Correlation Between NLR And Cardiac Function,Renal Function In Patients With Cardiorenal Syndrome

Background:At present,N-terminal B-type pro-brain natriuretic peptide(NT-proBNP),echocardiography and glomerular filtration rate are commonly used in clinical to assess cardiac function and renal function of patients with Cardiorenal Syndrome(CRS).However,the equipment for detecting these indicators is demanding and expensive.Dynamic detection will increase the economic burden of patients and society.Moreover,due to the restrictions of equipment and conditions,most primary hospitals cannot detect them.Inflammatory response and oxidative stress are one of the important pathogenesis of CRS.Studies have found that the levels of inflammatory markers are related to the levels of heart and kidney function in patients with CRS.Neutrophil-to-Lymphocyte ratio(NLR)is a newly discovered compound inflammatory response index in recent years.Compared with traditional inflammatory markers such as IL-6 and TNF-α,NLR has the advantages of simplicity,rapidity,low cost,good repeatability,high accessibility,and so on.Recent studies have confirmed that NLR is related to the occurrence,development and prognosis of inflammation-related diseases such as cardiac insufficiency and renal insufficiency.However,in patients with CRS with more complex conditions,the correlation between NLR and cardiac and renal function needs to be studied.Objective:To observe and compare the indexes of NLR,cardiac and renal function as well as cardiac remodeling in patients with cardiorenal syndrome,analyze the correlation between NLR and cardiac,renal function and cardiac remodeling in such patients,and explore the clinical value of NLR in evaluating cardiac and renal function in patients with cardiorenal syndrome.Methods:A total of 271 patients with heart failure in the Department of General Practice,Kunming Yan’an Hospital from April 2018 to April 2022 were selected and divided into an HF group 140 cases(88 males and 52 females,age 57.92± 13.40 years)and a CRS group 131 cases(76 males and 55 females,age 58.00±10.48 years)according to whether or not they were accompanied with renal impairment.62 healthy subjects who underwent physical examination in the physical examination center of Kunming Yan ’an Hospital during the same period were selected as the control group(29 males and 33 females,age 57.37±7.80 years).General information such as gender,age,smoking history,hypertension and/or diabetes mellitus,total cholesterol(TC),triglyceride(TG),and lowly density lipoprotein(LDL-C)of all participants were recorded.Detected biochemical indicators such as serum creatinine(SCr),urea nitrogen(BUN),uric acid(UA),NT-proBNP,and calculated the estimated glomerular filtration rate(eGFR)by the simplified MDRD formula.Detected the white blood cells(WBC),neutrophils(NEU),lymphocytes(LYM),platelets(PLT)of all participants,and calculate NLR.All the participants were examined by color Doppler echocardiography,and the left ventricular ejection fraction(LVEF)was recorded.Compare the differences of general information,biochemical indicators,heart failure and cardiac remodeling indicators,NLR between groups.The levels of NLR,NT-proBNP and LVEF of different NYHA functional grades in HF group and CRS group were compared.The levels of NLR,SCr,BUN and UA in different renal function levels were compared.The relationship between NLR and cardiac and renal function was analyzed.To analyze the correlation between NLR and cardiac remodeling.Results:1.The basic data of CRS group,HF group and control group were compared.Gender,age,smoking,hypertension and/or diabetes,BMI,SBP,DBP,TC,TG and LDL-C levels showed no statistical difference among the three groups(all P>0.05).There was no significant difference in the course and etiology of heart failure between the CRS group and HF group(P>0.05).Compared with the HF group,the levels of SCr,BUN and UA in the CRS group were increased(all P<0.001),and eGFR was decreased(P<0.001).Compared with the control group,the levels of SCr,BUN,UA and LDL-C in the CRS group were increased(all P<0.001),and eGFR was decreased(P<0.001).Compared with the control group,the levels of SCr,BUN and UA in the HF group were increased(all P<0.001),and eGFR was decreased(P<0.05).2.Compared with the control group,NT-proBNP,LA,LVEDD,RA,and RVEDD in the CRS group and HF group were increased,while LVEF was decreased,with statistically significant differences(P<0.001).Compared with the HF group,the NT-proBNP level in the CRS group was increased,and the difference