Abstract
The prognostic assessment of patients with acute pulmonary embolism (PE) is essential to drive its management. The search for new prognostic factors is a central issue for a more accurate estimate of short-term adverse events. Circulating neutrophils/lymphocytes ratio (NLR) has been suggested as prognostic biomarker for different cardiovascular diseases. Given the central role of inflammation, and in particular of neutrophils in the pathogenesis of VTE and its clinical history, NLR might represent a prognostic tool also in this setting. We performed a systematic review and meta-analysis of the literature to assess the prognostic role of NLR in patients with acute PE. MEDLINE and EMBASE were searched up to 2017, week 21. A bivariate random-effects regression approach was used to obtain summary estimate of accuracy of the high NLR adjusting for inter-study variability. Six studies for a total of 1424 patient are included. High NLR has a weighted mean sensitivity of 77% (95% CI 68–83) and a weighted mean specificity of 74% (95% CI 68–79). High NLR positive and negative predictive values are 24.4% (95% CI 20.4–28.3) and 96.7% (95% CI 95.6–97.8), respectively. The relevant impact of NLR on short-term mortality after an acute PE makes it a promising biomarker to better stratify patient prognosis.
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Konstantinides SV, Torbicki A, Agnelli G et al (2014) Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 35:3033–3069
Meyer G, Planquette B, Sanchez O (2015) Pulmonary embolism: whom to discharge and whom to thrombolyze? J Thromb Haemost 13(Suppl. 1):S252–S258
Elias A, Mallett S, Daoud-Elias M et al (2016) Prognostic models in acute pulmonary embolism: a systematic review and meta-analysis. BMJ Open 6:e010324
Lankeit M, Jiménez D, Kostrubiec M et al (2014) Validation of N-terminal pro-brain natriuretic peptide cut-off values for risk stratification of pulmonary embolism. Eur Respir J 43:1669–1677
Becattini C, Agnelli G, Vedovati MC et al (2011) Multidetector computed tomography for acute pulmonary embolism: diagnosis and risk stratification in a single test. Eur Heart J 32:1657–1663
Becattini C, Vedovati MC, Agnelli G (2007) Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation 116:427–433
Dentali F, Conte G, Guasti L (2016) Neutrophil-to-lymphocyte ratio: a new prognostic factor even in patients with heart failure. Pol Arch Med Wewn 126:116–117
Ergelen M, Uyarel H, Altay S et al (2014) Predictive value of elevated neutrophil to lymphocyte ratio in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction. Clin Appl Thromb Hemost 20:427–432
Bhat TM, Afari ME, Garcia LA (2016) Neutrophil lymphocyte ratio in peripheral vascular disease: a review. Expert Rev Cardiovasc Ther 14:871–875
Wang Q, Ma J, Jiang Z et al (2017) Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute pulmonary embolism: a systematic review and meta-analysis. Int Angiol. https://doi.org/10.23736/S0392-9590.17.03848-2
Korevaar DA, van Enst WA, Spijker R et al (2014) Reporting quality of diagnostic accuracy studies: a systematic review and meta-analysis of investigations on adherence to STARD. Evid Based Med 19:47–54
Reitsma JB, Glas AS, Rutjes AW et al (2005) Bivariate analysis of sensitivity and specificity produces informative measures in diagnostic reviews. J Clin Epidemiol 58:982–990
Zwinderman AH, Bossuyt PM (2008) We should not pool diagnostic likelihood ratios in systematic reviews. Stat Med 27:687–697
Akgüllü Ç, Ömürlü IK, Eryılmaz U et al (2015) Predictors of early death in patients with acute pulmonary embolism. Am J Emerg Med 33:214–221
Ma Y, Mao Y, He X et al (2016) The values of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in predicting 30 day mortality in patients with acute pulmonary embolism. BMC Cardiovasc Disord 16:123
Karataş MB, Ipek G, Onuk T et al (2016) Assessment of prognostic value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in patients with pulmonary embolism. Acta Cardiol Sin 32:313–320
Soylu K, Gedikli Ö, Ekşi A et al (2016) Neutrophil-to-lymphocyte ratio for the assessment of hospital mortality in patients with acute pulmonary embolism. Arch Med Sci 12:95–100
Kayrak M, Erdoğan HI, Solak Y et al (2014) Prognostic value of neutrophil to lymphocyte ratio in patients with acute pulmonary embolism: a retrospective study. Heart Lung Circ 23:56–62
Cavuş UY, Yildirim S, Sönmez E et al (2014) Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism. Turk J Med Sci 44:50–55
Beccatini C, Agnelli G (2017) Claims-based or clinical models for predicting 90-day post-pulmonary embolism outcomes. Intern Emerg Med 12:573–576
Hallenkamp K, Schwung J, Rossmann H et al (2015) Risk stratification of normotensive pulmonary embolism: prognostic impact of copeptin. Eur Respir J 46:1551–1553
Hobohm L, Hellenkamp K, Hasenfuß G et al (2016) Comparison of risk assessment strategies for not-high-risk pulmonary embolism. Eur Respir J 47:1054–1056
Vanni S, Nazerian P, Bova C et al (2017) Comparison of clinical score for identification of patients with pulmonary embolism at intermediate-high risk of adverse clinical outcome: the prognostic role of lactate. Intern Emerg Med 12:657–665
Engelmann B, Massberg SS (2013) Thrombosis as an intravascular effector of innate immunity. Nat Rev Immunol 13:34–45
von Brühl ML, Stark K, Steinhart A et al (2012) Monocytes, neutrophils, and platelets cooperate to initiate and propagate venous thrombosis in mice in vivo. J Exp Med 209:819–835
Vazquez-Garza E, Jerjes-Sanchez C, Navarrete A et al (2017) Venous thromboembolism: thrombosis, inflammation, and immunothrombosis for clinicians. J Thromb Thrombolysis 44:377–385
Aldabbous L, Abdul-Salam V, McKinnon T et al (2016) Neutrophil extracellular traps promote angiogenesis: evidence from vascular pathology in pulmonary hypertension. Arterioscler Thromb Vasc Biol 36:2078–2087
Connolly GC, Khorana AA, Kuderer NM et al (2010) Leucocytes, thrombosis and early mortality in cancer patients initiating chemotherapy. Thromb Res 126(2):113–118
Trujillo-Santos J, Di Micco P, Iannuzzo M et al (2008) Elevated blood cell count and outcome in cancer patients with venous thromboembolism. Findings from the RIETE Registry. Thromb Haemost 100(5):905–911
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Galliazzo, S., Nigro, O., Bertù, L. et al. Prognostic role of neutrophils to lymphocytes ratio in patients with acute pulmonary embolism: a systematic review and meta-analysis of the literature. Intern Emerg Med 13, 603–608 (2018). https://doi.org/10.1007/s11739-018-1805-2
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DOI: https://doi.org/10.1007/s11739-018-1805-2