Uric acid-lymphocyte ratios and myocardial damage parameters in ST elevated myocardial infarction

Yıl 2020, Cilt: 10 Sayı: 1, 108 - 113, 31.03.2020

Nahide Ekici Günay , Ahmet Oğuz Baktır İşıl Çakır Sabahattin Muhtaroğlu Mustafa Nisari

https://doi.org/10.16899/jcm.565897

Cited By: 1

Öz

Abstract

Background/Aims:Studies
recently have demonstrated the association between the major cardiovascular
poor outcomes and uricacid (UA), the neutrophil/lymphocyteratio (NLR), lymphocyte counts. Barely, the relation
between uricacid-to-lymphocyteratio (UALR) levels and inflammatory markers in
ST elevated myocardial infarction (STEMI) hasn’t been investigated yet. In our
current study, we tried to investigate whether alterations UALR levels between
patients unstable angina pectoris (UAP) patients and STEMI patients who
underwent primary percutaneous coronary
intervention (PCI). In this context, were searched that altherelations
of UALR with myocardial injury markers (troponin I, creatine kinase-MB),
inflammatory markers (C-reactive protein, and covariaties of blood count),
patients' lipid profiles and myocardial contractility.

Methods:A total
of 346 STEMI and UAP patients were enrolled in this retrospectively study.
T-test or Mann Witney U test was used to see the significant differences. We
found independent predictive factors for UA, NLR, and UALR for STEMI and ROC
analyses was performed for these parameters. 

Results:We showed significant
differences between UA, NLR and UALR levels (P<0.005)between STEMI and UAP
patients. We determined the optimal cut-off points as: 6.05mg/dL for UA (UAC
0.561, specifity%50, sensitivity%72); 0.179 for UALR (UAC 0.913,
specifity%96,sensitivity %92) ;2.3 for NLR (UAC 0.395,  specifity %82, sensitivity %88). 

Conclusions: For
the first time in the literature, it has been demonstrated that UALR is a
distinct parameter associated with troponin I levels and myocardial
contractility, and is more sensitive and specific than the NLR, UA and CRP
parameters routinely used in STEMI.

Anahtar Kelimeler

Uric acid, lymphocyte, neutrophyl-to-lymphocyteratio, myocardial infarction

Teşekkür

Ethics board approval was received for this study from institutional ethics committee of Healthy Sciency University, Kayseri Training and Research Hospital (Decision Number: 2016-52).

ST Yükselmeli Miyokard İnfarktüsünde Ürik Asit-Lenfosit Oranları ve Miyokard Hasarı Parametreleri

Öz

Amaç: Majör kardiyovasküler kötü sonuçlar ile ürik asit (UA), nötrofil/lenfosit oranı (NLO), lenfosit düzeyleri arasındaki ilişki güncel çalışmalar ile gösterilmiştir. Bu çalışmada, primer perkütan koroner girişim (PCI) yapılan STEMI ve anstabil angina pektoris (UAP) hastalarında UALO düzeylerini incelemek amaçlandı. Bu bağlamda, UALO 'nun miyokardiyal hasarlanma belirteçleri (troponin I, kreatin kinaz-MB), inflamatuar belirteçler (yüksek duyarlıklı C-reaktif protein(hsCRP) ve kan sayımı değişkenleri), serum lipidleri ve miyokardiyal kontraktilite ile ilişkileri incelendi.
Gereç ve Yöntem: Çalışmaya 176 STEMI ve 170 UAP olmak üzere toplam 346 hasta dâhil edildi. Parametreler arası anlamlı farkları görmek için T testi veya Mann-Witney U testi kullanıldı. STEMI ve UAP hastaları arasında anlamlı olarak farklı bulunan UA, NLO ve UALO için ROC analizleri yapıldı.
Bulgular: UA, NLR ve UALO düzeyleri STEMI’de ve UAP hastalarına göre anlamlı olarak farklı ve yüksek idi (sırasıyla p<0.001, p=0.014 ve p<0.001). Optimum kesme noktaları UA için 6.05 mg/dL (AUC 0.561, özgüllük % 50, duyarlılık % 72; UALO için 0.179 (AUC 0.980, özgüllük % 96, duyarlılık % 92); NLR için 2.3 (AUC 0.913, özgüllük% 82, duyarlılık,% 88 olarak bulundu.
Sonuç: STEMI hastalarında UALO ile NLO, hsCRP, LVEF1 ve hs-troponin I arasında anlamlı bir ilişki bulunmaktadır. STEMI hastalarının başvuru anında NLO, UA ve hsCRP’den daha dözgül ve duyarlı olarak bulduğumuz UALO düzeylerinin incelenmesini, miyokardın kasılma performansındaki bozulmanın bağımsız bir öngördürücüsü olarak kullanılabilecek, ucuz ve kolay erişilebilir bir rutin laboratuvar parametresi olarak öneriyoruz.   

