Heart failure (HF) is a common and serious condition with a global prevalence of 64.3 million [
The inflammatory response plays a potential role in the pathogenesis and adverse remodeling process in patients with both acute and chronic HF [
The neutrophil-to-lymphocyte ratio (NLR) is an emerging biomarker useful for predicting the risk and prognosis of cardiovascular diseases [
Furthermore, the mean platelet volume (MPV), a known biomarker of both proinflammatory and prothrombotic conditions [
We conducted a retrospective cohort study using the electronic medical records of consecutive patients with acute HF admitted to the H.R.H Maha Chakri Sirindhorn Medical Center of Srinakharinwirot University between January 1, 2017, and December 31, 2019. Patients included in the study must have been admitted with a principal diagnosis of HF and underwent transthoracic echocardiography. Exclusion criteria included a history of hematologic disease, severe infection, cancer, or recent corticosteroid use within 3 months prior to admission. HF was classified into three groups according to the HF guidelines of the European Society of Cardiology [
The primary outcome was a combined CVEs of CV death and hospitalization due to HF; acute coronary syndrome (ACS), including ST-segment elevation myocardial infarction, non-ST elevation myocardial infarction, and unstable angina; acute stroke or cerebrovascular accident; and cardiac arrhythmia. The secondary outcomes included readmission for HF, in-hospital death, and a composite outcome of CVEs and all-cause mortality. Patient data were collected at the index of hospitalization and included demographics, initial vital signs (respiratory rate (RR), pulse rate, and systolic and diastolic blood pressure), New York Heart Association (NYHA) functional classification, concomitant CV diseases, laboratory findings, current medication, electrocardiographic and echocardiogram findings, current medication, clinical course, and length of hospital stay. Clinical outcomes during admission and after discharge were collected from electronic medical records and telephone consults.
NLR was calculated by dividing absolute neutrophil counts by absolute lymphocyte counts derived from automated cell counters. MPVLR was computed by dividing the MPV by absolute lymphocyte counts. Both NLR and MPVLR were classified into two groups using different optimal cut-off values for each outcome. To define the optimal cut-off values of NLR and MPVLR, the receiver operating characteristic curve-based method of the Youden index was used. These cut-off points optimized the differentiating capability of the NLR and MPVLR when an equal weight was given to the sensitivity and specificity [
Continuous variables are expressed as the mean with standard deviation or the median with interquartile range (IQR) and were compared between CVEs and each outcome using the Student
The set of possible confounders for each outcome based on background knowledge and clinical practice was individually considered in the univariate analysis. Variables with a
