Analisis Neutrophil-to-Lymphocyte Ratio dan Platelet-to-Lymphocyte Ratio pada Pasien Infark Miokard Akut

Authors

  • Geoffrey Christian Lo Fakultas Kedokteran, Universitas Tarumanagara, Jakarta, Indonesia
  • Freddy Ciptono Fakultas Kedokteran, Universitas Tarumanagara, Jakarta, Indonesia

DOI:

https://doi.org/10.36452/jkdoktmeditek.v31i3.3563

Keywords:

acute myocardial infarction, inflammation, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio

Abstract

Introduction: Acute myocardial infarction (AMI) is a clinical manifestation of coronary atherosclerosis involving chronic inflammation. Neutrophilia, lymphopenia, and thrombocytosis due to systemic inflammation can be measured using hematological markers neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Previous studies have reported using NLR and PLR to determine the prognosis of cardiovascular disease. Purpose: This study aims to investigate whether NLR and PLR differ in the incidence of AMI, both NSTEMI (non-ST elevation myocardial infarction) and STEMI (ST elevation myocardial infarction), and to evaluate their predictive value. Methods: A cross-sectional study was conducted using complete blood count data from 141 AMI patients treated at Tzu Chi  Hospital from 2018 to 2024 upon their arrival at the emergency room. The data were analyzed using SPSS, utilizing the Mann-Whitney test to identify significant differences, and Receiver Operating Characteristic analysis to assess the predictive value and cut-off points for NLR and PLR. Results: There was a statistically significant difference in NLR in the incidence of AMI (p = 0.013) but no statistically significant difference in PLR in the incidence of AMI (p = 0.549). NLR with a cut-off of 4.34 (sensitivity 60.6%, specificity 60%) showed a low predictive value (AUC = 0.622), and PLR with a cut-off of 158.90 (sensitivity 53%, specificity 57.3%) had no predictive value (AUC = 0.529) to distinguish between NSTEMI and STEMI events. Conclusion: The difference in NLR was more significant and had better predictive value than PLR in AMI

Author Biography

Freddy Ciptono, Fakultas Kedokteran, Universitas Tarumanagara, Jakarta, Indonesia

Bagian Patologi Klinik, Fakultas Kedokteran, Universitas Tarumanagara, Jakarta, Indonesia

References

World Health Organization (WHO). Cardiovascular diseases (CVDs) [Internet]. 2021 [cited 2024 Aug 2]. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

Badan Kebijakan Pembangunan Kesehatan. Survei Kesehatan Indonesia (SKI) 2023 Dalam Angka [Internet]. 2023. [cited 2024 Aug 2]. Available from: https://www.badankebijakan.kemkes.go.id/ski-2023-dalam-angka/

Kementerian Kesehatan RI. Penyakit jantung penyebab utama kematian, Kemenkes Perkuat Layanan Primer [Internet]. 2022 [cited 2024 Aug 2]. Available from: https://sehatnegeriku.kemkes.go.id/baca/rilis-media/20220929/0541166/penyakit-jantung-penyebab-utama-kematian-kemenkes-perkuat-layanan-primer/

Singh A, Grossman SA. Coronary syndrome, acute. StatPearls [Internet]. 2018 [cited 2024 Aug 6]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/29083796

Theofilis P, Oikonomou E, Chasikidis C, Tsioufis K, Tousoulis D. Pathophysiology of acute coronary syndromes—Diagnostic and Treatment Considerations. Life [Internet]. 2023 [cited 2024 Aug 3];13(7):1543. Available from: https://doi.org/10.3390/life13071543

Adam CA, Șalaru DL, Prisacariu C, Marcu DTM, Sascău RA, Stătescu C. Novel biomarkers of atherosclerotic vascular disease—Latest Insights in the Research Field. Int J Mol Sci [Internet]. 2022 [cited 2024 Aug 13];23(9):4998. Available from: https://doi.org/10.3390/ijms23094998

Oylumlu M, Yıldız A, Oylumlu M, Yüksel M, Polat N, Bilik MZ, et al. Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality patients with acute coronary syndrome. Anadolu Kardiyol Derg [Internet]. 2015 [cited 2025 Jan 31];15(4):277–83. Available from: https://doi.org/10.5152/akd.2014.5366

