Prognostic utility of leukocyte parameters for prediction of in-hospital mortality among patients with acute myocardial infarction

Abstract

Among the tools presented today for predicting the risk of death from acute myocardial infarction (AMI) the most popular one is GRACE risk score. Along with it, due to the improvement of the prognostic value of the score, a number of parameters are displayed, the main features of which are the availability and ease of interpretation on early stages of hospitalization. The most promising among those are leukocyte parameters. While most studies evaluate the long-term prognosis of AMI, our work focused on potential precursors of in-hospital events. Among 228 patients diagnosed with AMI, 18 died at the hospital. They had a significantly higher GRACE and Gensini scores (p < 0.001). Also, patients of this group had s higher levels of leukocytes, granulocytes, lymphocytes and the neutrophil to lymphocyte ratio (NLR) (p < 0,05). According to the regression analysis, the NLR index along with GRACE was strongly connected to in-hospital mortality (OR = 1,364, 95 % CI 1,119-1,664, p = 0.002). To determine the prognostic value of these indicators, ROC analysis was performed. When evaluating the sensitivity (Se) and specificity (Sp) of parameters, the following results were obtained: GRACE score (Se = 80.0 %, Sp = 77.8 %, AUC 0.854), NLR (Se = 73.3 %, Sp = 73, 4 %, AUC 0.758), GRACE + NLR (Se = 80.0 %, Sp = 84.1 %, AUC 0.91). Thus, the combination of the GRACE risk score and NLR is more effective for predicting in-hospital mortality among patients with AMI.