Both NLR and MPVLR were found to have equal ability to predict the risks of our outcomes; thus, we converted them into a combined NLR and MPVLR using a point-based risk score. It was derived from the
All
Table
Baseline characteristics of patients with heart failure, stratified by cardiovascular events.
Characteristics | Mean (SD) | CVEs ( | No CVEs | ||
---|---|---|---|---|---|
Male sex, | 144 (44.9) | 40 (41.7) | 104 (46.2) | -0.62 | 0.53 |
Age (years) | 67.4 (14.9) | 69.5 (13.6) | 66.5 (15.4) | 1.80 | 0.07 |
BW (kg) | 61.7 (15.9) | 58.4 (12.2) | 63.2 (17.2) | 2.48 | 0.01 |
Height (cm) | 159.7 (8.9) | 159.9 (8.9) | 159.7 (8.9) | -0.24 | 0.81 |
BMI (kg/m2) | 24.1 (5.6) | 22.8 (4.3) | 24.7 (5.9) | -2.70 | <0.05 |
BMI class, | |||||
<18.5 kg/m2 | 33 (10.3) | 12 (12.5) | 21 (9.3) | ||
18.5-24.9 kg/m2 | 172 (53.6) | 60 (62.5) | 112 (49.8) | 7.56 | 0.06 |
25.0-29.9 kg/m2 | 79 (24.6) | 16 (16.7) | 63 (28.0) | ||
30.0 kg/m2 | 37 (11.5) | 8 (8.3) | 29 (12.9) | ||
Hypertension, | 275 (85.7) | 79 (82.3) | 196 (87.1) | -1.11 | 0.27 |
Diabetes mellitus, | 181 (56.4) | 52 (54.2) | 129 (57.3) | -0.28 | 0.78 |
Dyslipidemia, | 188 (58.6) | 56 (58.3) | 132 (58.7) | 0.03 | 0.98 |
Coronary heart disease, | 132 (41.1) | 73 (55.3) | 59 (44.7) | 1.69 | 0.09 |
Cerebrovascular accident, | 52 (16.2) | 24 (25.0) | 28 (12.4) | 2.81 | <0.05 |
CKD stage, | |||||
Stage 1 | 166 (51.7) | 49 (51.0) | 117 (52.0) | ||
Stage 2 | 10 (3.1) | 3 (3.1) | 7 (3.1) | ||
Stage 3 | 50 (15.6) | 14 (14.6) | 36 (16.0) | 3.20 | 0.53 |
Stage 4 | 32 (9.9) | 14 (14.6) | 18 (8.0) | ||
Stage 5 | 63 (19.6) | 16 (16.7) | 47 (20.9) | ||
Alcohol consumption | |||||
Never | 247 (82.1) | 79 (84.9) | 168 (80.8) | ||
Quit | 35 (11.6) | 10 (10.8) | 25 (12.0) | 0.96 | 0.62 |
Current | 19 (6.3) | 4 (4.3) | 15 (7.2) | ||
Smoking | |||||
Never | 223 (73.4) | 75 (79.8) | 148 (70.5) | ||
Quit | 59 (19.4) | 15 (15.9) | 44 (20.9) | 3.89 | 0.14 |
Current | 22 (7.2) | 4 (4.3) | 18 (8.6) | ||
Rhythm, | |||||
Sinus | 247 (76.9) | 64 (66.7) | 183 (81.3) | 7.66 | <0.05 |
Atrial fibrillation | 74 (23.1) | 32 (33.3) | 42 (18.7) | ||
LVEF (%) | 45.4 (16.9) | 45.2 (16.9) | 45.5 (17.0) | -0.07 | 0.94 |
Type of HF, | |||||
HFrEF | 127 (39.6) | 37 (38.5) | 90 (40.0) | 0.03 | 0.87 |
HFmEF | 39 (12.2) | 13 (13.5) | 26 (11.6) | 0.19 | 0.66 |
HFpEF | 155 (48.3) | 46 (47.9) | 82 (48.4) | 0.00 | 0.96 |
SBP (mmHg) | 142.2 (27.7) | 138.6 (28.2) | 143.7 (27.4) | -1.79 | 0.07 |
DBP (mmHg) | 82.3 (16.9) | 80.0 (18.3) | 83.2 (16.3) | -1.85 | 0.06 |
Mean BP (mmHg) | 102.2 (19.1) | 99.6 (19.8) | 103.4 (18.7) | -1.96 | 0.05 |
Pulse rate (bpm) | 92.3 (20.6) | 93.4 (25.4) | 91.8 (18.3) | 0.87 | 0.38 |
Respiratory rate (per min) | 23.6 (4.3) | 24.5 (4.3) | 23.2 (4.2) | 2.77 | <0.05 |
NYHA classification, | |||||
III | 183 (57.0) | 39 (40.6) | 144 (64.0) | 3.99 | <0.05 |
IV | 138 (42.9) | 57 (59.4) | 81 (36.0) | ||
Comorbidity, | |||||
Acute coronary syndrome | 43 (13.4) | 22 (22.9) | 21 (9.3) | 3.13 | <0.05 |
Valvular heart diseaseb | 57 (17.8) | 25 (26.0) | 32 (14.2) | 2.41 | 0.02 |
Cardiomyopathy (CM) | 181 (56.4) | 55 (57.3) | 126 (56.0) | ||
Ischemic CM | 87 (27.1) | 31 (32.3) | 56 (24.9) | ||
Nonischemic CM | 50 (15.6) | 11 (11.5) | 39 (17.3) | 2.79 | 0.41 |