Anahtar Kelimeler

ürik asit, lenfosit, nötrofil/lenfosit oranı, miyokard enfarktüsü, koroner anjiyografi

Kaynakça

• References1. Pozo E, Agudo-Quilez P, Rojas-Gonzalez A, Alvarado T, Olivera MJNoninvasive diagnosis of vulnerable coronary plaque. World J Cardiol 2016; 26: 520-33.
• 2. Frostegard J. SLE, atherosclerosis and cardiovascular disease. J Intern Med2005; 257:485-95.
• 3. Sheng F, Chen B, He M, Zhang M, Shen G Neutrophil to lymphocyte ratio is related to electrocardiographic sign of spontaneous reperfusion in patients with ST-segment elevation myocardial infarction. Arch Med Res2016;47,180-5.
• 4. Gertler MM, Garn SM, Levine SA Serum uric acid in relation to age and physique in health and in coronary heart disease. Ann Intern Med 1951; 34: 1421-31.
• 5. Baker JF, Krishnan E, Chen L, Schumacher HR. Serum uric acid and cardiovascular disease: recent developments, and where do they leave us? Am J Me 2005; 118: 816– 26.
• 6. Brand FN, McGee DL, Kannel WB, Stokes J, Castelli WP. Hyperuricemia as a risk factor of coronary heart disease: The Framingham Study. Am J Epidemiol 1985; 121, 11-8.
• 7. Meisinger C, Koenig W, Baumert J, Döring A. Uric acid levels are associated with all-cause and cardiovascular disease mortality independent of systemic inflammation in men from the general population. The Monika/Kora Cohort Study. Arterioscler. Thromb. Vasc. Biol 2008; (28):1186 –92.8. Raatikainen MJ, Peuhkurinen KJ, Hassinen IE. Contribution of endothelium and cardiomyocytes to hypoxia-induced adenosine release. J Mol Cell Cardiol1994;26: 1069-80. 9. Culleton BF, Larson MG, Kannel WB, Levy D. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med 1999: 131; 7-13.
• 10. Leyva F, Anker SD, Godsland IF, Teixeira M, Hellewell PG, Kox WJ. Uric acid in chronic heart failure: a marker of chronic inflammation. Eur Heart J 1998: 19; 1814-22.
• 11. Brodov Y, Behar S, Goldenberg I, Boyko V. Usefulness of Combining Serum Uric Acid and C-Reactive Protein for Risk Stratification of Patients With Coronary Artery Disease Am J Cardiol 2009; 104:194–8.
• 12. Ridker PM, Hennekens CH, Buring J, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med2000;342: 836–43.
• 13. Annen B, Mang G, Schuiki E, Strebel U, Knoblauch M C-reactive protein and relative lymphocytopenia: early markers of acute myocardial infarction? Schweiz Med Wochenschr 1999; 11: 1931-4.
• 14. Pai JK, Pischon T, Ma J, Manson JE, Hankinson SE. Inflammatory markers and the risk of coronary heart disease in men and women. N Engl J Med 2004; 351: 2599-610.
• 15. Núnez J, Sanchis J, Bodí V, Núnez E, Mainar L. 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: 251-7.
• 16. Hwang C, Levis JT. ECG diagnosis: ST-elevation myocardial infarction. Perm J. 2014;18(2):e133.
• 17. Pipitone S, Buonocore R, Gennari D, Lippi G. Comparison of nucleated red blood cell count with four commercial hematological analyzers. Clin. Chem. Lab. Med 2015; 53: 315–8.
• 18. Freedman DS, Williamson DF, Gunter EW, Byers T. Relation of serum uric acid to mortality and ischemic heart disease. The Nhanes Epidemiologic Follow-up Study. Am J Epidemiol 1995;141: 637-44.
• 19. Akpek M, Kaya MG, Uyarel H, Yarlioglues M, Kalay N, Günebakmaz O. (2011) The association of serum uric acid levels on coronary flow in patients with STEMI undergoing primary PCI. Atherosclerosis, 219: 334-41.
• 20. Polonski L, Gasior M, Gierlotka M, Kalarus Z, Cieslinski A. Polish Registry of Acute Coronary Syndromes (PL-ACS). Characteristics, treatments and outcomes of patients with acute coronary syndromes in Poland. Kardiol Pol, 2007; 65: 861-72.
• 21. Duan SY, Xing CY, Zhang B, Chen Y. Detection and evaluation of renal biomarkers in a swine model of acute myocardial infarction and reperfusion. Int J Clin Exp Pathol 2015; 8: 8336-47.
• 22. Ghaffar S, Salehi R, Mazani S, Aghavali S. Association of serum uric acid level with mortality and morbidity of patients with acute ST-elevation myocardial infarction. J CardiovascThorac Res 2016; 8: 56-60.
• 23. Liu HZ, Deng W, Li JL, Tang YM, Zhang LT, Cui Y. Peripheral blood lymphocyte subset levels differ in patients with hepatocellular carcinoma. Oncotarget. 2016; 22: 7(47):77558-64.
• 24. Beydoun MA, Fanelli-Kuczmarski MT, Canas JA, Beydoun HA, Evans MK, Zonderman AB. Dietary factors are associated with serum uric acid trajectory differentially by race among urban adults. Br J Nutr. 2018;120(8):935–945.
• 25. Barbieri L, Verdoia M, Schaffer A, Marino P, Suryapranata H, De Luca G. Impact of sex on uric acid levels and its relationship with the extent of coronary artery disease: A single-centre study. Atherosclerosis 2015; 241(1):241-8.