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The impact of admission neutrophil-to-platelet ratio on in-hospital and long-term mortality in patients with infective endocarditis

  • Xue-biao Wei , Yuan-hui Liu , Peng-cheng He EMAIL logo , Dan-qing Yu EMAIL logo , Ning Tan , Ying-ling Zhou and Ji-yan Chen
Published/Copyright: December 17, 2016
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 55 Issue 6

Abstract

Background:

Infective endocarditis (IE) is associated with increased neutrophil and reduced platelet counts. We assessed the relationship between the neutrophil-to-platelet ratio (NPR) on admission and adverse outcomes in patients with IE.

Methods:

Patients diagnosed with IE between January 2009 and July 2015 (n=1293) were enrolled, and 1046 were finally entered into the study. Study subjects were categorized into four groups according to NPR quartiles: Q1<18.9 (n=260); Q2: 18.9–27.7 (n=258); Q3: 27.7–43.3 (n=266); and Q4>43.3 (n=262). Cox proportional hazards regression was performed to identify risk factors for long-term mortality; the optimal cut-off was evaluated by receiver operating characteristic curves.

Results:

Risk of in-hospital death increased progressively with NPR group number (1.9 vs. 5.0 vs. 9.8 vs. 14.1%, p<0.001). The follow-up period was a median of 28.8 months, during which 144 subjects (14.3%) died. Long-term mortality increased from the lowest to the highest NPR quartiles (7.6, 11.8, 17.4, and 26.2%, respectively, p<0.001). Multivariate Cox proportional hazard analysis revealed that lgNPR (HR=2.22) was an independent predictor of long-term mortality. Kaplan-Meier survival curves showed that subjects in Q4 had an increased long-term mortality compared with the other groups.

Conclusions:

Increased NPR was associated with in-hospital and long-term mortality in patients with IE. As a simple and inexpensive index, NPR may be a useful and rapid screening tool to identify IE patients at high risk of mortality.

Keywords: infective endocarditis; neutrophil; outcome; platelet
Corresponding authors: Peng-cheng He, MD, PhD and Dan-qing Yu, MD, PhD, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou 510080, Guangdong, P.R. China, Phone: 020-83827812, Fax: 020-83827812
aXue-biao Wei and Yuan-hui Liu are considered as co-first authors.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Conflict of interest: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Ternhag A, Cederstrom A, Torner A, Westling K. A nationwide cohort study of mortality risk and long-term prognosis in infective endocarditis in Sweden. PLoS One 2013;8:e67519.10.1371/journal.pone.0067519Search in Google Scholar PubMed PubMed Central

2. Thuny F, Giorgi R, Habachi R, Ansaldi S, Le Dolley Y, Casalta JP, et al. Excess mortality and morbidity in patients surviving infective endocarditis. Am Heart J 2012;164:94–101.10.1016/j.ahj.2012.04.003Search in Google Scholar PubMed

3. Fernandez-Hidalgo N, Almirante B, Tornos P, Gonzalez-Alujas MT, Planes AM, Galinanes M, et al. Immediate and long-term outcome of left-sided infective endocarditis. A 12-year prospective study from a contemporary cohort in a referral hospital. Clin Microbiol Infect 2012;18:E522–30.10.1111/1469-0691.12033Search in Google Scholar PubMed

4. Mokhles MM, Ciampichetti I, Head SJ, Takkenberg JJ, Bogers AJ. Survival of surgically treated infective endocarditis: a comparison with the general Dutch population. Ann Thorac Surg 2011;91:1407–12.10.1016/j.athoracsur.2011.02.007Search in Google Scholar PubMed

5. Heiro M, Helenius H, Hurme S, Savunen T, Metsarinne K, Engblom E, et al. Long-term outcome of infective endocarditis: a study on patients surviving over one year after the initial episode treated in a Finnish teaching hospital during 25 years. BMC Infect Dis 2008;8:49.10.1186/1471-2334-8-49Search in Google Scholar PubMed PubMed Central

6. Lalani T, Chu VH, Park LP, Cecchi E, Corey GR, Durante-Mangoni E, et al. In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis. J Am Med Assoc Intern Med 2013;173:1495–504.10.1001/jamainternmed.2013.8203Search in Google Scholar PubMed

