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Meta-Analysis
. 2024 Apr;17(2):426-447.
doi: 10.1007/s12265-023-10425-2. Epub 2023 Aug 18.

Neutrophil-Enriched Biomarkers and Long-Term Prognosis in Acute Coronary Syndrome: a Systematic Review and Meta-analysis

Jaquelina Y T Yiu  1 , Kathryn E Hally  1 , Peter D Larsen  1 , Ana S Holley  2
Affiliations
Meta-Analysis

Neutrophil-Enriched Biomarkers and Long-Term Prognosis in Acute Coronary Syndrome: a Systematic Review and Meta-analysis

Jaquelina Y T Yiu et al. J Cardiovasc Transl Res. 2024 Apr.

Abstract

Activated neutrophils release a range of inflammatory products that represent potential biomarkers, and there is interest in the prognostic value of these in acute coronary syndrome (ACS) patients. We conducted a systematic review to examine neutrophil-enriched biomarkers and the occurrence of major adverse cardiovascular events (MACE) in patients with ACS. We identified twenty-seven studies including 17,831 patients with ACS. The most studied biomarkers were neutrophil gelatinase-associated lipocalin (NGAL) and myeloperoxidase (MPO). Meta-analyses showed that elevated NGAL was associated with higher MACE rates (unadjusted risk ratio (RR) 1.52, 95% CI 1.12-2.06, p = 0.006) as were elevated MPO levels (unadjusted RR 1.61, 95% CI 1.22-2.13, p = 0.01). There was limited data suggesting that increased levels of calprotectin, proteinase-3 and double-stranded DNA were also associated with MACE. These results suggest that higher levels of neutrophil-enriched biomarkers may be predictive of MACE in patients with ACS, although higher-quality studies are needed to confirm these observations.

Keywords: Acute coronary syndromes; Neutrophils; Prognosis.

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Conflict of interest statement

Author JY received a University of Otago Doctoral Scholarship for her PhD studies (2019–2021). The authors have no conflicts of interest to declare that are relevant to the content of this article.

Figures

Fig 1
Fig 1
Overview of study selection for the systematic review and meta-analysis. The selection, screening, and inclusion of studies evaluating the association between neutrophil-enriched soluble markers and major cardiovascular events in ACS patients are detailed in the flow diagram, adapted from the PRISMA 2020 guidelines for systematic review reporting [6]
Fig. 2
Fig. 2
Meta-analysis for neutrophil gelatinase-associate lipocalin (NGAL) and myeloperoxidase (MPO). A, C The forest plots illustrate the unadjusted individual and summary risk ratios (RR) for MACE among ACS patients with high and low baseline levels of NGAL (A) and MPO (C) during hospital admission. The summary RR is indicated by the diamond and was calculated based on random effects meta-analysis using REML estimation and Hartung-Knapp adjustment. Weightings for each of the studies included in the model are proportionally reflected by the size of the box. The widths of the intersecting horizontal lines indicate the 95% confidence intervals. B, D Evidence used for publication bias assessment for NGAL (B) and MPO (D) is illustrated in the funnel plots, which present the logRR of studies investigating either NGAL or MPO against the inverse standard error. The shaded contours represent varying levels of statistical significance as indicated by the key. The null effect is denoted by the vertical dotted line
See this image and copyright information in PMC

References

    1. Lewis EF, Moye LA, Rouleau JL, Sacks FM, Arnold JMO, Warnica JW, et al. Predictors of late development of heart failure in stable survivors of myocardial infarction: The CARE study. J Am Coll Cardiol. 2003;42(8):1446–1453. doi: 10.1016/S0735-1097(03)01057-X. - DOI - PubMed
    1. Chen B, Frangogiannis NG. Immune cells in repair of the infarcted myocardium. Microcirculation. 2017;24(1). 10.1111/micc.12305. - PubMed
    1. Tecchio C, Micheletti A, Cassatella MA. Neutrophil-derived cytokines: facts beyond expression. Front Immunol. 2014;5:508. doi: 10.3389/fimmu.2014.00508. - DOI - PMC - PubMed
    1. Ma Y. Role of neutrophils in cardiac injury and repair following myocardial infarction. Cells. 2021;10(7):1676. 10.3390/cells10071676. - PMC - PubMed
    1. Ley K, Laudanna C, Cybulsky MI, Nourshargh S. Getting to the site of inflammation: the leukocyte adhesion cascade updated. Nat Rev Immunol. 2007;7(9):678–689. doi: 10.1038/nri2156. - DOI - PubMed

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