عنوان مقاله [English]
Introduction: Acute coronary syndrome (ACS) is an important cause of death. It is important to identify factors predicting mortality of these patients. The aim of this systematic review was to evaluate the prognostic role of platelet-to-lymphocyte ratio (PLR) in patients with ACS.
Materials and Methods: PubMed, Embase and Web of Knowledge databases were searched for relevant studies in, December 29th 2018. Studies investigating the association of PLR with mortality of ACS patients were included in the systematic review. Data extraction and quality assessment are performed independently by two authors. Meta-analysis of hazard ratios and the results of diagnostic statistical methods was performed.
Results: A total of Thirteen studies with 17111 participants were included in the systematic review. Significant association between PLR and mortality rate was observed in all but one study. The pooled hazard ratios of short-term and long-term mortality in high PLR group compared to low PLR group were 2.187 (CI95%: 1.56-3.06) and 2.40 (CI95%: 1.69-3.42), respectively. Moreover, PLR showed a moderate prognostic accuracy for short-term and long-term mortality with area under the SROC curves of 0.710 and 0.668, respectively.
Conclusion: PLR is significantly associated with mortality in ACS patients and can be used alone or in combination with other prognostic markers and scoring systems to stratify the risk of these patients.
1. Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. Ann Transl Med. 2016; 4(13): 256.
2. Sarkees ML, Bavry AA. Acute coronary syndrome (unstable angina and non-ST elevation MI). BMJ Clin Evid. 2009;2009. pii: 0209.
3. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133(4):e38-360. doi: 10.1161/CIR.0000000000000350.
4. Mohseni J, Kazemi T, Maleki MH, Beydokhti H. A Systematic Review on the Prevalence of Acute Myocardial Infarction in Iran. Heart Views. 2017; 18(4): 125–132.
5. Rogers WJ, Frederick PD, Stoehr E, Canto JG, Ornato JP, Gibson CM, et al. Trends in presenting characteristics and hospital mortality among patients with ST elevation and non-ST elevation myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006. Am Heart J. 2008;156(6):1026-34. doi: 10.1016/j.ahj.2008.07.030.
6.Celık T, Balta S, Demır M, Osman Yıldırım A, Kaya MG, Ozturk C, et al. Predictive value of admission red cell distribution width-platelet ratio for no-reflow phenomenon in acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Cardiol J. 2016;23(1):84-92. doi: 10.5603/CJ.a2015.0070.
7. Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, et al. The TIMI risk score for unstable angina/non–ST elevation MI: a method for prognostication and therapeutic decision making. Jama. 2000;284(7):835-42.
8. Morrow DA, Antman EM, Parsons L, de Lemos JA, Cannon CP, Giugliano RP, et al. Application of the TIMI risk score for ST-elevation MI in the National Registry of Myocardial Infarction 3. Jama. 2001;286(11):1356-9.
9. Davies MJ, Thomas A. Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med. 1984;310(18):1137-40.
10. Davì G, Patrono C. Platelet activation and atherothrombosis. N Engl J Med. 2007;357(24):2482-94.
11. Min GT, Wang YH, Yao N, Zhao JM, Wang J, Wang HP, et al. The prognostic role of pretreatment platelet-to-lymphocyte ratio as predictors in patients with colorectal cancer: a meta-analysis. Biomark Med. 2017;11(1):87-97.
12. Tian C, Song W, Tian X, Sun Y. Prognostic significance of platelet-to-lymphocyte ratio in patients with ovarian cancer: A meta-analysis. Eur J Clin Invest. 2018;48(5):e12917.
13. Zheng J, Cai J, Li H, Zeng K, He L, Fu H, et al. Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio as Prognostic Predictors for Hepatocellular Carcinoma Patients with Various Treatments: a Meta-Analysis and Systematic Review. Cell Physiol Biochem. 2017;44(3):967-981. doi: 10.1159/000485396.
14. Zhou Y, Cheng S, Fathy AH, Qian H, Zhao Y. Prognostic value of platelet-to-lymphocyte ratio in pancreatic cancer: a comprehensive meta-analysis of 17 cohort studies. Onco Targets Ther. 2018;11:1899-1908. doi: 10.2147/OTT.S154162.
15. Qiang G, Liang C, Xiao F, Yu Q, Wen H, Song Z, et al. Prognostic significance of platelet-to-lymphocyte ratio in non-small-cell lung cancer: a meta-analysis. Onco Targets Ther. 2016;9:869-76.
