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
Review
. 2024 Jun 4;16(6):e61647.
doi: 10.7759/cureus.61647. eCollection 2024 Jun.

Effect of Elevated Neutrophil-to-Lymphocyte Ratio on Adverse Outcomes in Patients With Myocardial Infarction: A Systematic Review and Meta-Analysis

Nana O Banahene  1 , Tanya Sinha  2 , Sanam Shaikh  3 , Aung K Zin  4 , Khaldoun Khreis  5 , Sandipkumar S Chaudhari  6   7 , Calvin R Wei  8 , Sujith K Palleti  9
Affiliations
Review

Effect of Elevated Neutrophil-to-Lymphocyte Ratio on Adverse Outcomes in Patients With Myocardial Infarction: A Systematic Review and Meta-Analysis

Nana O Banahene et al. Cureus. .

Abstract

Myocardial infarction (MI), a leading cause of morbidity and mortality globally, is characterized by an underlying inflammatory process driven by atherosclerosis. The neutrophil-to-lymphocyte ratio (NLR), a readily available and cost-effective marker of systemic inflammation, has emerged as a potential predictor of adverse outcomes in patients with MI. This meta-analysis aimed to evaluate the association between elevated NLR and the risk of major adverse cardiovascular events (MACE) and all-cause mortality in patients with MI. A comprehensive literature search was conducted across multiple databases, including Embase, Web of Science, PubMed, and OVID Medicine, to identify relevant studies published from January 1, 2011, onward. Studies reporting the effect of NLR values on MACE and mortality in adult patients with MI, including both ST-elevation (STEMI) and non-ST-elevation (NSTEMI) subtypes, were included. Data extraction and quality assessment were performed independently by multiple authors. The meta-analysis included 37 studies, comprising a total of 18 studies evaluating the risk of MACE and 30 studies assessing all-cause mortality. The pooled analysis revealed a significantly increased risk of MACE (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.53-2.28, P < 0.01) and all-cause mortality (OR 2.29, 95% CI 1.94-2.70, P < 0.01) in patients with elevated NLR compared to those without elevated NLR. Subgroup analyses stratified by follow-up duration and study design further supported the consistent association between elevated NLR and adverse outcomes. In conclusion, this meta-analysis demonstrates a significant association between elevated NLR and an increased risk of MACE and all-cause mortality in patients with MI. These findings highlight the potential clinical utility of NLR as a prognostic marker and underscore the importance of further research to validate its predictive value and establish optimal cutoff values for risk stratification in this patient population.

Keywords: cardiovascular outcomes; elevated neutrophil to lymphocyte ratio; mortality; myocardial infarction; systematic review and meta analysis.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Study selection process (PRISMA flowchart).
PRISMA< Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. Forest plot evaluating the association between high NLR and MACE.
Sources: [9,11,13,15,17-21,25-27,29,34,36,40,43-44]. NLR, neutrophil-to-lymphocyte ratio; MACE, major adverse cardiovascular event; CI, confidence interval; SE, standard error
Figure 3
Figure 3. Forest plot evaluating the association between high NLR and all-cause mortality.
Sources: [10,12-17,19-25,28-35,37-42,44-45]. NLR, neutrophil-to-lymphocyte ratio; CI, confidence interval
See this image and copyright information in PMC

References

    1. Executive summary: heart disease and stroke statistics--2012 update: a report from the American Heart Association. Roger VL, Go AS, Lloyd-Jones DM, et al. Circulation. 2012;125:188–197. - PubMed
    1. Population trends in the incidence and outcomes of acute myocardial infarction. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. N Engl J Med. 2010;362:2155–2165. - PubMed
    1. Advancements in myocardial infarction management: exploring novel approaches and strategies. Sachdeva P, Kaur K, Fatima S, et al. Cureus. 2023;15:0. - PMC - PubMed
    1. Inflammation and atherosclerosis. Libby P, Ridker PM, Maseri A. Circulation. 2002;105:1135–1143. - PubMed
    1. Elevated neutrophil to lymphocyte ratio predicts overall and cardiovascular mortality in maintenance peritoneal dialysis patients. An X, Mao HP, Wei X, et al. Int Urol Nephrol. 2012;44:1521–1528. - PubMed

LinkOut - more resources