Kyaw T, Peter K, Li Y, Tipping P, Toh BH, Bobik A. Cytotoxic lymphocytes and atherosclerosis: significance, mechanisms and therapeutic challenges. Br J Pharmacol [Internet]. 2017 [cited 2025 Jan 28];174(22):3956–72. Available from: https://doi.org/10.1111/bph.13845

Guo T meng, Cheng B, Ke L, Guan S ming, Qi B ling, Li W zhu, et al. Prognostic value of neutrophil to lymphocyte ratio for in-hospital mortality in elderly patients with acute myocardial infarction. Curr Med Sci [Internet]. 2018 [cited 2025 Jan 23];38(2):354–9. Available from: https://doi.org/10.1007/s11596-018-1887-0

Yildiz A, Yuksel M, Oylumlu M, Polat N, Akyuz A, Acet H, et al. The utility of the platelet–lymphocyte ratio for predicting no reflow in patients with ST-segment elevation myocardial infarction. Clin Appl Thromb [Internet]. 2015 Apr 14 [cited 2025 Jan 21];21(3):223–8. Available from: https://journals.sagepub.com/doi/10.1177/1076029613519851

Ahbap E, Sakaci T, Kara E, Sahutoglu T, Koc Y, Basturk T, et al. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in evaluation of inflammation in end-stage renal disease. Clin Nephrol [Internet]. 2016 [cited 2024 Aug 3];85(4):199–208. Available from: https://doi.org/10.5414/CN108584

Selanno Y, Darmawaty ER, Wibawa SY, Abdullah AA. Analysis of NLR, HDL, and Hs-Troponin I as adiagnostic marker in STEMI and NSTEMI patients. Indones J Clin Pathol Med Lab [Internet]. 2022 [cited 2025 Jan 8];29(1):38–42. Available from: https://doi.org/10.24293/ijcpml.v29i1.2083

Algın A, Özdemir S. Comparison of the monocyte-to-HDL cholesterol ratio between patients with STEMI and NSTEMI: A retrospective observational study. J Clin Med Kazakhstan [Internet]. 2021 [cited 2025 Jan 25];18(6):45–9. Available from: https://doi.org/10.23950/jcmk/11326

Ertürk M, Turhan Caglar FN, Bıyık İ. Correlations between hematological indicators and other known markers in acute coronary syndromes. E J Cardiovasc Med [Internet]. 2017 [cited 2025 Jan 8];5(4):67–74. Available from: https://doi.org/10.15511/ejcm.17.00467

Harun H, Bahrun U, ER D. Platelet-lymphocyte ratio (PLR) markers in acute coronary syndrome(Platelet lymphocyte ratio (PLR) sebagai petanda sindrom koroner akut). Indones J Clin Pathol Med Lab [Internet]. 2018 [cited 2025 Jan 8];23(1):7–11. Available from: https://doi.org/10.24293/ijcpml.v23i1.1176

Yuan S, Li L, Pu T, Fan X, Wang Z, Xie P, et al. The relationship between NLR, LDL-C/HDL-C, NHR and coronary artery disease. PLoS One [Internet]. 2024 [cited 2025 Jan 16];19(7):1-12. Available from: https://doi.org/10.1371/journal.pone.0290805

Jebari-Benslaiman S, Galicia-García U, Larrea-Sebal A, Olaetxea JR, Alloza I, Vandenbroeck K, et al. Pathophysiology of atherosclerosis. Int J Mol Sci [Internet]. 2022 [cited 2024 Aug 16];23(6):3346. Available from: https://doi.org/10.3390/ijms23063346

Pende A, Artom N, Bertolotto M, Montecucco F, Dallegri F. Role of neutrophils in atherogenesis: an update. Eur J Clin Invest [Internet]. 2016 [cited 2025 Jan 16];46(3):252–63. Available from: https://doi.org/10.1111/eci.12566