16. Acar G, Kalkan ME, Avci A, Alizade E, Tabakci MM, Toprak C, et al. The relation of platelet-lymphocyte ratio and coronary collateral circulation in patients with stable angina pectoris and chronic total occlusion. Clin Appl Thromb Hemost. 2015;21(5):462-8. doi: 10.1177/1076029613508599.
17. Gary T, Pichler M, Belaj K, Hafner F, Gerger A, Froehlich H, et al. Platelet-to-lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS One. 2013;8(7):e67688.
18. Sunbul M, Gerin F, Durmus E, Kivrak T, Sari I, Tigen K, et al. Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension. Clin Exp Hypertens. 2014;36(4):217-21. doi: 10.3109/10641963.2013.804547.
19. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097.
20. Altman DG, McShane LM, Sauerbrei W, Taube SE. Reporting recommendations for tumor marker prognostic studies (REMARK): explanation and elaboration. PLoS Med. 2012;9(5):e1001216. doi: 10.1371/journal.pmed.1001216.
21.Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 2007;8(1):16.
22.Abrahan LL, Aherrera JAM, Ramos JDA, Reganit PF, Punzalan FE. Association of the platelet–lymphocyte ratio (PLR) with outcomes in patients admitted for acute coronary syndrome: The PLACS study. Phillippine Journal of Internal Medicine. 2017;55(3):1-9.
23. Adam AM, Rizvi AH, Haq A, Naseem R, Rehan A, Shaikh AT, et al. Prognostic value of blood count parameters in patients with acute coronary syndrome. Indian Heart Journal. 2018;70(2):233-40.
24. Ayça B, Akin F, Çelik Ö, Yüksel Y, Öztürk D, Tekiner F,et al. Platelet to lymphocyte ratio as a prognostic marker in primary percutaneous coronary intervention. Platelets. 2015;26(7):638-44. doi: 10.3109/09537104.2014.968117.
25.Azab B, Shah N, Akerman M, McGinn Jr JT. Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction. J Thromb Thrombolysis. 2012 Oct;34(3):326-34.
26. Çiçek G, Açikgoz SK, Bozbay M, Altay S, Uğur M, Uluganyan M, et al. Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio Combination Can Predict Prognosis in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Angiology. 2015;66(5):441-7. doi: 10.1177/0003319714535970.
27. Hudzik B, Szkodzinski J, Gorol J, Niedziela J, Lekston A, Gasior M, et al. Platelet-to-lymphocyte ratio is a marker of poor prognosis in patients with diabetes mellitus and ST-elevation myocardial infarction. Biomark Med. 2015;9(3):199-207. doi: 10.2217/bmm.14.100.
28.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. Anatol J Cardiol. 2015;15(4):277-83. doi: 10.5152/akd.2014.5366.
29. Ozcan Cetin EH, Cetin MS, Aras D, Topaloglu S, Temizhan A, Kisacik HL, et al. Platelet to lymphocyte ratio as a prognostic marker of in-hospital and long-term major adverse cardiovascular events in ST-segment elevation myocardial infarction. Angiology. 2016;67(4):336-45. doi: 10.1177/0003319715591751
30. Sharma KH, Shah KH, Patel I, Patel AK, Chaudhari S. Do circulating blood cell types correlate with modifiable risk factors and outcomes in patients with acute coronary syndrome (ACS)?. Indian Heart J. 2015;67(5):444-51. doi: 10.1016/j.ihj.2015.06.005.
31. 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. 2017;68(4):346-353. doi: 10.1177/0003319716657258.
32. Temiz A, Gazi E, Güngör Ö, Barutçu A, Altun B, Bekler A, et al. Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with ST-elevated myocardial infarction. Med Sci Monit. 2014;20:660-5. doi: 10.12659/MSM.890152.
33. Toprak C, Tabakci MM, Simsek Z, Arslantas U, Durmus HI, Ocal L, et al. Platelet/lymphocyte ratio was associated with impaired myocardial perfusion and both in-hospital and long-term adverse outcome in patients with ST-segment elevation acute myocardial infarction undergoing primary coronary intervention. Postepy w Kardiologii Interwencyjnej. 2015;11(4):288-97.
