Hemogram-derived ratios as prognostic markers for major adverse cardiovascular events in patients with non-ST-segment elevation myocardial infarction

doi:10.5662/wjm.v15.i2.98143

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World J Methodol. Jun 20, 2025; 15(2): 98143
Published online Jun 20, 2025. doi: 10.5662/wjm.v15.i2.98143

Table 1 Sociodemographic data, median, median (25^th-75^th percentiles)/n (%)

Variable		MACE (n = 86)	Control (n = 84)	P value
Age		69.5 (60.0-79.0)	66.0 (60.0-73.0)	0.557
Weight		86.5 (81.0-107.0)	86 (81.0-107.0)	0.287
Height		1.71 (1.64-1.88)	1.70 (1.65-1.84)	0.119
BMI		28.75 (27.2-36.2)	30.5 (27.7-35.8)	0.453
Hypertension	No	6 (7.0)	15 (17.9)	0.026
Hypertension	Yes	80 (93.0)	69 (82.1)
Diabetes mellitus	No	53 (61.6)	46 (54.8)	0.276
Diabetes mellitus	Yes	33 (38.4)	38 (45.2)
Hyperlipoproteinemia	No	25 (29.1)	21 (25.0)	0.859
Hyperlipoproteinemia	Yes	61 (70.9)	63 (75.0)
Alcohol consumption	No	51 (59.3)	56 (66.7)	0.700
Alcohol consumption	Yes	35 (40.7)	28 (33.3)
Tobacco consumption	No	49 (57.0)	36 (42.9)	0.050
Tobacco consumption	Yes	37 (43.0)	48 (57.1)
MACE	Lethal	35 (40.7)
MACE	Non-lethal	51 (59.3)

BMI: Body mass index; MACE: Major adverse cardiovascular event.

Table 2 Primary hematological and inflammatory parameters in studied groups, median (25^th-75^th percentiles)

Parameter	Time	MACE (n = 86)	Control (n = 84)	P value
Leukocytes	T1	9.9 (7.9-11.9)	9.3 (7.4-11.8)	0.322
Leukocytes	T2	9.1 (7.3-11.3)	8.9 (6.7-10.6)	0.264
Erythrocytes	T1	4.5 (4.1-5.0)	4.3 (3.9-4.8)	0.078
Erythrocytes	T2	4.5 (4.0-4.9)	4.4 (4.0-4.9)	0.581
Platelets	T1	238.5 (187.0-286.0)	220.0 (176.5-253.5)	0.056
Platelets	T2	240.0 (174.0-283.0)	216.5 (180.0-257.0)	0.287
Monocytes	T1	0.7 (0.5-0.9)	0.7 (0.5-0.9)	0.344
Monocytes	T2	0.7 (0.6-1.0)	0.8 (0.6-0.9)	0.882
Basophils	T1	0.0 (0.0-0.0)	0.0 (0.0-0.1)	0.563
Basophils	T2	0.0 (0.0-0.0)	0.0 (0.0-0.1)	0.403
Eosinophils	T1	0.0 (0.0-0.1)	0.1 (0.0-0.1)	0.111
Eosinophils	T2	0.0 (0.0-0.1)	0.1 (0.0-0.2)	0.321
Lymphocytes	T1	1.6 (1.1-2.1)	1.5 (1.2-2.0)	0.130
Lymphocytes	T2	1.7 (1.2-2.3)	1.8 (1.2-2.3)	0.090
Neutrophils	T1	7.3 (5.6-9.0)	6.4 (4.7-9.8)	0.611
Neutrophils	T2	6.2 (4.9-8.7)	5.8 (4.2-7.5)	0.374
C-reactive protein	T1	7.4 (2.6-30.4)	8.9 (2.2-21.5)	0.215
C-reactive protein	T2	30.5 (6.3-67.7)	13.4 (5.0-48.5)	0.051

MACE: Major adverse cardiovascular event.

