Exploratory analysis of the neutrophil to lymphocyte ratio in patients with pulmonary arterial hypertension

TY - JOUR

T1 - Exploratory analysis of the neutrophil to lymphocyte ratio in patients with pulmonary arterial hypertension

AU - Harbaum, Lars

AU - Baaske, Kaaja M

AU - Simon, Marcel

AU - Oqueka, Tim

AU - Sinning, Christoph

AU - Glatzel, Antonia

AU - Lüneburg, Nicole

AU - Sydow, Karsten

AU - Bokemeyer, Carsten

AU - Klose, Hans

PY - 2017/4/26

Y1 - 2017/4/26

N2 - BACKGROUND: Chronic inflammation emerges as a feature of the pathogenesis of pulmonary arterial hypertension (PAH) in experimental models. Alterations of circulating cell subsets have been observed in patients with PAH. We aimed to assess associations of the white blood cell count with disease severity and outcome in patients with PAH.METHODS: The total and differential white blood cell count was related to functional parameters, pulmonary hemodynamics and transplantation-free survival in 77 patients with PAH in an observational single center study.RESULTS: An increased neutrophil/lymphocyte ratio was associated with poor World Health Organization functional class and shorter 6-minute walking distance, as well as with elevated right atrial pressure and high level of N-terminal prohormone of brain natriuretic peptide. During a median follow-up period of 31 months (range 16-56) 23 patients died and 2 patients were referred to lung transplantation. Using uni- and subsequent bivariate Cox proportional hazards analyses an increased neutrophil/lymphocyte ratio was associated with unfavorable transplantation-free survival independent of hemodynamic parameters and C-reactive protein. The prognostic implication sustained in subsets of patients with incident PAH and in the absence of cardiovascular risk factors.CONCLUSIONS: The results of this analysis indicate that a neutrophilic inflammation may be associated with clinical deterioration and poor outcome in patients with PAH. Assessing the composition of the differential white blood cell count may render prognostic information and could represent a step towards incorporating an inflammatory marker into the clinical management of patients with PAH.

AB - BACKGROUND: Chronic inflammation emerges as a feature of the pathogenesis of pulmonary arterial hypertension (PAH) in experimental models. Alterations of circulating cell subsets have been observed in patients with PAH. We aimed to assess associations of the white blood cell count with disease severity and outcome in patients with PAH.METHODS: The total and differential white blood cell count was related to functional parameters, pulmonary hemodynamics and transplantation-free survival in 77 patients with PAH in an observational single center study.RESULTS: An increased neutrophil/lymphocyte ratio was associated with poor World Health Organization functional class and shorter 6-minute walking distance, as well as with elevated right atrial pressure and high level of N-terminal prohormone of brain natriuretic peptide. During a median follow-up period of 31 months (range 16-56) 23 patients died and 2 patients were referred to lung transplantation. Using uni- and subsequent bivariate Cox proportional hazards analyses an increased neutrophil/lymphocyte ratio was associated with unfavorable transplantation-free survival independent of hemodynamic parameters and C-reactive protein. The prognostic implication sustained in subsets of patients with incident PAH and in the absence of cardiovascular risk factors.CONCLUSIONS: The results of this analysis indicate that a neutrophilic inflammation may be associated with clinical deterioration and poor outcome in patients with PAH. Assessing the composition of the differential white blood cell count may render prognostic information and could represent a step towards incorporating an inflammatory marker into the clinical management of patients with PAH.

KW - Journal Article

U2 - 10.1186/s12890-017-0407-5

DO - 10.1186/s12890-017-0407-5

M3 - SCORING: Journal article

C2 - 28446163

VL - 17

SP - 72

JO - BMC PULM MED

JF - BMC PULM MED

SN - 1471-2466

IS - 1

ER -