Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio to Predict TCPC Patients at Risk for PLE

Objectives: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) represent inexpensive and easily accessible markers of systemic inflammation, whose role in cardiovascular disease has been studied extensively in the past few years. Elevated NLR has been associated with increased mortality in patients with acute heart failure, has shown to predict cardiac arrhythmias and long-term mortality in patients with coronary syndromes. While PLR is associated with immune suppression and thrombosis, in patients with congenital heart disease data on NLR are still rare and underestimated. We investigated NLR and PLR in patients after TCPC, including patients with and without PLE. Our aim was to discuss whether NLR and PLR are potential markers for PLE diagnosis.

Methods: Patients who underwent TCPC at our institution were retrospectively screened. Routine laboratory parameters were analyzed. NLR and PLR were calculated in 49 patients (n = 10 TCPC with PLE, n = 30 TCPC without PLE, and n = 9 d-TGA patients as biventricular control group).

Result: Absolute neutrophil count and thrombocytes were significantly increased in TCPC with PLE compared with patients without PLE (p < 0.0001 and p = 0.037) while lymphocytes were decreased in TCPC with PLE (p = 0.038). NLR was significantly elevated in TCPC with PLE compared with TCPC without PLE (7.5 vs. 2.6; p < 0.0001) and d-TGA patients (7.5 vs. 2.0; p = 0.0015). PLR was significantly elevated compared with TCPC without PLE (327 vs. 147; p = 0.002) and d-TGA (327 vs. 123; p = 0.0133). NLR in TCPC patients negatively correlates with serum albumin (p < 0.0001), IgG (p < 0.0004) and whole protein (p < 0.0001) and correlates positively with &α-1 antitrypsin in stool (p < 0.0001).

Conclusion: NLR and PLR represent strong marker of PLE in patients after TCPC and may represent as a new additional marker in PLE diagnostic. Both parameters were significantly increased and correlate with standard parameters for PLE diagnostics.