Neutrophil-lymphocyte ratio and clinical outcomes in 19,697 patients with atrial fibrillation: Analyses from ENGAGE AF- TIMI 48 trial

Int J Cardiol. 2023 Sep 1:386:118-124. doi: 10.1016/j.ijcard.2023.05.031. Epub 2023 May 19.

Abstract

Background: The neutrophil-to-lymphocyte ratio (NLR) is the ratio between neutrophil and lymphocyte counts measured in peripheral blood. NLR is easily calculable based on a routine blood test available worldwide and may reflect systemic inflammation. However, the relationship between NLR and clinical outcomes in atrial fibrillation (AF) patients is not well-described.

Methods: We calculated NLR at baseline in ENGAGE AF-TIMI 48, a randomized trial comparing edoxaban versus warfarin in patients with AF followed for 2.8 years (median). The association of baseline NLR with major bleeding events, major adverse cardiac events (MACE), cardiovascular death, stroke/systemic embolism, and all-cause mortality were calculated.

Results: The median baseline NLR in 19,697 patients was 2.53 (interquartile range 1.89-3.41). NLR was associated with major bleeding events (HR 1.60; 95% CI 1.41-1.80), stroke/systemic embolism (HR 1.25; 95% CI, 1.09-1.44), MI (HR 1.73; 95% CI 1.41-2.12), MACE (HR 1.70; 95% CI 1.56-1.84), CV (HR 1.93; 95% CI 1.74-2.13) and all-cause mortality (HR 2.00; 95% CI 1.83-2.18). The relationships between NLR and outcomes remained significant after adjustment for risk factors. Edoxaban consistently reduced major bleeding. MACE, and CV death across NLR groups vs. warfarin.

Conclusions: NLR represents a widely available, simple, arithmetic calculation that could be immediately and automatically reported during a white blood cell differential measurement to identify patients with AF at increased risk of bleeding, CV events, and mortality.

Keywords: Atrial fibrillation; Bleeding; CV death; NLR; Neutrophil-lymphocyte ratio.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Anticoagulants / therapeutic use
  • Atrial Fibrillation* / chemically induced
  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / drug therapy
  • Embolism* / chemically induced
  • Factor Xa Inhibitors / adverse effects
  • Hemorrhage / chemically induced
  • Hemorrhage / diagnosis
  • Humans
  • Lymphocytes
  • Neutrophils
  • Stroke* / chemically induced
  • Treatment Outcome
  • Warfarin / adverse effects

Substances

  • Anticoagulants
  • edoxaban
  • Factor Xa Inhibitors
  • Warfarin