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Usefulness of the neutrophil-to-lymphocyte ratio in predicting the severity of coronary artery disease: a Gensini score assessment.

AIM
The usefulness of the white blood cell (WBC) count and neutrophil-to-lymphocyte ratio (NLR) in predicting the severity of stable coronary artery disease (CAD) has not been sufficiently evaluated, particularly based on strict coronary assessments. The aim of the present study was to investigate the WBC count and NLR in predicting the severity of angiographically proven CAD.


METHODS
A total of 2,976 CAD patients and 571 non-CAD patients were consecutively enrolled, and the CAD patients were classified into the three groups according to the tertile of the Gensini score (GS, low GS<18, n=989; intermediate GS 18-41, n=995 and high GS>41, n=992). The efficacy of the WBC count and NLR in predicting the risk and severity of CAD as well as the correlations between these markers and the GS were analyzed. A receiver operating characteristic (ROC) curve analysis was also performed.


RESULTS
The NLR was found to be an independent predictor of both the presence of CAD (OR=1.18, 95%CI: 1.09-1.27, p=0.009) and a high GS (OR=1.10, 95%CI: 1.01-1.16, p=0.032). In addition, there were mild positive correlations between the GS and the NLR, WBC and proportions of neutrophils and monocytes. In the ROC curves analysis, the NLR was found to have the largest area under the curve (AUC=0.63, 95%CI: 0.59-0.67, p=0.000), with an optimal cut-off value of 2.04 (sensitivity: 62.1%, specificity: 54.8%) for predicting a high GS.


CONCLUSIONS
The NLR is a valuable independent predictor of the severity of CAD assessed according to the GS. In particular, an NLR of >2.04 indicates a higher risk of CAD and greater severity of CAD lesions.