Summary
Some studies have suggested that high levels of total white blood cell (WBC) count
and C-reactive protein (CRP) may be considered as independent prognostic factors in
patients with acute coronary syndromes (ACS) and/or after cardiac revascularisation
by percutaneous coronary intervention or coronary artery bypass grafting surgery.
Evidence on the role of neutrophils in cardiovascular disease is less compelling.
Therefore, we conducted a systematic review of the literature with the aim of identifying
all the available evidence to clarify the role of neutrophils (absolute or relative
count, neutrophil/lymphocyte ratio) as a prognostic risk factor in patients with ACS
and/or cardiac revascularisation. All published studies evaluating the role of neutrophils
as a risk factor for clinical outcomes were assessed using the MEDLINE and EMBASE
databases. Study selection, data extraction and validity assessment was performed
independently by two reviewers. Twenty-one studies (17 of which had positive results)
for a total of more than 34,000 patients were included. Ten of 13 studies in ACS patients
found that neutrophils measured on-admission are related to mortality rate and/or
to major adverse clinical events. A predictive value of neutrophils after cardiac
revascularisation procedures was reported in seven out of eight studies. Most of the
studies showed that neutrophils were independent predictors of cardiovascular outcomes
when analysed concomitantly with other markers of inflammation (WBC, CRP). The findings
of our systematic review highlight the potential application of this inexpensive and
readily available inflammatory marker for risk stratification in patients with ACS
and/or cardiac revascularisation.
Keywords
Systematic review - neutrophils - outcome - acute coronary syndromes - revascularisation