7. Delahaye F, Alla F, Beguinot I, Bruneval P, Doco-Lecompte T, Lacassin F, et al. In-hospital mortality of infective endocarditis: prognostic factors and evolution over an 8-year period. Scand J Infect Dis 2007;39:849–57.10.1080/00365540701393088Search in Google Scholar PubMed

8. Klein M, Wang A. Infective Endocarditis. J Intensive Care Med 2016;31:151–63.10.1177/0885066614554906Search in Google Scholar PubMed

9. Heiro M, Helenius H, Sundell J, Koskinen P, Engblom E, Nikoskelainen J, et al. Utility of serum C-reactive protein in assessing the outcome of infective endocarditis. Eur Heart J 2005;26:1873–81.10.1093/eurheartj/ehi277Search in Google Scholar PubMed

10. Turak O, Ozcan F, Isleyen A, Basar FN, Gul M, Yilmaz S, et al. Usefulness of neutrophil-to-lymphocyte ratio to predict in-hospital outcomes in infective endocarditis. Can J Cardiol 2013;29:1672–8.10.1016/j.cjca.2013.05.005Search in Google Scholar PubMed

11. Drews RE, Weinberger SE. Thrombocytopenic disorders in critically ill patients. Am J Respir Crit Care Med 2000;162(2 Pt 1):347–51.10.1164/ajrccm.162.2.ncc3-00Search in Google Scholar PubMed

12. Cho SY, Jeon YL, Kim W, Kim WS, Lee HJ, Lee WI, et al. Mean platelet volume and mean platelet volume/platelet count ratio in infective endocarditis. Platelets 2014;25:559–61.10.3109/09537104.2013.857394Search in Google Scholar PubMed

13. Ferrera C, Vilacosta I, Fernandez C, Lopez J, Sarria C, Olmos C, et al. Usefulness of thrombocytopenia at admission as a prognostic marker in native valve left-sided infective endocarditis. Am J Cardiol 2015;115:950–5.10.1016/j.amjcard.2015.01.021Search in Google Scholar PubMed

14. Sy RW, Chawantanpipat C, Richmond DR, Kritharides L. Development and validation of a time-dependent risk model for predicting mortality in infective endocarditis. Eur Heart J 2011;32:2016–26.10.1093/eurheartj/ehp085Search in Google Scholar PubMed

15. Li JS, Sexton DJ, Mick N, Nettles R, Fowler VJ, Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000;30:633–8.10.1086/313753Search in Google Scholar PubMed

16. Ma YC, Zuo L, Chen JH, Luo Q, Yu XQ, Li Y, et al. Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol 2006;17:2937–44.10.1681/ASN.2006040368Search in Google Scholar PubMed

17. Angeletti S, Battistoni F, Fioravanti M, Bernardini S, Dicuonzo G. Procalcitonin and mid-regional pro-adrenomedullin test combination in sepsis diagnosis. Clin Chem Lab Med 2013;51:1059–67.10.1515/cclm-2012-0595Search in Google Scholar PubMed

18. Angeletti S, Dicuonzo G, Fioravanti M, De Cesaris M, Fogolari M, Lo PA, et al. Procalcitonin, MR-proadrenomedullin, and cytokines measurement in sepsis diagnosis: advantages from test combination. Dis Markers 2015;2015:951532.10.1155/2015/951532Search in Google Scholar PubMed PubMed Central

19. Angeletti S, Spoto S, Fogolari M, Cortigiani M, Fioravanti M, De Florio L, et al. Diagnostic and prognostic role of procalcitonin (PCT) and MR-pro-adrenomedullin (MR-proADM) in bacterial infections. Apmis 2015;123:740–8.10.1111/apm.12406Search in Google Scholar PubMed

20. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del ZF, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015;36:3075–128.10.1093/eurheartj/ehv319Search in Google Scholar PubMed

21. Tok D, Canpolat U, Tok D, Turak O, Isleyen A, Oksuz F, et al. Association of mean platelet volume level with in-hospital major adverse events in infective endocarditis. Wien Klin Wochenschr 2015;127:197–202.10.1007/s00508-015-0746-2Search in Google Scholar PubMed

22. Turak O, Canpolat U, Ozcan F, Yayla C, Mendi MA, Oksuz F, et al. D-dimer level predicts in-hospital mortality in patients with infective endocarditis: a prospective single-centre study. Thromb Res 2014;134:587–92.10.1016/j.thromres.2014.06.015Search in Google Scholar PubMed