Mangold A, Alias S, Scherz T, Hofbauer T, Jakowitsch J, Panzenböck A, et al. Coronary neutrophil extracellular trap burden and deoxyribonuclease activity in ST-elevation acute coronary syndrome are predictors of ST-segment resolution and infarct size. Circ Res [Internet]. 2015 [cited 2025 Jan 16];116(7):1182–92. Available from: https://doi.org/10.1161/CIRCRESAHA.116.304944

Wikananda GDD, Diartoputra AYR. Association of neutrophil-lymphocyte ratio and platelet lymphocyte ratio with GRACE risk score and high-sensitivity troponin T in acute coronary syndrome patient. Intisari Sains Medis [Internet]. 2023 [cited 2025 Jan 16];14(2):489–92. Available from: https://doi.org/10.15562/ism.v14i2.1637

Aladio JM, Costa D, Matsudo M, Pérez de la Hoz A, González D, Brignoli A, et al. Cortisol-mediated stress response and mortality in acute coronary syndrome. Curr Probl Cardiol [Internet]. 2021 [cited 2025 Jan 16];46(3):100623. Available from: https://doi.org/10.1016/j.cpcardiol.2020.100623

Zafrir B, Hussein S, Jaffe R, Barnett-Griness O, Saliba W. Lymphopenia and mortality among patients undergoing coronary angiography: Long-term follow-up study. Cardiol J [Internet]. 2022 [cited 2025 Jan 16];29(4):637–46. Available from: https://doi.org/10.5603/CJ.a2020.0141

Budzianowski J, Pieszko K, Burchardt P, Rzeźniczak J, Hiczkiewicz J. The role of hematological indices in patients with acute coronary syndrome. Dis Markers [Internet]. 2017 [cited 2025 Jan 16];2017: 3041565. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5646322/

Dentali F, Nigro O, Squizzato A, Gianni M, Zuretti F, Grandi AM, et al. Impact of neutrophils to lymphocytes ratio on major clinical outcomes in patients with acute coronary syndromes: A systematic review and meta-analysis of the literature. Int J Cardiol [Internet]. 2018 Sep [cited 2025 Jan 16];266:31–7. Available from: https://doi.org/10.1016/j.ijcard.2018.02.116

Tahto E, Jadric R, Pojskic L, Kicic E. Neutrophil-to-lymphocyte ratio and its relation with markers of inflammation and myocardial necrosis in patients with acute coronary syndrome. Med Arch (Sarajevo, Bosnia Herzegovina) [Internet]. 2017 [cited 2025 Jan 16];71(5):312–5. Available from: https://doi.org/10.5455/medarh.2017.71.312-315

Hong D, Choi KH, Song Y Bin, Lee JM, Park TK, Yang JH, et al. Prognostic implications of post-percutaneous coronary intervention neutrophil-to-lymphocyte ratio on infarct size and clinical outcomes in patients with acute myocardial infarction. Sci Rep [Internet]. 2019 [cited 2025 Jan 16];9(1):1-9. Available from: https://doi.org/10.1038/s41598-019-46117-8

Mansiroglu AK, Sincer I, Gunes Y. Assessment of neutrophil and neutrophil/ lymphocyte ratio in coronary collateral developed patients with acute coronary syndrome. Rev Assoc Med Bras [Internet]. 2020 [cited 2025 Jan 16];66(7):954–9. Available from: https://doi.org/10.1590/1806-9282.66.7.954

Tsioumpekou M, Krijgsman D, Leusen JHW, Olofsen PA. The role of cytokines in neutrophil development, tissue homing, function and plasticity in health and disease. Cells [Internet]. 2023 [cited 2025 Jan 24];12(15):1981. Available from: https://doi.org/10.3390/cells12151981

Bouzidi N, Gamra H. Relationship between serum interleukin-6 levels and severity of coronary artery disease undergoing percutaneous coronary intervention. BMC Cardiovasc Disord [Internet]. 2023 [cited 2025 Jan 24];23(1). Available from: https://doi.org/10.1186/s12872-023-03570-8

Maréchal P, Tridetti J, Nguyen ML, Wéra O, Jiang Z, Gustin M, et al. Neutrophil phenotypes in coronary artery disease. J Clin Med [Internet]. 2020 [cited 2025 Jan 24];9(5):1–14. Available from: https://doi.org/10.3390/jcm9051602

