Predicting Acute Myocardial Infarction Severity Using Inflammatory Markers Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio

Abiseka Panji Baskoro, Enrico Ananda Budiono, Vina Sari Nugrahaning Widi, An Aldia Asrial, Irnizarifka Irnizarifka, Hanimar Chania

Abstract

 

Introduction: Acute myocardial infarction (AMI) remains as one of major contributors to cardiovascular mortality worldwide. While Killip class and GRACE score are established tools for assessing AMI severity, evidence regarding prognostic potential of hematologic inflammatory markers, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) remains limited, particularly in Southeast Asia. This study aimed to see the correlation between NLR and PLR with Killip classification, GRACE score, and in-hospital mortality in AMI patients.

Methods: This retrospective study included 47 AMI patients admitted to the Intensive Cardiovascular Care Unit of Universitas Sebelas Maret Hospital between September 2024 and June 2025. Data on clinical and laboratory parameters were extracted from medical records. NLR and PLR were calculated from complete blood count values. Killip class and GRACE score were assessed at admission. Statistical analyses included correlation tests, regression models, and outcome comparisons.

Results: Higher NLR and PLR values were significantly associated with increasing Killip class (ρ = 0.897 and ρ = 0.921, respectively) and GRACE score (p < 0.001). PLR was independent predictor of Killip class (p = 0.020), while only troponin I was independently associated with in-hospital mortality (p = 0.040). The GRACE score regression model showed excellent explanatory power (R² = 0.919), with NLR, PLR, and clinical variables contributing significantly.

Conclusion: NLR and PLR are significantly correlated with AMI severity and risk scores. PLR may serve as a simple adjunctive marker for early clinical stratification in AMI.

Keywords

acute myocardial infarction; NLR; PLR; killip class; GRACE score

Full Text:

PDF

References

  1. Naveed MA, Neppala S, Chigurupati HD, Ali A, Rehan MO, Fath A, et al. Acute myocardial infarction-related mortality among older adults (≥65 years) with malignancy in the U.S. from 1999 to 2020. International Journal of Cardiology Cardiovascular Risk and Prevention. 2025 Jun;25:200392.
  2. De Luca L, Maggioni A Pietro, Cavallini C, Leonardi S, Lucci D, Sacco A, et al. Clinical profile and management of patients with acute myocardial infarction admitted to cardiac care units: The EYESHOT-2 registry. Int J Cardiol. 2025 Jan;418:132601.
  3. Martha JW, Sihite TA, Listina D. The Difference in Accuracy Between Global Registry of Acute Coronary Events Score and Thrombolysis in Myocardial Infarction Score in Predicting In-Hospital Mortality of Acute ST-Elevation Myocardial Infarction Patients. Cardiol Res. 2021 Jun;12(3):177–85.
  4. Liyis BG de, Ciaves AF, Intizam MH, Jusuf PJ, Artha IMJR. Hematological Biomarkers of Troponin, Neutrophil-to-Lymphocyte Ratio, and Monocyte-toLymphocyte Ratio Serve as Effective Predictive Indicators of High-Risk Mortality in Acute. Biomedicine (Taipei). 2023 Nov 27;13(4):32–43.
  5. Pashapour P, Ghaffarii S, Separham A. The relationship of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in peripheral blood with ST-segment resolution and the clinical outcomes of STEMI patients receiving thrombolytic therapy. Romanian Journal of Internal Medicine. 2019 Mar 1;57(1):47–54.
  6. Xin J, Liu Y, Zhang C, Wang Q. Predictive value of novel inflammatory markers combined with GRACE score for in-hospital outcome in patients with ST-segment elevation myocardial infarction: a retrospective observational study. BMJ Open. 2025 Apr 3;15(4):e096621.
  7. Karadeniz F, Karadeniz Y, Altuntaş E. Systemic immune–inflammation index, and neutrophilto-lymphocyte and platelet-to-lymphocyte ratios can predict clinical outcomes in patients with acute coronary syndrome. Cardiovasc J Afr. 2024 Sep 1;35(2):18–24.
  8. Tudurachi BS, Anghel L, Tudurachi A, Sascău RA, Stătescu C. Assessment of Inflammatory Hematological Ratios (NLR, PLR, MLR, LMR and Monocyte/HDL–Cholesterol Ratio) in Acute Myocardial Infarction and Particularities in Young Patients. Int J Mol Sci. 2023 Sep 21;24(18):14378.
  9. Willim HA, Pakpahan SP, Suprihatin E, Agustyana A, Arilaksono DG, Suhardi S. Association Between Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio with Global Registry of Acute Coronary Events Risk Score in Acute Myocardial Infarction. Cermin Dunia Kedokteran. 2021 Jun 2;48(6):299–302.
  10. Karaca G, Ekmekci A, Kimiaei A, Safaei S, Özer N, Tayyareci G. The Impact of the Neutrophil-to-Lymphocyte Ratio on In-Hospital Outcomes in Patients With Acute ST-Segment Elevation Myocardial Infarction. Cureus. 2024 Feb 18;
  11. Wang H, Zulikaier T, Yumaierjiang B, Lyu S, He P. Platelet-To-Lymphocyte Ratio Efficiency in Predicting Major Adverse Cardiovascular Events After Percutaneous Coronary Intervention in Acute Coronary Syndromes: A Meta-Analysis. Rev Cardiovasc Med. 2025 May 21;26(5).
  12. Oylumlu M, Oylumlu M, Arslan B, Polat N, Özbek M, Demir M, et al. Platelet-to-lymphocyte ratio is a predictor of long-term mortality in patients with acute coronary syndrome. Advances in Interventional Cardiology. 2020;16(2):170–6.
  13. Wang H, Li L, Ma Y. Platelet‐to‐lymphocyte ratio a potential prognosticator in acute myocardial infarction: A prospective longitudinal study. Clin Cardiol. 2023 Jun 14;46(6):632–8.
  14. Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, et al. Cardiac-Specific Troponin I Levels to Predict the Risk of Mortality in Patients with Acute Coronary Syndromes. New England Journal of Medicine. 1996 Oct 31;335(18):1342–9.
  15. Firani NK, Prisilla J. Procalcitonin and Troponin-I as Predictor of Mortality in Acute Myocardial Infarction Patients. INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY. 2022 Jun 3;28(2):170–4.
  16. Wikananda GDD, Diartoputra AYR. Association of Neutrophil-lymphocyte ratio and platelet lymphocyte ratio with GRACE risk score and high-sensitivity Troponin T in acute coronary syndrome patient. Intisari Sains Medis. 2023 Jun 7;14(2):489–92.
  17. Liu J, Ao W, Zhou J, Luo P, Wang Q, Xiang D. The correlation between PLR-NLR and prognosis in acute myocardial infarction. Am J Transl Res. 2021;13(5):4892–9

DOI: https://doi.org/10.13057/smj.v8i2.105956

Refbacks

  • There are currently no refbacks.