23. Kolaczkowska E, Kubes P. Neutrophil recruitment and function in health and inflammation. Nat Rev Immunol 2013;13:159–75.10.1038/nri3399Search in Google Scholar PubMed

24. Amulic B, Cazalet C, Hayes GL, Metzler KD, Zychlinsky A. Neutrophil function: from mechanisms to disease. Annu Rev Immunol 2012;30:459–89.10.1146/annurev-immunol-020711-074942Search in Google Scholar PubMed

25. O’Hartaigh B, Bosch JA, Thomas GN, Lord JM, Pilz S, Loerbroks A, et al. Which leukocyte subsets predict cardiovascular mortality? From the Ludwigshafen Risk and Cardiovascular Health (LURIC) Study. Atherosclerosis 2012;224:161–9.10.1016/j.atherosclerosis.2012.04.012Search in Google Scholar PubMed

26. Laki K. Our ancient heritage in blood clotting and some of its consequences. Ann N Y Acad Sci 1972;202:297–307.10.1111/j.1749-6632.1972.tb16342.xSearch in Google Scholar PubMed

27. Thomas MR, Storey RF. The role of platelets in inflammation. Thromb Haemost 2015;114:449–58.10.1160/TH14-12-1067Search in Google Scholar PubMed

28. Koenen RR. The prowess of platelets in immunity and inflammation. Thromb Haemost 2016;116:605–12.10.1160/TH16-04-0300Search in Google Scholar PubMed

29. Dore M, Korthuis RJ, Granger DN, Entman ML, Smith CW. P-selectin mediates spontaneous leukocyte rolling in vivo. Blood 1993;82:1308–16.10.1182/blood.V82.4.1308.1308Search in Google Scholar

30. Moore KL, Patel KD, Bruehl RE, Li F, Johnson DA, Lichenstein HS, et al. P-selectin glycoprotein ligand-1 mediates rolling of human neutrophils on P-selectin. J Cell Biol 1995;128:661–71.10.1083/jcb.128.4.661Search in Google Scholar PubMed PubMed Central

31. Ma YQ, Plow EF, Geng JG. P-selectin binding to P-selectin glycoprotein ligand-1 induces an intermediate state of alphaMbeta2 activation and acts cooperatively with extracellular stimuli to support maximal adhesion of human neutrophils. Blood 2004;104:2549–56.10.1182/blood-2004-03-1108Search in Google Scholar

32. Bayer AS, Sullam PM, Ramos M, Li C, Cheung AL, Yeaman MR. Staphylococcus aureus induces platelet aggregation via a fibrinogen-dependent mechanism which is independent of principal platelet glycoprotein IIb/IIIa fibrinogen-binding domains. Infect Immun 1995;63:3634–41.10.1128/iai.63.9.3634-3641.1995Search in Google Scholar

33. Niemann S, Spehr N, Van Aken H, Morgenstern E, Peters G, Herrmann M, et al. Soluble fibrin is the main mediator of Staphylococcus aureus adhesion to platelets. Circulation 2004;110:193–200.10.1161/01.CIR.0000134486.93030.E7Search in Google Scholar

34. Cahill TJ, Prendergast BD. Infective endocarditis. Lancet 2016;387:882–93.10.1016/S0140-6736(15)00067-7Search in Google Scholar

35. Vincent JL, Yagushi A, Pradier O. Platelet function in sepsis. Crit Care Med 2002;30(5 Suppl):S313–7.10.1097/00003246-200205001-00022Search in Google Scholar

36. Yaguchi A, Lobo FL, Vincent JL, Pradier O. Platelet function in sepsis. J Thromb Haemost 2004;2:2096–102.10.1111/j.1538-7836.2004.01009.xSearch in Google Scholar

37. Gawaz M, Dickfeld T, Bogner C, Fateh-Moghadam S, Neumann FJ. Platelet function in septic multiple organ dysfunction syndrome. Intensive Care Med 1997;23:379–85.10.1007/s001340050344Search in Google Scholar

38. Cox D, Kerrigan SW, Watson SP. Platelets and the innate immune system: mechanisms of bacterial-induced platelet activation. J Thromb Haemost 2011;9:1097–107.10.1111/j.1538-7836.2011.04264.xSearch in Google Scholar