was statistically significant(P<0.001).LA,LVEDD,RA,RVEDD and LVEF showed no statistical difference(all P>0.05).3.Compared with the control group,there was no statistical difference in WBC and NEU levels between CRS group and HF group(P>0.05),while LYM and PLT levels decreased and NLR increased with statistical significance(P<0.05).Compared with HF group,the levels of WBC and NEU in CRS group were not statistically different(P>0.05),while the levels of LYM and PLT decreased and NLR increased,with statistical significance(P<0.05).4.Patients in HF group were divided into class Ⅱ,class Ⅲ and class Ⅳ groups according to NYHA functional classification.The levels of NLR and NT-proBNP increased with the increase of functional classification(all P<0.05),and LVEF decreased with the increase of functional classification(P<0.05).5.Patients in CRS group were divided into class Ⅱ,class Ⅲ and class Ⅳ groups according to NYHA functional classification.The levels of NLR and NT-proBNP increased with the increase of functional classification(all P<0.05),and LVEF decreased with the increase of functional classification(P<0.05).6.Patients in HF group were divided into two groups according to eGFR:group 1(eGFR≥90)and group 2(eGFR ≤60<90).Compared with group 1,the levels of NLR,SCr,BUN and UA in the group 2 increased with statistical significance(P<0.05).7.Patients in CRS group were divided into two groups according to eGFR:group 3(30 ≤eGFR<60)and group 4(15 ≤eGFR<30).Compared with group 3,the levels of NLR,SCr and BUN in the group 4 increased with statistical significance(all P<0.05),while the level of UA was not statistically different(P>0.05).8.Correlation between NLR and NT-proBNP,NYHA classification,eGFR and renal function in HF group:NLR was positively correlated with NT-proBNP,NYHA classification,SCr,BUN and UA(r=0.324;r=0.291;r=0.299;r=0.195;r=0.258,all P<0.05);Negatively correlated with eGFR(r=-0.361,P<0.001).9.Correlation between NLR and NT-proBNP,NYHA classification,eGFR and renal function in CRS group:NLR was positively correlated with NT-proBNP,NYHA classification,SCr,BUN and UA(r=0.301;r=0.331;r=0.466;r=0.202;r=0.308,all P<0.05);There was a negative correlation with eGFR(r=-0.209,P<0.05).10.Correlation between heart remodeling and NLR,NT-proBNP and eGFR in HF group:NLR positively correlated with LA,LVEDD,RA and IVS(r=0.707;r=0.735;r=0.295;r=0.613,all P<0.05);There was a negative correlation with LVEF(r=-0.452,P<0.001);There was no correlation with RVEDD(P>0.05).NT-proBNP positively correlated with LA and LVEDD(r=0.318;r=0.294,P<0.001),negatively correlated with LVEF(r=-0.459,P<0.001),and not correlated with RA,RVEDD and IVS(P>0.05);eGFR positively correlated with LVEF(r=0.214,P<0.05)and negatively correlated with LA,LVEDD and IVS(r=-0.387;r=-0.317;r=0.308,P<0.001),and no association with RA or RVEDD(P>0.05).11.Correlation of NLR,NT-proBNP and eGFR with cardiac remodeling in CRS group:NLR positively correlated with LA,LVEDD,RA and IVS(r=0.698;r=0.728;r=0.362;r=0.487,all P<0.05);There was a negative correlation with LVEF(r=-0.454,P<0.001);There was no correlation with RVEDD(P>0.05).NT-proBNP was positively correlated with LA,LVEDD and IVS(r=0.253;r=0.262;r=0.275,P<0.001),negatively correlated with LVEF(r=-0.495,P<0.001),and not correlated with RA and RVEDD(P>0.05);eGFR positively correlated with LVEF(r=0.039,P<0.05)and negatively correlated with LA,LVEDD,RA and IVS(r=-0.440;r=-0.364;r=-0.178;r=-0.307,P<0.001),not associated with RVEDD(P>0.05).Conclusions:1.The levels of NLR and NT-proBNP were increased in CRS group and HF group,and higher in CRS group.NLR was positively correlated with NT-proBNP level and increased with the increase of functional classification,indicating that NLR might be used as a reference index for evaluating the cardiac function of CRS patients.2.The level of NLR was increased in both the CRS group and the HF group,and the level was higher in the CRS group.NLR was positively correlated with SCr,BUN,and negatively correlated with eGFR,indicating that NLR might be used as a reference index for the evaluation of renal function in CRS patients.3.The NLR of CRS group was higher than that of HF group,indicating that patients with CRS had higher degree of inflammatory response and more complex disease condition than patients with HF.4.The NLR in the HF group had a positive correlation with LA,LVEDD,RA,and IVS,and a negative correlation with LVEF,but it also had a correlation in the CRS group,indicating that NLR had certain value in the evaluation of cardiac remodeling in CRS patients.