Hypertensive CM | 44 (13.7) | 13 (13.5) | 31 (13.8) | ||
HT emergency | 32 (9.9) | 7 (7.3) | 25 (11.1) | -1.11 | 0.27 |
Medication, | |||||
Statin | 235 (73.2) | 75 (78.1) | 160 (71.1) | 1.19 | 0.23 |
Beta-blocker | 182 (56.7) | 60 (62.5) | 122 (54.2) | 1.19 | 0.24 |
ACEIs | 101 (31.5) | 22 (22.9) | 79 (35.1) | -2.19 | 0.03 |
ARBs | 55 (17.1) | 20 (20.8) | 35 (15.6) | 1.26 | 0.21 |
Aspirin | 177 (55.1) | 54 (56.3) | 123 (54.7) | 0.33 | 0.74 |
P2Y12 inhibitors | 92 (28.7) | 32 (33.3) | 60 (26.7) | 2.18 | 0.34 |
Diuretics | 224 (69.8) | 60 (62.5) | 164 (72.9) | -1.90 | 0.06 |
WBC, ×103, median (IQR) (cells/mL) | 8.20 (6.4, 10.4) | 8.6 (6.7, 10.4) | 8.1 (6.4, 10.0) | -0.66 | 0.51 |
Neutrophil (%) | 68.0 (11.0) | 71.6 (10.7) | 66.5 (10.8) | 3.89 | <0.001 |
Neutrophil count, ×103, median (IQR) (cells/mL) | 5.4 (4.3, 7.1) | 6.1 (4.6, 7.4) | 5.1 (4.0, 7.0) | -0.36 | 0.72 |
Lymphocyte (%) | 22.5 (10.6) | 19.2 (9.9) | 23.9 (10.6) | -3.87 | <0.001 |
Lymphocyte count, ×103, median (IQR) (cells/mL) | 1.7 (1.1, 2.4) | 1.3 (0.9, 2.0) | 1.8 (1.2, 2.4) | -2.07 | 0.04 |
NLR, median (IQR) | 3.2 (2.3, 5.0) | 5.0 (3.4) | 3.6 (2.7) | 4.25 | <0.001 |
Q1 ( | 2.2 (0.7) | 1.9 (0.7) | 2.3 (0.7) | 5.24 | <0.001 |
Q2 ( | 5.9 (3.3) | 6.2 (3.3) | 5.8 (3.3) | ||
Platelets, ×103 (cells/mL) | 254.7 (92.4) | 251.3 (94.5) | 256.1 (91.6) | -0.50 | 0.61 |
Hb (g/dL) | 10.7 (2.6) | 10.7 (2.5) | 10.7 (2.7) | -0.08 | 0.94 |
Anemiac | 245 (76.3) | 74 (77.1) | 171 (76.0) | 0.32 | 0.75 |
MPV (fL) | 10.4 (0.9) | 10.7 (1.0) | 10.3 (0.9) | 2.80 | 0.005 |
MPVLR | 7.5 (4.9) | 9.0 (5.7) | 6.9 (4.5) | 3.92 | <0.001 |
Q1 ( | 5.0 (1.9) | 5.1 (2.0) | 5.0 (1.8) | 5.12 | <0.001 |
Q2 ( | 13.6 (4.9) | 13.4 (5.3) | 13.9 (4.6) | ||
BUN, median (IQR) (mg/dL) | 24.9 (18.1, 43.5) | 25.5 (18.8, 40.5) | 24.6 (16.9, 43.9) | -0.15 | 0.89 |
Creatinine, median (IQR), mg/dL | 1.5 (1.1, 2.7) | 1.5 (1.1, 2.6) | 1.5 (1.0, 2.8) | -0.23 | 0.82 |
Sodium (mmol/L) | 136.2 (8.0) | 136.4 (4.0) | 136.2 (9.2) | 0.17 | 0.86 |
Potassium, median (IQR) (mmol/L) | 4.0 (3.6, 4.4) | 4.0 (3.6, 4.4) | 4.0 (3.6, 4.5) | -0.36 | 0.72 |
Magnesium (mg/dL) | 2.1 (0.4) | 2.0 (0.5) | 2.1 (0.3) | -0.13 | 0.89 |
Phosphorous (mmol/L) | 4.1 (1.3) | 4.3 (1.4) | 4.1 (1.2) | 0.64 | 0.52 |
Albumin (g/dL) | 3.5 (0.5) | 3.4 (0.5) | 3.5 (0.6) | -1.10 | 0.27 |
Troponin, median (IQR), (ng/mL) | 57.7 (20.0, 172.0) | 115.0 (55.0, 410.5) | 40.0 (16.0, 137.0) | 1.47 | 0.14 |
NT-pro-BNP (×103), median (IQR) (pg/mL) | 5.2 (2.6-13.6) | 9.9 (4.5, 14.1) | 4.2 (1.7, 12.7) | 0.92 | 0.36 |
Data are reported by
Up to the end of the 3-year follow-up, 320 patients had a median follow-up time of 23 months (IQR: 2, 33 months). Of these, 96 patients (29.9%) had CVEs, 106 (33.0%) died, 62 (19.3%) were rehospitalized with HF, and 21 (6.5%) died at the time of admission. The incidence rate of CVEs was 60.57 per 1,000 population per year. Fifty percent of patients with HF were free of the composite outcome at approximately 39.8 months. The log-rank tests of equality across NLR and MPVLR groups for prediction of CVEs had a
Kaplan-Meier survival estimation of NLR and MPVLR for cardiovascular events and a composite outcome.