Table 3 Comparative analysis of hematological-derived ratios between major adverse cardiovascular event group and controls, median (25^th-75^th percentiles)

HDR	Time	MACE	Control	P value
NLR	T1	4.394 (2.974-7.432)	4.179 (2.534-7.715)	0.537
NLR	T2	3.804 (2.231-7.092)	3.053 (2.186-4.903)	0.070
dNLR	T1	2.775 (1.803-4.643)	2.258 (1.669-4.204)	0.214
dNLR	T2	2.486 (1.481-4.377)	1.915 (1.430-3.088)	0.100
NPR	T1	0.031 (0.024-0.041)	0.029 (0.020-0.047)	0.685
NPR	T2	0.028 (0.020-0.042)	0.024 (0.018-0.039)	0.103
NLPR	T1	0.020 (0.012-0.032)	0.018 (0.012-0.037)	0.762
NLPR	T2	0.017 (0.010-0.034)	0.013 (0.009-0.024)	0.086
PLR	T1	152.678 (95.053-238.760)	138.596 (100.865-187.930)	0.597
PLR	T2	147.935 (92.642-219.337)	120.218 (93.713-169.146)	0.259
MNR	T1	0.095 (0.060-0.141)	0.119 (0.081-0.145)	0.088
MNR	T2	0.111 (0.076-0.158)	0.138 (0.105-0.168)	0.022
MLR	T1	0.432 (0.279-0.639)	0.453 (0.304-0.664)	0.407
MLR	T2	0.441 (0.285-0.628)	0.389 (0.308-0.628)	0.692
LMR	T1	2.315 (1.564-3.586)	2.207 (1.507-3.286)	0.407
LMR	T2	2.270 (1.593-3.504)	2.572 (1.592-3.243)	0.692
LCR	T1	0.180 (0.041-0.642)	0.180 (0.046-0.800)	0.551
LCR	T2	0.103 (0.021-0.356)	0.139 (0.031-0.391)	0.194
CRP/Ly	T1	5.539 (1.418-24.320)	5.347 (1.233-20.531)	0.556
CRP/Ly	T2	9.664 (2.813-47.006)	7.172 (2.559-32.454)	0.194
SII	T1	1044.079 (588.656-1812.658)	933.499 (553.663-1471.157)	0.355
SII	T2	935.137 (467.116-1778.563)	636.296 (458.472-1214.234)	0.071
AISI	T1	730.143 (392.295-1399.338)	619.153 (367.070-1231.876)	0.663
AISI	T2	645.503 (306.489-1525.542)	509.665 (265.857-831.593)	0.121
SIRI	T1	2.795 (1.767-4.904)	2.955 (1.585-5.844)	0.968
SIRI	T2	2.576 (1.511-6.067)	2.124 (1.359-4.433)	0.144

HDR: Hematological-derived ratios; NLR: Neutrophil-to-lymphocyte ratio; dNLR: Derived neutrophil-to-lymphocyte ratio; NPR: Neutrophil-to-platelet ratio; NLPR: Neutrophil-to-lymphocyte and platelet ratio; PLR: Platelet-to-lymphocyte ratio; MNR: Monocyte to neutrophil ratio; MLR: Monocyte/lymphocyte ratio; LMR: Lymphocyte-to-monocyte ratio; LCR: Lymphocyte to C-reactive protein ratio; CRP/Ly: C-reactive protein-to-lymphocyte ratio; SII: Systemic immune inflammation index; AISI: Aggregate index of systemic inflammation; SIRI: Systemic inflammation response index; T1: Analysis at admission; T2: Analysis after 24 hours.

Table 4 Comparative analysis of hematological-derived indices among non-ST segment elevation myocardial infarction patients with major adverse cardiovascular event with lethal and non-lethal outcome, median (25^th-75^th percentiles)