Sun XP, Li J, Zhu WW, Li DB, Chen H, Li HW, et al. Impact of platelet-to-lymphocyte ratio on clinical outcomes in patients with ST-segment elevation myocardial infarction. Angiology [Internet]. 2017 [cited 2025 Jan 21];68(4):346–53. Available from: https://doi.org/10.1177/0003319716657258

Kosmas N, Simitsis P, Alevyzakis E, Rizos E, Zapantiotis D, Rallidis LS. Hair cortisol concentration, a stress biomarker, is gradually increasing before an acute myocardial infarction. Coron Artery Dis [Internet]. 2024 [cited 2025 Jan 24]; 36(3):218–24. Available from: https://doi.org/10.1097/MCA.0000000000001468

Setianingrum EPPA. The difference between neutrofil total, neutrophil / lymphocyte and platelets / lymphocyte ratio in normal patients, NSTEMI, STEMI. Indones J Clin Pathol Med Lab [Internet]. 2019 [cited 2025 Jan 16];25(3):268–73. Available from: https://doi.org/10.24293/ijcpml.v25i3.1445

Lestari, Wibawa SY, Lopa AT, Rauf D. Prognostic value of platelet-lymphocyte ratio and high-density lipoprotein in patients with acute myocardial infarct. Indones J Clin Pathol Med Lab [Internet]. 2021 [cited 2025 Jan 16];28(1):46–50. Available from: https://doi.org/10.24293/ijcpml.v28i1.1730

3Kamińska J, Koper OM, Siedlecka-Czykier E, Matowicka-Karna J, Bychowski J, Kemona H. The utility of inflammation and platelet biomarkers in patients with acute coronary syndromes. Saudi J Biol Sci [Internet]. 2018 [cited 2025 Jan 31];25(7):1263–71. Available from: https://doi.org/10.1016/j.sjbs.2016.10.015

Akboga MK, Canpolat U, Yayla C, Ozcan F, Ozeke O, Topaloglu S, et al. Association of platelet to lymphocyte ratio with inflammation and severity of coronary atherosclerosis in patients with stable coronary artery disease. Angiology [Internet]. 2016 [cited 2025 Jan 21];67(1):89–95. Available from: https://doi.org/10.1177/0003319715583186

El Missiri A, Awad M, Shaheen S. The relation between platelet/lymphocyte ratio and the occurrence of no reflow in patients with ST-segment elevation myocardial infarction managed by primary percutaneous coronary intervention. Int J Cardiovasc Acad [Internet]. 2021 [cited 2025 Jan 21];7(1):2–8. Available from: https://doi.org/10.4103/ijca.ijca_52_20

Indriastuti E, Hernaningsih Y, Indrasari YN, Andrianto. Immature platelet fraction as a potential marker to differentiate types of acute coronary syndrome. Indones J Clin Pathol Med Lab [Internet]. 2020 [cited 2025 Jan 24];27(1):16–21. Available from: https://doi.org/10.24293/ijcpml.v27i1.1609

Hashemian AM, Ramezani J, Ahmadian MA, Ziaee M, Sharifi MD, Moghadam HZ, et al. Could mean platelet volume differentiate acute coronary syndrome (ACS) types? J Med Chem Sci [Internet]. 2023 [cited 2025 Jan 24];6(1):44–54. Available from: https://doi.org/10.26655/JMCHEMSCI.2023.1.6

Huang HL, Chen CH, Kung C Te, Li YC, Sung PH, You HL, et al. Clinical utility of mean platelet volume and immature platelet fraction in acute coronary syndrome. Biomed J [Internet]. 2019 [cited 2025 Jan 24];42(2):107–15. Available from: https://doi.org/10.1016/j.bj.2018.12.005

Published

2025-06-16

How to Cite

Geoffrey Christian Lo, & Freddy Ciptono. (2025). Analisis Neutrophil-to-Lymphocyte Ratio dan Platelet-to-Lymphocyte Ratio pada Pasien Infark Miokard Akut. Jurnal Kedokteran Meditek, 31(3). https://doi.org/10.36452/jkdoktmeditek.v31i3.3563

Issue

Section

Artikel Penelitian