Kaplan-Meier survival estimates CVEs by NLR
Kaplan-Meier survival estimates CVEs by MPVLR
Kaplan-Meier survival estimates composite outcome by NLR
Kaplan-Meier survival estimates composite outcome by MPVLR
Univariate and multivariate analysis with a Cox proportional hazard model of risk factors for cardiovascular events of patients with heart failure.
Variables | Univariate analysis | Multivariate analysis (NLR) | Multivariate analysis (MPVLR) | Multivariate analysis | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
HR | 95% CI | HR | 95% CI | HR | 95% CI | HR | 95% CI | |||||||||||
Lower | Upper | Lower | Upper | Lower | Upper | Lower | Upper | |||||||||||
NLR | ||||||||||||||||||
| 1 | 1 | <0.05 | 1 | <0.05 | 1 | <0.05 | |||||||||||
| 1.19 | 3.30 | 5.24 | 2.11 | 5.16 | 3.11 | 1.98 | 4.89 | 2.42 | 1.46 | 4.01 | |||||||
MPVLR | ||||||||||||||||||
| 1 | <0.05 | 1 | <0.05 | 1 | <0.05 | ||||||||||||
| 1.08 | 2.93 | 5.12 | 1.94 | 4.42 | 2.86 | 1.87 | 4.39 | 1.95 | 1.22 | 3.10 | |||||||
BMI | -0.06 | 0.94 | -2.70 | 0.90 | 0.98 | <0.05 | ||||||||||||
CVA | 0.67 | 1.95 | 2.81 | 1.22 | 3.10 | <0.05 | ||||||||||||
Rhythm | ||||||||||||||||||
Sinus | 1 | 1 | <0.05 | 1 | 0.02 | 1 | <0.05 | 1 | 0.05 | |||||||||
Atrial fibrillation | 0.63 | 1.88 | 2.89 | 1.22 | 2.89 | 1.76 | 1.12 | 2.78 | 2.86 | 1.87 | 4.39 | 1.60 | 1.00 | 2.56 | ||||
Mean BP | -0.01 | 0.99 | -1.96 | 0.98 | 1.00 | 0.05 | ||||||||||||
Respiratory rate | 0.05 | 1.06 | 2.77 | 1.02 | 1.09 | <0.05 | 1.05 | 1.00 | 1.09 | 0.04 | 1.05 | 1.00 | 1.09 | 0.03 | 1.05 | 1.00 | 1.09 | 0.04 |
NYHA | ||||||||||||||||||
III | 1 | 1 | <0.05 | 1 | 1 | <0.05 | 1 | <0.05 | ||||||||||
IV | 0.84 | 2.32 | 3.99 | 1.53 | 3.49 | 2.21 | 1.45 | 3.38 | <0.05 | 2.14 | 1.39 | 3.31 | 2.16 | 1.40 | 3.34 | |||
Etiology | ||||||||||||||||||
ACS | 0.77 | 2.17 | 3.13 | 1.33 | 3.52 | <0.05 | 2.17 | 1.32 | 3.57 | <0.05 | 2.41 | 1.46 | 3.96 | <0.05 | 2.33 | 1.41 | 3.86 | <0.05 |
VHD | 0.57 | 1.77 | 2.41 | 1.11 | 2.81 | 0.02 | 1.71 | 1.06 | 2.75 | 0.03 | 1.71 | 1.04 | 2.79 | 0.03 | 1.83 | 1.12 | 2.98 | 0.02 |
Medication | ||||||||||||||||||
ACEIs | -0.54 | 0.58 | -2.19 | 0.36 | 0.94 | 0.03 | ||||||||||||
PLR | 0.002 | 1.00 | 3.09 | 1.001 | 1.003 | <0.05 | ||||||||||||
MPV | 0.27 | 1.31 | 2.80 | 1.08 | 1.58 | <0.05 |
Abbreviations: NLR: neutrophil-lymphocyte ratio; MPVLR: mean platelet volume-to-lymphocyte ratio; CI: confidential interval; HR: hazard ratio; BMI: body mass index; CVA: cerebrovascular accident; BP: blood pressure; NYHA: New York Heart Association Classification; ACS: acute coronary syndrome; VHD: valvular heart disease; ACEIs: angiotensin-converting enzyme inhibitors; PLR: platelet to lymphocyte ratio; MPV: mean platelet volume.