HDR	Time	Lethal outcome (n = 35)	Non-lethal outcome (n = 51)	P value
NLR	T1	7.432 (4.542-12.551)	3.816 (2.423-5.783)	< 0.001
NLR	T2	6.934 (3.672-12.165)	2.794 (2.167-5.580)	< 0.001
dNLR	T1	3.955 (2.721-6.764)	2.618 (1.667-3.675)	0.009
dNLR	T2	3.142 (2.056-5.686)	2.124 (1.436-3.295)	0.027
NPR	T1	0.032 (0.028-0.045)	0.030 (0.023-0.038)	0.090
NPR	T2	0.031 (0.026-0.053)	0.026 (0.018-0.038)	0.047
NLPR	T1	0.029 (0.021-0.043)	0.016 (0.011-0.030)	0.005
NLPR	T2	0.035 (0.017-0.056)	0.013 (0.009-0.028)	< 0.001
PLR	T1	238.000 (150.420-303.448)	124.887 (92.446-191.566)	0.007
PLR	T2	195.349 (149.359-353.846)	122.619 (83.529-169.186)	0.001
MNR	T1	0.067 (0.054-0.107)	0.111 (0.072-0.144)	0.028
MNR	T2	0.074 (0.043-0.112)	0.131 (0.099-0.172)	0.000
MLR	T1	0.609 (0.424-0.892)	0.365 (0.272-0.509)	0.008
MLR	T2	0.559 (0.428-0.756)	0.417 (0.282-0.553)	0.028
LMR	T1	1.641 (1.121-2.358)	2.742 (1.966-3.681)	0.008
LMR	T2	1.788 (1.324-2.337)	2.400 (1.808-3.549)	0.028
LCR	T1	0.047 (0.015-0.163)	0.371 (0.084-0.748)	0.001
LCR	T2	0.027 (0.008-0.102)	0.151 (0.027-0.424)	0.002
CRP/Ly	T1	21.145 (6.137-66.303)	2.321 (1.327-10.517)	0.001
CRP/Ly	T2	37.403 (9.790-121.186)	6.630 (2.361-37.340)	0.002
SII	T1	1812.658 (950.655-3283.542)	919.518 (561.464-1277.483)	0.001
SII	T2	1778.563 (852.908-2800.333)	673.179 (413.184-1362.656)	0.001
AISI	T1	1399.338 (695.922-2265.644)	536.824 (370.566-910.278)	0.003
AISI	T2	1353.896 (625.428-1836.498)	473.738 (293.227-1110.313)	0.011
SIRI	T1	4.511 (2.677-9.560)	2.473 (1.565-3.845)	0.003
SIRI	T2	4.653 (2.639-9.270)	2.244 (1.482-4.164)	0.009

HDR: Hematological-derived ratios; NLR: Neutrophil-to-lymphocyte ratio; dNLR: Derived neutrophil-to-lymphocyte ratio; NPR: Neutrophil-to-platelet ratio; NLPR: Neutrophil to lymphocyte and platelet ratio; PLR: Platelet-to-lymphocyte ratio; MNR: Monocyte to neutrophil ratio; MLR: Monocyte/lymphocyte ratio; LMR: Lymphocyte-to-monocyte ratio; LCR: Lymphocyte to C-reactive protein ratio; CRP/Ly: C-reactive protein-to-lymphocyte ratio; SII: Systemic immune inflammation index; AISI: Aggregate index of systemic inflammation; SIRI: Systemic inflammation response index; T1: Analysis at admission; T2: Analysis after 24 hours.

Table 5 Area under the curve analysis for observed hematological-derived ratios regarding death