39. Ghosh TK, Khan N, Malik A. Platelet auto-antibodies in septicaemic patients. Indian J Pathol Microbiol 1999;42:31–5.Search in Google Scholar

40. Francois B, Trimoreau F, Vignon P, Fixe P, Praloran V, Gastinne H. Thrombocytopenia in the sepsis syndrome: role of hemophagocytosis and macrophage colony-stimulating factor. Am J Med 1997;103:114–20.10.1016/S0002-9343(97)00136-8Search in Google Scholar

41. Sy RW, Chawantanpipat C, Richmond DR, Kritharides L. Thrombocytopenia and mortality in infective endocarditis. J Am Coll Cardiol 2008;51:1824–5.10.1016/j.jacc.2008.01.034Search in Google Scholar PubMed

Received: 2016-6-16
Accepted: 2016-10-31
Published Online: 2016-12-17
Published in Print: 2017-6-1

©2017 Walter de Gruyter GmbH, Berlin/Boston

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  24. The impact of admission neutrophil-to-platelet ratio on in-hospital and long-term mortality in patients with infective endocarditis
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  33. Immunoassay interference caused by heterophilic antibodies interacting with biotin
  34. Red blood cell distribution width and mean platelet volume are potential prognostic indices for patients with primary biliary cirrhosis
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https://doi.org/10.1515/cclm-2016-0527
Keywords for this article
infective endocarditis; neutrophil; outcome; platelet

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Biotin interference on immunoassay methods: sporadic cases or hidden epidemic?
  4. Reviews
  5. False biochemical diagnosis of hyperthyroidism in streptavidin-biotin-based immunoassays: the problem of biotin intake and related interferences
  6. Vitamin K plasma levels determination in human health
  7. Mini Review
  8. Point-of-care testing INR: an overview
  9. Opinion Paper
  10. Could accreditation bodies facilitate the implementation of medical guidelines in laboratories?
  11. Genetics and Molecular Diagnostics
  12. QMPSF is sensitive and specific in the detection of NPHP1 heterozygous deletions
  13. General Clinical Chemistry and Laboratory Medicine
  14. High-dose biotin therapy leading to false biochemical endocrine profiles: validation of a simple method to overcome biotin interference
  15. Multicenter performance evaluation of a second generation cortisol assay
  16. A rapid UPLC-MS/MS assay for the simultaneous measurement of fluconazole, voriconazole, posaconazole, itraconazole, and hydroxyitraconazole concentrations in serum
  17. A microplate assay to measure classical and alternative complement activity
  18. Serological diagnosis and prognosis of severe acute pancreatitis by analysis of serum glycoprotein 2
  19. Retrospective evaluation of the clinical utility of serological biomarkers in Chinese patients with inflammatory bowel disease: 2-year clinical experience
  20. Infrared analysis of lipoproteins in the detection of alcohol biomarkers
  21. Coexistence of anti-β2-glycoprotein I domain I and anti-phosphatidylserine/prothrombin antibodies suggests strong thrombotic risk
  22. Antiphosphatidylserine/prothrombin antibodies as biomarkers to identify severe primary antiphospholipid syndrome
  23. Cardiovascular Diseases
  24. The impact of admission neutrophil-to-platelet ratio on in-hospital and long-term mortality in patients with infective endocarditis
  25. Letters to the Editor
  26. Biotin interference in immunoassays mimicking subclinical Graves’ disease and hyperestrogenism: a case series
  27. A simple method to detect biotin interference on immunoassays
  28. Proposed classification for a variant of Kounis syndrome
  29. Lyophilized hemoglobin E control material for the dichlorophenol-indophenol (DCIP) test
  30. Procalcitonin variation before and after 100-km ultramarathon
  31. Preliminary study in specific activity of molecular components in allergy: implications for diagnostics and relationship with disease severity
  32. A 2-min at 4500 g rather than a 15-min at 2200 g centrifugation does not impact the reliability of 10 critical coagulation assays
  33. Immunoassay interference caused by heterophilic antibodies interacting with biotin
  34. Red blood cell distribution width and mean platelet volume are potential prognostic indices for patients with primary biliary cirrhosis
  35. Neutrophil CD64 molecule expression can predict bloodstream infection in septic shock patients
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