Association of NLR and MPVLR with a prognosis of subsequent cardiovascular events and mortality in patients with heart failure.
Outcome | Number of events | Crude HR | 95% CI | Adjusted HR | 95% CI | ||
---|---|---|---|---|---|---|---|
Cardiovascular eventsa | |||||||
| 27 | 1 (reference) | 1 (reference) | <0.001 | 1 (reference) | 1 (reference) | <0.001 |
| 69 | 3.30 | 2.11-5.16 | 3.11 | 1.98-4.89 | ||
| 48 | 1 (reference) | 1 (reference) | <0.001 | 1 (reference) | 1 (reference) | <0.001 |
| 44 | 2.93 | 1.94-4.42 | 2.86 | 1.87-4.39 | ||
Rehospitalization for HFb | |||||||
| 26 | 1 (reference) | 1 (reference) | 0.002 | 1 (reference) | 1 (reference) | <0.001 |
| 36 | 2.23 | 1.34-3.69 | 2.70 | 1.58-4.61 | ||
| 25 | 1 (reference) | 1 (reference) | 0.020 | 1 (reference) | 1 (reference) | <0.001 |
| 35 | 1.84 | 1.10-3.08 | 2.84 | 1.59-5.07 | ||
In-hospital deathc | |||||||
| 3 | 1 (reference) | 1 (reference) | 0.002 | 1 (reference) | 1 (reference) | 0.003 |
| 18 | 10.62 | 2.46-45.81 | 9.54 | 2.19-41.40 | ||
| 4 | 1 (reference) | 1 (reference) | <0.001 | 1 (reference) | 1 (reference) | <0.001 |
| 15 | 10.43 | 3.45-31.55 | 7.87 | 2.56-24.19 | ||
Composite outcomed | |||||||
| 38 | 1 (reference) | 1 (reference) | <0.001 | 1 (reference) | 1 (reference) | <0.001 |
| 119 | 4.82 | 3.34-6.96 | 4.76 | 3.29-6.89 | ||
| 50 | 1 (reference) | 1 (reference) | <0.001 | 1 (reference) | 1 (reference) | <0.001 |
| 100 | 3.50 | 2.49-4.92 | 3.64 | 2.58-5.15 |
Abbreviations: NLR: neutrophil-lymphocyte ratio; MPVLR: mean platelet volume-to-lymphocyte ratio; CI: confidential interval; HR: hazard ratio; HF: heart failure; NYHA: New York Heart Association; ACS: acute coronary syndrome. aA multivariate Cox proportional hazard model adjusted for NYHA classification, ACS, heart rhythm, initial respiratory rate, and underlying valvular heart disease (VHD). bA multivariate Cox proportional hazard model adjusted for NYHA classification, ACS, taking beta-blocker, and anemia. cA multivariate Cox proportional hazard model adjusted for NYHA classification, initial systolic blood pressure, and initial respiratory rate. dA multivariate Cox proportional hazard model adjusted for NYHA classification, ACS, heart rhythm, and body mass index.
For readmission for HF outcome, NYHA class IV, concomitant ACS, prescribed beta-blocker during hospitalization, and anemic status were significant variables in the multivariate Cox proportional hazard model (Table
The receiver operating characteristic curves of NLR, MPVLR, and combined NLR and MPVLR for each outcome are illustrated in Figure
Receiver operating characteristics curves and AUC of NLR, MPVLR, and combined NLR and MPVLR for each outcome.
ROC curves of NLR, MPVLR, combined NLR and MPVLR for CVEs
ROC curves of NLR, MPVLR, combined NLR and MPVLR for HF-related readmission
ROC curves of NLR, MPVLR, combined NLR and MPVLR for in-hospital death
ROC curves of NLR, MPVLR, combined NLR and MPVLR for composite outcomes
Area under the receiver operating characteristics curve (AUC) stratified according to each outcome.
