The Relationship Between Neutrophil To Lymphocyte Ratio And GRACE Score In Patients With Acute Coronary Syndrome

Objectives:By analyzing the correlation between neutrophil lymphocyte ratio(NLR)and GRACE score in patients with acute coronary syndrome and the predictive value of NLR for high-risk GRACE score,the predictive value of NLR for in-hospital cardiac events in patients with acute coronary syndrome was investigated.It provides a simple,easy and effective reference indicator for clinicians to identify low-risk populations early,assess patient prognosisand develop optimal treatment options.Methods:388 patients with suspected acute coronary syndrome who were admitted to the Department of Cardiology of Yan'an University Affiliated Hospital for the first time due to discomfort in the anterior region from October 2017 to November 2018,all patients enrolled underwent coronary angiography during hospitalization.blood biochemical tests within 30 minutes or the next morning after admission.According to the results of coronary angiography,190 patients were divide into the control group and 198 patients as ACS group.The diagnosis of ACS is based on the latest guidelines for ACS definition published by the American Heart Association/European Heart Association.Calculate GRACE score of all ACS patients after admission,According to the GRACE score,the ACS component was divide into the low-risk group(GRACE<109 points,n= 60 cases),the intermediate-risk group(109 ? GRACE ? 140 points,n = 62 cases),and the high-risk group(GRACE > 140 points,n =76 cases);According to the ROC curve of the high-risk GRACE score measured by the initial NLR value after admission,NLR=2.70 is the best intercept point,the ACS patients are grouped into low NLR groups(NLR?2.70,n=80 cases)and high NLR groups(NLR> 2.70,n =118 cases).All data were by using by using SPSS 20.0 statistical software.Results:1.Compared with the control group,WBC,NE,and NLR were all elevated in the ACS group,there was no significant difference in LYM between the two groups(P>0.05).2.Compared with the low-risk group,NE and NLR values were increased in sucession in the middle-risk group and the high-risk group,Multiple comparisons between the three groups showed statistically significant differences in NE and NLR,between any two groups(P<0.05).WBC was statistically significant difference in low-risk group and high-risk group,low-risk group and the intermediate-risk group were statistically significant(P<0.05),the differences of WBC between intermediat-risk group and high-risk group were no statistically significant(P>0.05).The differences of LYM between low-risk group and high-risk group were statistically significant(P<0.05).LYM was no statistically significant difference in the low-risk group and the intermediate-risk group,the intermediate-risk group and the high-risk group(P>0.05).3.Spearman correlation analysis was used to analyze the correlation between hematology data and GRACE scores: WBC(r=0.379,P,P<0.01),NE(r=0.387,P<0.01),NLR(r=0.460,P<0.01)and GRACE scores were positively correlated,respectively.and LYM was negatively correlated with GRACE scores(r=-0.279,P<0.01).4.Using ROC curve analysis of high-risk GRACE patients,we found that in the diagnosis of high-risk GRACE patients,the area under the curve formed of hematology data were for White Blood Cell:0.551(95%CI0.424-0.678,P=0.02),for neutrophils NE:0.590(95%CI0.466-0.714,P=0.0.02),NLR:0.654(95%CI0.538-0.770,P=0.03).Therefore,The area under the curve formed of NLR is the largest.NLR of 2.70 was the best cut point for patients with high-risk GRACE,with a specificity of 52.0% and a sensitivity of 69.6%.5.Compared with the low NLR group,incidence of in-hospital cardiac events(new heart failure,new arrhythmia,reinfarction,any cause death and cardiogenic shock)were significantly increased in high NLR group,and the difference was statistically significant(P<0.05);there was no difference in the incidence of stroke between the two groups(P>0.05)6.Taking the in-hospital cardiac events as the dependent variable,Univariate and multivariate Logstic regression analysis was performed using basic data,biochemical data,blood cell data,and GRACE score as independent variables.The results showed: age,history of hypertension,history of diabetes,history of smoking,NLR,pro-BNP,and GRACE scores is independent risk factor for cardiac events in the hospital.7.According to the ROC curve analysis of in-hospital adverse events based on NLR,GRACE showed :when NLR was 2.70,it had 65.5% sensitivity and 63.8% specificity of the area under the curve was 0.712(95% CI =0.607-0.816)for predicting in-hospital cardiac events.When GRACEwas 109,it had 81.8% sensitivity and 76.7% specificity of the area under the curve was 0.872(95%CI=0.801-0.943)for predicting in-hospital cardiac events Conclusions:1.NLR is positively correlated with GRACE score,which predicts low sensitivity and low specificity in patients with high-risk ACS.2.NLR is an independent risk factor for in-hospital cardiac events in ACS and it has a certain value in predicting in-hospital cardiac events.