hodgson L, Wang Q, Adabag S, Mahoney B, Frascone R, Helmer G, Lick C, Conterato M, Baran K, Bart B, Bachour F, Roh S, Panetta C, Stark R, Haugland M, Mooney M, Wesley K, Yannopoulos D. Early Access to the Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol. J Am Heart Assoc. 2016;5:pii: e002670. - PMC - PubMed