Variables | AUC | 95% CI | Sensitivity (%) | Specificity (%) | |
---|---|---|---|---|---|
Cardiovascular events | |||||
NLR | 0.67 | 0.61-0.72 | 75.2 | 66.1 | <0.05 |
MPVLR | 0.63 | 0.58-0.69 | 45.3 | 79.7 | |
Combined NLR and MPVLR | 0.77 | 0.72-0.83 | 84.6 | 58.7 | |
Rehospitalization | |||||
NLR | 0.56 | 0.48-0.64 | 61.2 | 61.0 | <0.05 |
MPVLR | 0.55 | 0.46-0.63 | 60.2 | 57.1 | |
Combined NLR and MPVLR | 0.72 | 0.65-0.79 | 82.1 | 60.8 | |
In-hospital mortality | |||||
NLR | 0.79 | 0.66-0.91 | 87.5 | 70.8 | 0.03 |
MPVLR | 0.78 | 0.65-0.90 | 79.6 | 75.7 | |
Combined NLR and MPVLR | 0.92 | 0.88-0.96 | 88.7 | 85.5 | |
Composite outcome | |||||
NLR | 0.80 | 0.75-0.85 | 71.6 | 86.8 | 0.07 |
MPVLR | 0.78 | 0.72-0.83 | 62.8 | 91.1 | |
Combined NLR and MPVLR | 0.83 | 0.79-0.88 | 79.8 | 84.7 |
Abbreviations: NLR: neutrophil-lymphocyte ratio; MPVLR: mean platelet volume-to-lymphocyte ratio; CI: confidential interval.
This study evaluated the predictive role of the NLR and MPVLR on CVEs, readmission for HF, in-hospital death, and composite outcomes of patients hospitalized with AHF. During the 3-year follow-up, higher levels of NLR and MPVLR at baseline were independently associated with all outcomes after discharge. Notably, combining both NLR and MPVLR improved the ability to portend CVEs, readmission for HF, and in-hospital mortality than individual NLR or MPVLR.
The findings of this study correspond with the results from other published studies. In a previous prospective study of patients with acute decompensated HF, elevated NLR was associated with higher rates of in-hospital, 3-year mortality after discharge [
The association between high NLR levels and worse CV outcomes in patients with HF could be explained by the activation of neutrophils from inflammatory and autonomic responses [
In addition, MPV has been found to be an independent variable for predicting in-hospital and 6-month mortality [
Our study had several strengths. This was the first to analyse the prognostic factors for CV outcomes in patients with AHF using routinely measured biomarkers (NLR, MPVLR, and combined NLR and MPVLR) by automated cell counters. The combination of the NLR and MPVLR had better performance for predicting CVEs and composite outcomes. A previous study reported a higher cut-off value of NLR to predict the mortality outcome compared to ours (NLR 5 to 7) [
This study had some limitations. This study was a retrospective cohort analysis that could not collect and evaluate the variation of NLR and MPVLR on clinical outcomes over a follow-up period. It was also based on a single center and was restricted to patients with AHF requiring hospitalization, which may have introduced bias. Our analysis did not include some potential confounders, such as concomitant inflammation, malignancy, and genetic factors, because of our limited data. Due to many missing data (86.3%), B-type natriuretic peptide and/or NT-pro-BNP were not analyzed in the study. However, a recent study revealed that the NLR was comparable with NT-pro-BNP as a prognostic marker in elderly patients with chronic HF [
Our findings demonstrated that 13.4% of patients with AHF had ACS as a precipitating factor, and the percentages of those with CVEs had ACS as their comorbidity was significantly higher than those without CVEs (Table
Our study demonstrated that elevated NLR and MPVLR on admission in patients with AHF were independently associated with worse CVEs, rehospitalization for HF, in-hospital death, and composite outcomes of CVEs and all-cause mortality.
Combined NLR and MPVLR was derived from
For the categorical variables of ACS, VHD, BetaBlocker use, and anemia, the patients were assigned the value 1 for the category they belong to and 0 for the other categories, whereas those with variables of NYHA class IV, AF rhythm, NLR, and MPVLR equal or above cut-offs were designated as 1 and 0 for the others. Different cut-off values for categorical NLR and MPVLR of each outcome are as follows:
The data used to support the findings of this study are included within the article.
The authors declare that there is no conflict of interest regarding the publication of this article.
The authors are grateful to Assoc. Prof. Dr. Sasivimol Rattanasiri, a lecturer of the Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand, for statistical analysis. We would also like to thank Editage (