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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Hemogram-derived ratios as prognostic markers for major adverse cardiovascular events in patients with non-ST-segment elevation myocardial infarction
Emir Bećirović, Minela Bećirović, Sabina Šegalo, Amir Bećirović, Semir Hadžić, Kenana Ljuca, Emsel Papić, Lamija Ferhatbegović, Malik Ejubović, Amira Jagodić Ejubović, Amila Kovčić, Armin Šljivo, Emir Begagić
Emir Bećirović, Department of Intensive Care, University Clinical Center Tuzla, Tuzla 75000, Bosnia and Herzegovina
Minela Bećirović, Department of Nephrology, University Clinical Center Tuzla, Tuzla 75000, Bosnia and Herzegovina
Sabina Šegalo, Emsel Papić, Department of Laboratory Technologies, Faculty of Health Sciences, University of Sarajevo, Sarajevo 71000, Bosnia and Herzegovina
Amir Bećirović, Semir Hadžić, Department of Endocrinology, University Clinical Center Tuzla, Tuzla 75000, Bosnia and Herzegovina
Kenana Ljuca, School of Medicine, University of Tuzla, Tuzla 75000, Bosnia and Herzegovina
Lamija Ferhatbegović, Department for Internal Diseases and Hemodialysis, Canton Hospital Zenica, Zenica 72000, Bosnia and Herzegovina
Malik Ejubović, Amira Jagodić Ejubović, Department of Internal Medicine, Canton Hospital Zenica, Zenica 72000, Bosnia and Herzegovina
Amila Kovčić, Department of Radiotherapy, University Clinical Center Tuzla, Tuzla 75000, Bosnia and Herzegovina
Armin Šljivo, Department of Cardiology, University Clinical Center Sarajevo, Sarajevo 72000, Bosnia and Herzegovina
Emir Begagić, Department of General Medicine, University of Zenica, School of Medicine, Zenica 72000, Bosnia and Herzegovina
Co-first authors: Emir Bećirović and Minela Bećirović.
Author contributions: Bećirović E and Bećirović M designed the research study; Bećirovic A, Hadžić S, and Ljuca K performed the research; Šegalo S and Papić E supervised the research; Ferhatbegović L, Ejubović M and Ejubović AJ wrote the manuscript; Kovčić A, Šljivo A and Begagić E analyzed the data. All authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee at University Clinical Centre Tuzla, Bosnia and Herzegovina, No: 02-09/2-97-21.
Clinical trial registration statement: No application for registration was made for this study.
Informed consent statement: All study participants, or their legal guardians, provided written consent prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: There is no additional data available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Emir Begagić, MD, Academic Research, Department of General Medicine, University of Zenica, School of Medicine, Zenica 72000, Bosnia and Herzegovina.
begagicem@gmail.com
Received: June 18, 2024
Revised: September 29, 2024
Accepted: October 20, 2024
Published online: June 20, 2025
Processing time: 161 Days and 13.7 Hours
BACKGROUND
Non-ST segment elevation myocardial infarction (NSTEMI) poses significant challenges in clinical management due to its diverse outcomes. Understanding the prognostic role of hematological parameters and derived ratios in NSTEMI patients could aid in risk stratification and improve patient care.
AIM
To evaluate the predictive value of hemogram-derived ratios for major adverse cardiovascular events (MACE) in NSTEMI patients, potentially improving clinical outcomes.
METHODS
A prospective, observational cohort study was conducted in 2021 at the Internal Medicine Clinic of the University Hospital in Tuzla, Bosnia and Herzegovina. The study included 170 patients with NSTEMI, who were divided into a group with MACE and a control group without MACE. Furthermore, the MACE group was subdivided into lethal and non-lethal groups for prognostic analysis. Alongside hematological parameters, an additional 13 hematological-derived ratios (HDRs) were monitored, and their prognostic role was investigated.
RESULTS
Hematological parameters did not significantly differ between non-ST segment elevation myocardial infarction (NSTEMI) patients with MACE and a control group at T1 and T2. However, significant disparities emerged in HDRs among NSTEMI patients with lethal and non-lethal outcomes post-MACE. Notably, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were elevated in lethal outcomes. Furthermore, C-reactive protein-to-lymphocyte ratio (CRP/Ly) at T1 (> 4.737) demonstrated predictive value [odds ratio (OR): 3.690, P = 0.024]. Both NLR at T1 (> 4.076) and T2 (> 4.667) emerged as significant predictors, with NLR at T2 exhibiting the highest diagnostic performance, as indicated by an area under the curve of 0.811 (95%CI: 0.727-0.859) and OR of 4.915 (95%CI: 1.917-12.602, P = 0.001), emphasizing its important role as a prognostic marker.
CONCLUSION
This study highlights the significant prognostic value of hemogram-derived indexes in predicting MACE among NSTEMI patients. During follow-up, NLR, PLR, and CRP/Ly offer important insights into the inflammatory processes underlying cardiovascular events.
Core Tip: This study underscores the significant role of hematological-derived ratios in predicting major adverse cardiovascular events (MACE) among NSTEMI patients. Elevated neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with higher mortality rates post-MACE, with NLR at follow-up showing the highest predictive accuracy (area under the curve of 0.811). These findings suggest that monitoring NLR, PLR, and C-reactive protein-to-lymphocyte ratio (CRP/Ly) can offer valuable insights into the inflammatory mechanisms at play in cardiovascular risk, aiding in early intervention and improving patient outcomes.