34. Zhou D, Fan Y, Wan Z, Wen W, Wang X, Zhou J, et al. Platelet-to-Lymphocyte Ratio Improves the Predictive Power of GRACE Risk Score for Long-Term Cardiovascular Events in Patients with Acute Coronary Syndrome. Cardiology. 2016;134(1):39-46. doi: 10.1159/000442939.
35. Li W, Liu Q, Tang Y. Platelet to lymphocyte ratio in the prediction of adverse outcomes after acute coronary syndrome: a meta-analysis. Scientific reports. 2017;7:40426-.
36.Li H, Zhou Y, Ma Y, Han S, Zhou L. The prognostic value of the platelet-to-lymphocyte ratio in acute coronary syndrome: a systematic review and meta-analysis. Kardiol Pol. 2017;75(7):666-73. doi: 10.5603/KP.a2017.0068.
37. Mok Y, Ballew SH, Bash LD, Bhatt DL, Boden WE, Bonaca MP, et al. International Validation of the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention in Post-MI Patients: A Collaborative Analysis of the Chronic Kidney Disease Prognosis Consortium and the Risk Validation Scientific Committee. J Am Heart Assoc. 2018;7(14). pii: e008426. doi: 10.1161/JAHA.117.008426.
38. Gholap NN, Achana FA, Davies MJ, Ray KK, Gray L, Khunti K. Long-term mortality after acute myocardial infarction among individuals with and without diabetes: A systematic review and meta-analysis of studies in the post-reperfusion era. Diabetes Obes Metab. 2017;19(3):364-374. doi: 10.1111/dom.12827.
39.Abrahan LL 4th, Ramos JDA, Cunanan EL, Tiongson MDA, Punzalan FER. . Red Cell Distribution Width and Mortality in Patients With Acute Coronary Syndrome: A Meta-Analysis on Prognosis. Cardiol Res. 2018;9(3):144-152. doi: 10.14740/cr732w.
40. Zhang S, Diao J, Qi C, Jin J, Li L, Gao X, et al. Predictive value of neutrophil to lymphocyte ratio in patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention: a meta-analysis. BMC Cardiovasc Disord. 2018;18(1):75.
41.Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352(16):1685-95.
42. Lindemann S, Krämer B, Seizer P, Gawaz M. Platelets, inflammation and atherosclerosis. J Thromb Haemost. 2007;5 Suppl 1:203-11.
43. Gurbel PA, Bliden KP, Kreutz RP, Dichiara J, Antonino MJ, Tantry US. The link between heightened thrombogenicity and inflammation: pre-procedure characterization of the patient at high risk for recurrent events after stenting. Platelets. 2009;20(2):97-104.
44.Klovaite J, Benn M, Yazdanyar S, Nordestgaard B. High platelet volume and increased risk of myocardial infarction: 39 531 participants from the general population. J Thromb Haemost. 2011;9(1):49-56. doi: 10.1111/j.1538-7836.2010.04110.x.
45. Jakl M, Sevcik R, Ceral J, Fatorova I, Horacek JM, Vojacek J. Mean platelet volume and platelet count: overlooked markers of high on-treatment platelet reactivity and worse outcome in patients with acute coronary syndrome. Anadolu Kardiyol Derg. 2014;14(1):85-6. doi: 10.5152/akd.2013.4803.
46. Mallat Z, Tedgui A. Immunomodulation to combat atherosclerosis: the potential role of immune regulatory cells. Expert Opin Biol Ther. 2004;4(9):1387-93.
47. Núñez J, Sanchis J, Bodí V, Núñez E, Mainar L, Heatta AM, et al. Relationship between low lymphocyte count and major cardiac events in patients with acute chest pain, a non-diagnostic electrocardiogram and normal troponin levels. Atherosclerosis. 2009;206(1):251-7. doi: 10.1016/j.atherosclerosis.2009.01.029.
48. Ommen SR, Hodge DO, Rodeheffer RJ, McGregor CG, Thomson SP, Gibbons RJ. Predictive power of the relative lymphocyte concentration in patients with advanced heart failure. Circulation. 1998;97(1):19-22.
49. Bekler A, Gazi E, Yılmaz M, Temiz A, Altun B, Barutçu A, et al. Could elevated platelet-lymphocyte ratio predict left ventricular systolic dysfunction in patients with non-ST elevated acute coronary syndrome? Anatol J Cardiol. 2015;15(5):385-90. doi: 10.5152/akd.2014.5434.