Dabla PK, Shrivastav D, Mehta V, Singh S, Mir R. White blood cells and neutrophil-to-high density lipoprotein ratio as predictive markers of left ventricular dysfunction in heart failure. World J Methodol 2026; 16(1): 108178 [DOI: 10.5662/wjm.v16.i1.108178]
Corresponding Author of This Article
Pradeep Kumar Dabla, MD, Professor, Department of Biochemistry, Govind Ballabh Pant Institute of Postgraduate Medical Education, JLN Marg, New Delhi 110002, India. pradeep.dabla@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Observational Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Mar 20, 2026 (publication date) through Feb 13, 2026
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Journal Information of This Article
Publication Name
World Journal of Methodology
ISSN
2222-0682
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Dabla PK, Shrivastav D, Mehta V, Singh S, Mir R. White blood cells and neutrophil-to-high density lipoprotein ratio as predictive markers of left ventricular dysfunction in heart failure. World J Methodol 2026; 16(1): 108178 [DOI: 10.5662/wjm.v16.i1.108178]
Pradeep Kumar Dabla, Department of Biochemistry, Govind Ballabh Pant Institute of Postgraduate Medical Education, New Delhi 110002, India
Dharmsheel Shrivastav, Department of Biochemistry, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Associated Maulana Azad Medical College, New Delhi 110002, India
Dharmsheel Shrivastav, Department of Biochemistry, Noida International University, Noida 203201, Uttar Pradesh, India
Vimal Mehta, Department of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi 110002, India
Swati Singh, Department of Biochemistry, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi 110002, India
Rashid Mir, Department of Medical Lab Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, India
Author contributions: Dabla PK designed the study; Dabla PK and Shrivastav D analyzed the manuscript; Dabla PK provided facilities for biochemical testing and Mehta V provided the facility for the enrollment of patients; Shrivastav D and Singh S drafted the manuscript; Dabla PK, Mehta V and Mir R critically reviewed the manuscript and contributed in finalization of the manuscript analysis; all authors reviewed and approved the manuscript.
Institutional review board statement: All procedures performed in this study involving human participants were conducted in accordance with the ethical standards of the Institutional Ethics Committee of Maulana Azad Medical College and associated hospitals, New Delhi, India (Approval No. F1/IEC/MAMC/85/03/21/No. 422; Date: 30.08.2021), and with the 1964 Helsinki declaration and its later amendments.
Informed consent statement: Written informed consent was taken from all participants included in the study.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Data sharing statement: Data is available from the corresponding author on request.
Corresponding author: Pradeep Kumar Dabla, MD, Professor, Department of Biochemistry, Govind Ballabh Pant Institute of Postgraduate Medical Education, JLN Marg, New Delhi 110002, India. pradeep.dabla@gmail.com
Received: April 8, 2025 Revised: June 7, 2025 Accepted: September 1, 2025 Published online: March 20, 2026 Processing time: 308 Days and 21.7 Hours
Abstract
BACKGROUND
Systemic inflammation, especially of white blood cells (WBCs), is being increasingly accepted as a central mechanism underlying the pathogenesis and development of heart failure (HF). Few studies have assessed their effectiveness as accessible and cost-efficient biomarkers for the early detection of left ventricular dysfunction, as well as their potential predictive value in patients with coronary artery disease (CAD).
AIM
To explore the correlation between WBC parameters and low left ventricular ejection fraction (LVEF) in HF patients and to evaluate its predictive potential.
METHODS
Two-hundred patients with angiographically proven CAD were enrolled in the study. Lymphocyte and neutrophil counts were measured in an automated analyzer. The number of neutrophils was divided by serum level of high density lipoprotein (HDL) to obtain the neutrophil-to-HDL ratio (NHR). Regression analysis was used to examine correlations, and receiver operating characteristic curve analysis was employed to identify predictive value of these hematological markers.
RESULTS
WBC, neutrophils, lymphocytes, and NHR are significantly higher among HF patients with low LVEF. Regression analysis revealed a negative association between LVEF and WBC (r2 = 0.007), neutrophils (r2 = 0.019), lymphocytes (r2 = 0.089), and the NHR (r2 = 0.013). ROC analysis revealed that the AUC for WBC was 0.61, with a sensitivity of 72% and specificity of 60%, while neutrophils showed the same AUC (0.61) but with 56% sensitivity and 60% specificity. Lymphocytes showed a higher AUC of 0.68 (72% sensitivity, 60% specificity), while NHR had the lowest AUC at 0.59 (65% sensitivity, 52% specificity).
CONCLUSION
These data indicate that parameters of WBCs, notably lymphocytes, neutrophils, and NHR, can act as useful biomarkers for detection of decreased LVEF in patients with HF. These findings suggest that neutrophils, lymphocytes, and NHR are not only routinely available and cost-effective markers but may also serve as early predictors of reduced LVEF in CAD patients, offering potential utility in clinical risk stratification and management. Further research is needed to validate these findings and explore their potential as clinical risk markers and therapeutic targets in CAD with HF.
Core Tip: Literature has established white blood cells (WBC) as a key player in the inflammatory response, including ventricular remodeling and interstitial fibrosis. Several studies have demonstrated that WBC differentials such as lymphocytes and neutrophils and neutrophil-to-high density lipoprotein ratio are linked to heart failure (HF) development, particularly, in patients with low left ventricular ejection fraction (LVEF). In the present study, we explore the association between these parameters and LVEF, focusing on their predictive potential in HF.
