Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014;6(1):35-41.
doi: 10.5681/jcvtr.2014.007. Epub 2014 Mar 21.

The Predictive Value of Total Neutrophil Count and Neutrophil/Lymphocyte Ratio in Predicting In-hospital Mortality and Complications After STEMI

Free PMC article

The Predictive Value of Total Neutrophil Count and Neutrophil/Lymphocyte Ratio in Predicting In-hospital Mortality and Complications After STEMI

Samad Ghaffari et al. J Cardiovasc Thorac Res. .
Free PMC article


Introduction: Leukocytosis, predominantly neutrophilia, has previously been described following ST elevation myocardial infarction (STEMI). The exact contribution of this phenomenon to the clinical outcome of STEMI is yet to be shown. We examined cellular inflammatory response to STEMI in the blood and its association with in-hospital mortality and/or adverse clinical events.

Methods: In this cross-sectional study, 404 patients who were admitted with the diagnosis of acute STEMI at Madani Heart Hospital from March 2010 to March 2012 were studied. The complete blood cell count (CBC) was obtained from all patientswithin12-24 hours of the onset of symptoms. Total leukocytes were counted and differential count was obtained for neutrophils, lymphocytes and neutrophil/lymphocyte ratio (NLR) were evaluated. Association of cellular response with the incidence of post-MI mortality/complications was assessed by multiple logistic regression analyses.

Results: In-hospital mortality and post-STEMI complication rate were 3.7% and 43.6%, respectively. Higher age (P=0.04), female gender (0.002), lower ejection fraction (P<0.001) and absolute neutrophil count (P=0.04) were predictors of mortality. Pump failure in the form of acute pulmonary edema or cardiogenic shock occurred in 35 (8.9%) of patients. Higher leukocyte (P<0.03) and neutrophil counts (P<0.03) and higher NLR (P=0.01) were predictors of failure. The frequency of ventricular tachyarrhythmias (VT/VF) at the first day was associated with higher neutrophil count (P<0.001) and higher NLR level (P<0.001). In multivariate analysis neutrophil count was an independent predictor of mortality (OR=2.94; 1.1-8.4, P=0.04), and neutrophil count [OR=1.1, CI (1.01-1.20), P=0.02], female gender [OR=2.34, CI (1.02-4.88), P=0.04] and diabetes [OR=2.52, CI (1.21-5.2), P=0.003] were independent predictors of heart failure.

Conclusion: A single CBC analysis may help to identify STEMI patients at risk for mortality and heart failure, and total neutrophil count is the most valuable in predicting both.

Keywords: Acute Myocardial Infarction; Neutrophil/Lymphocyteratio; ST Segment Elevation; Total Neutrophil Count; White Blood Cell.

Similar articles

See all similar articles

Cited by 25 articles

See all "Cited by" articles


    1. White PD, Mallory GK, Salcedo-Salgar J. The Speed of Healing of Myocardial Infarcts. Trans Am Clin Climatol Assoc. 1936;52:97–104 101. - PMC - PubMed
    1. Bursi F, Weston SA, Killian JM, Gabriel SE, Jacobsen SJ, Roger VL. C-reactive protein and heart failure after myocardial infarction in the community. Am J Med. 2007;120:616–622. - PubMed
    1. Fuster V, Lewis A. Conner Memorial LectureMechanisms leading to myocardial infarction: insights from studies of vascular biology. Circulation. 1994;90:2126–2146. - PubMed
    1. Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med. 1999;340:115–126. - PubMed
    1. Thomson SP, Gibbons RJ, Smars PA, Suman VJ, Pierre RV, Santrach PJ. et al. Incremental value of the leukocyte differential and the rapid creatine kinase-MB isoenzyme for the early diagnosis of myocardial infarction. Ann Intern Med. 1995;122:335–341. - PubMed

LinkOut - more resources