Variable	Time	AUC/ROC analysis
Variable	Time	AUC (95%CI)	Cut-off	Se	Sp	P value
AISI	T1	0.675 (0.599-0.745)	> 1113.861	64.0	76.6	0.004
AISI	T2	0.690 (0.615-0.759)	> 911.4	68.0	75.9	0.004
CRP/Ly	T1	0.702 (0.448-0.603)	> 4.737	84.0	53.1	< 0.001
CRP/Ly	T2	0.718 (0.643-0.784)	> 22.3	72.00	70.34	< 0.001
dNLRT	T1	0.681 (0.606-0.751)	> 2.46	84.0	51.0	0.002
dNLRT	T2	0.671 (0.595-0.741)	> 4.81	44.0	89.0	0.007
LCR	T1	0.698 (0.623-0.766)	≤ 0.202	84.00	52.45	< 0.001
LCR	T2	0.699 (0.637-0.774)	≤ 0.041	71.00	69.34	< 0.001
LMRT	T1	0.634 (0.557-0.707)	≤ 1.926	64.00	66.90	0.038
LMRT	T2	0.638 (0.561-0.710)	≤ 1.952	64.00	69.66	0.033
MLR	T1	0.634 (0.557-0.707)	> 0.509	64.00	66.90	0.039
MLR	T2	0.637 (0.560-0.710)	> 0.509	64.00	69.66	0.033
MNR	T1	0.673 (0.597-0.743)	≤ 0.08	64.00	71.03	0.004
MNR	T2	0.681 (0.649-0.724)	≤ 0.079	60.00	74.28	< 0.001
NLPR	T1	0.664 (0.588-0.735)	> 0.018	80.00	55.17	0.004
NLPR	T2	0.757 (0.686-0.819)	> 0.021	68.00	70.34	< 0.001
NLR	T1	0.707 (0.632-0.774)	> 4.076	84.00	51.72	< 0.001
NLR	T2	0.811 (0.727-0.859)	> 4.667	74.00	76.72	< 0.001
NPR	T1	0.598 (0.520-0.672)	> 0.028	72.00	48.97	0.072
NPR	T2	0.657 (0.580-0.728)	> 0.025	76.00	52.41	0.005
PLR	T1	0.676 (0.600-0.745)	> 230.232	52.00	84.14	0.005
PLR	T2	0.719 (0.645-0.785)	> 159.74	72.00	72.41	< 0.001
SII	T1	0.706 (0.631-0.773)	> 1745.18	56.00	82.76	< 0.001
SII	T2	0.744 (0.671-0.808)	> 1400.466	64.00	81.38	< 0.001
SIRI	T1	0.661 (0.584-0.731)	> 3.907	68.00	66.90	< 0.001
SIRI	T2	0.684 (0.608-0.753)	> 4.164	64.00	74.48	0.003

HDR: Hematological-derived ratios; NLR: Neutrophil-to-lymphocyte ratio; dNLR: Derived neutrophil-to-lymphocyte ratio; NPR: Neutrophil-to-platelet ratio; NLPR: neutrophil to lymphocyte and platelet ratio; PLR: Platelet-to-lymphocyte ratio; MNR: Monocyte to neutrophil ratio; MLR: Monocyte/lymphocyte ratio; LMR: Lymphocyte-to-monocyte ratio; LCR: Lymphocyte to C-reactive protein ratio; CRP/Ly: C-reactive protein-to-lymphocyte ratio; SII: Systemic immune inflammation index; AISI: Aggregate index of systemic inflammation; SIRI: Systemic inflammation response index; T1: Analysis at admission; T2: Analysis after 24 hours; AUC: Area under the curve; ROC: Receiver operating characteristic.

Table 6 Logistic regression predictive analysis regarding major adverse cardiovascular events-lethal outcome among patients with non-ST segment elevation myocardial infarction

Variable	OR	95%CI		P value
Variable	OR	Lower	Upper	P value
CRP/Ly (T1) > 4.737	3.690	1.140	11.942	0.024
CRP/Ly (T2) > 22.3	2.839	0.835	9.650	0.095
NLPR (T2) > 0.021	2.780	0.751	10.285	0.126
NLR (T1) > 4.076	1.300	1.121	1.743	0.009
NLR (T2) > 4.667	4.915	1.917	12.602	0.001
PLR (T2) > 159.74	3.262	0.958	11.102	0.059
SII (T1) > 1745.18	2.642	0.650	10.743	0.175
SII (T2) > 1400.466	1.352	0.295	6.205	0.698

NLR: Neutrophil-to-lymphocyte ratio; NLPR: Neutrophil-to-lymphocyte and platelet ratio; PLR: Platelet-to-lymphocyte ratio; CRP/Ly: C-reactive protein-to-lymphocyte ratio; SII: Systemic immune inflammation index; T1: Analysis at admission; T2: Analysis after 24 hours; OR: Odds ratio.

Citation: Bećirović E, Bećirović M, Šegalo S, Bećirović A, Hadžić S, Ljuca K, Papić E, Ferhatbegović L, Ejubović M, Jagodić Ejubović A, Kovčić A, Šljivo A, Begagić E. Hemogram-derived ratios as prognostic markers for major adverse cardiovascular events in patients with non-ST-segment elevation myocardial infarction. World J Methodol 2025; 15(2): 98143
URL: https://www.wjgnet.com/2222-0682/full/v15/i2/98143.htm
DOI: https://dx.doi.org/10.5662/wjm.v15.i2.98143