The role of neutrophil to platelet ratio in predicting death in elderly patients with ST-elevation myocardial infarction receiving percutaneous coronary intervention

Background Despite receiving percutaneous coronary intervention(PCI),the mortality in elderly patients with ST-segment elevation myocardial infarction(STEMI)remains high.The aim of this study was to explore the prognostic value of neutrophil to platelet ratio(NPR)in elderly STEMI patients receiving PCI.Methods Patients≥65 years old with the diagnosis of STEMI who had received PCI was retrospectively enrolled between January 2010 and April 2016 in the Guangdong Provincial People's Hospital.The relationship between NPR and inhospital and 1-year mortality was evaluated.Results A total of 767 elderly patients with STEMI were included and divided into three groups according to the tertiles of NPR:<37(n=253),37-54(n=257),and≥54(n=257).Multivariate logistic regression analysis showed an independent correlation between elevated NPR and in-hospital death[odds ratio(OR)=1.02,95%confidential interval(CI):1.01-1.03,P<0.001].The receiver operating characteristic curve(AUC)analysis demonstrated a relatively high predictive value for NPR in identifying in-hospital death(AUC=0.765,95%CI:0.704-0.825,P<0.001,sensitivity=77.1%,specificity=69.0%,optimal cut-off value=54).As for 1-year mortality,multivariate Cox survival analysis revealed that NPR[hazard ratio(HR)=1.003,95%CI:1.001-1.004,P<0.001],as a continuous variable,and NPR>54(HR=2.70,95%CI 1.72-4.22,P<0.001),as a categorial variable,were both independent predictors for 1-year mortality.Conclusions NPR is a feasible predictor of poor prognosis for elderly patients with STEMI receiving PCI.

Prognostic Significance of Prognostic Nutritional Index in Elderly Patients Receiving Heart Valve Replacement

Background Valvular heart disease has become a concerning problem globally and has gradually been solved by valve replacement surgery. However, the prognostic significance of preoperative Prognostic Nutritional Index(PNI) in elderly patients receiving heart valve replacement remains unclear. Method Our study enrolled 3745elderly patients receiving heart valve replacement from January 2010 to December 2017 in Guangdong Provincial People’s Hospital. The PNI were calculated at admission and patients were divided into three groups according to the tertiles of PNI: >49(n=1181), 44-49(n=1341) and <44(n=1223). Univariate and multivariable analysis were conducted to explore the relationship between PNI and in-hospital death. Results Patients with lower PNI may be indicated with worse nutritional status and with higher rate of in-hospital death. Age(OR: 1.052, P=0.004), NYHA classification(OR: 2.547, P<0.001), anemia(OR: 1.508, P=0.033), platelet count(OR: 0.994, P<0.001), LVEF(OR: 0.983, P<0.05), tricuspid regurgitation(OR: 1.898, P=0.002), CABG(OR: 2.119, P<0.001), PNI(OR: 1.57,P=0.012) were all independent predictor for in-hospital mortality of patients receiving heart valve replacement after accounting for confounding factors. Kaplan-Meier analysis proved that patients with lower PNI would have higher risk to suffer from one-year mortality compared with the group with higher PNI(Log-rank: 55.682, P<0.001). Conclusions In general, PNI was an independent factor for evaluating nutritional status and could predict in-hospital death in elderly patients receiving heart valve replacement.