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Platelet to lymphocyte ratio as a prognostic marker in primary percutaneous coronary intervention

We read the letter by Sertoglu et al. commenting on our paper entitled ‘Platelet to Lymphocyte Ratio as a Prognostic Marker in Primary Percutaneous Coronary Intervention’ [1, 2]. Sertoglu et al. [1] suggested that hypertension and diabetes (DM) could be confounders in our study. There was no statistically significant difference in the number of hypertensives in both groups in our study [2]. Sertoglu et al. refer to a study [3] that showed an increased PLR in diabetic patients with nephropathy and macroalbuminuria compared with diabetic patients with microor non-albuminuria. While mean creatinine was 1.43 mg/dl in the patients with increased PLR in that study (3), that value was 1.0 mg/dl in the patients with increased PLR in our study [2]. There was no non-diabetic control group in the Akbas et al. study [3]. Therefore, whether the increased PLR in the diabetic patients with nephropathy was due to DM or nephropathy is controversial. To our knowledge no study evaluated the association between the PLR and DM so the impact of DM on the PLR is still unknown. Sertoglu et al. comment on the high white blood count (WBC) in our study [2]. WBC (particularly neutrophil count) increases in acute myocardial infarction (AMI) and correlates with infarct size and prognosis [4]. Active infection in the patients with AMI in the acute phase is diagnosed by medical history, physical examination and blood tests (e.g. ESR, CRP) but not WBC. If an increased WBC persists following AMI, active infection would be suspected. Therefore, we do not think that patients with AMI and infection were included in our study [2]. There is a significant association between lymphocyte count and malnutrition particularly in older patients [5]. Mean age of the patients in our study [2] was 57 years; we did not note any patients with malnutrition in our study The neutrophil to lymphocyte ratio (NLR) was an independent predictor of no-reflow, Syntax score and in-hospital adverse events as much as the PLR in our study. There are studies commenting on the prognostic value of NLR in AMI [6, 7]. The aim of our study did not include the prognostic value of NLR or the NLR combined with PLR in AMI so it was not discussed.