IMPORTANCE OF TOTAL NEUTROPHIL COUNT, NEUTROPHIL-TO LYMPHOCYTE RATIO AND PLATELET-TO-LYMPHOCYTE RATIO IN PREDICTING IMMEDIATE OUTCOMES OF ACUTE MYOCARDIAL INFARCTION
Authors: Dr. Nikhilkumar Thakkar Bhagyen, Dr. Rashmi Modwal
Publication Date: 2026/09/23
DOI: 10.59551/10.59551/IJHMP/25832069/2026.7.2.161
Abstract
<p>Background: Acute myocardial infarction (AMI) remains a major cause of morbidity and mortality worldwide. Inflammation plays an important role in the pathogenesis of myocardial infarction and influences infarct size, ventricular dysfunction and subsequent complications. Simple hematological parameters obtained from a routine complete blood count, particularly total neutrophil count (TNC), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), may provide useful information regarding systemic inflammatory and thrombotic activity. This study evaluated the association of these parameters with immediate outcomes in patients with AMI. Methods: This observational cross-sectional study included 138 patients aged >18 years diagnosed with AMI and admitted to the Departments of General Medicine, Cardiology and Emergency Medicine at the National Institute of Medical Sciences and Research, Jaipur. Patients with infection, malignancy, hematological disorders, autoimmune disease, pre existing valvular disease, previous myocardial infarction, steroid therapy and other causes of chest pain were excluded. TNC, total lymphocyte count, platelet count, NLR and PLR were assessed at admission. Clinical characteristics, ECG findings, troponin I, ejection fraction, TIMI score and Killip class were recorded. Patients were evaluated for major adverse cardiovascular events (MACE). Results: The mean age was 57.60 ± 12.77 years, and 91 (65.9%) patients were male. MACE occurred in 15 patients (10.9%). Patients with MACE had significantly higher TNC (5.61 ± 1.26 vs 4.78 ± 1.93 ×10⁹/L; p=0.034) and lower lymphocyte counts (1.06 ± 0.40 vs 2.37 ± 0.91 ×10⁹/L; p<0.001). NLR was significantly higher among patients with MACE (5.83 ± 2.04 vs 2.41 ± 1.70; p<0.001), as was PLR (313.67 ± 101.53 vs 143.34 ± 95.20; p<0.001). ROC analysis demonstrated that NLR had the highest predictive performance for MACE (AUC 0.912), followed by PLR (AUC 0.887) and TNC (AUC 0.742). An NLR cut-off >3.95 demonstrated 86.7% sensitivity and 84.6% specificity. Conclusion: TNC, NLR and PLR were significantly associated with immediate adverse outcomes in patients with AMI. Among the evaluated hematological parameters, NLR demonstrated the highest predictive accuracy. These inexpensive and readily available markers may serve as useful adjuncts to conventional clinical assessment and risk stratification.</p>
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