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Neutrophil to Lymphocyte Ratio Is Related to Thrombotic Complications and Survival in Continuous Flow Left Ventricular Assist Devices

Ferrera, Carlos*,†; Gonzalez Fernandez, Oscar; Bouzas, Noelia; Castrodeza, Javier; Green, Thomas; Woods, Andrew; Robinson-Smith, Nicola; Tovey, Sian; Jakovljevic, Djordje G.; Shah, Asif‡,§; Booth, Karen‡,§; Parry, Gareth§; Schueler, Stephan‡,§; MacGowan, Guy A.†,§,¶

doi: 10.1097/MAT.0000000000000971
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Left ventricular assist devices (LVADs) have become an established treatment for advanced heart failure, although with long-term support these patients are potentially exposed to serious complications. Our purpose was to assess the role of the neutrophil to lymphocyte ratio (NLR) in LVAD complications and to evaluate if higher values of NLR after 4–6 months on LVAD support (NLR 4_6m) are associated with worse prognosis. All consecutive patients who received a HeartWare LVAD (N = 188, age 50 ± 13 years), as bridge to transplant from December 2009 to January 2018 were included. Neutrophil to lymphocyte ratio was recorded pre-LVAD, post-LVAD, after 4–6 months on support and in case of a first adverse event to occur after the 4–6 months NLR was recorded. Median NLR values were pre-LVAD 4.26 (interquartile range [IQR], 3.1–6.9), at 1 day postoperative 11.6 (IQR, 8.3–16.6), and NLR 4_6m 4.4 (IQR, 3.0–6.4) (p < 0.001). Neutrophil to lymphocyte ratio increased significantly when patients had an infection, stroke, or pump thrombosis, as compared with the NLR 4_6m (all p < 0.05). Patients with NLR 4_6m ≥ median had higher rates of stroke and mortality. Survival time was shorter among patients with NLR 4_6m ≥ 4.4 (log-rank test p = 0.006). Neutrophil to lymphocyte ratio 4_6m was found to be predictive of increased mortality (area under the curve of 0.62, p = 0.007). After multivariate analysis, NLR 4_6m remained independently associated with increased mortality (hazard ratio [HR] 1.67; 95% confidence interval [CI], 1.03–2.7; p = 0.037). Neutrophil to lymphocyte ratio 4_6m values significantly increase in association with adverse events on LVAD support and are independently associated with mortality. This association suggests presence of inflammation adversely affects LVAD outcomes.

From the *Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain

Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom

Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom

§Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, United Kingdom

Institutes of Genetic Medicine and Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.

Submitted for consideration September 2018; accepted for publication in revised form January 2019.

Disclosure: Dr. MacGowan received grants from Medtronic speaker fees and also received research funding from European Union (unrelated to this study). The other authors have no conflicts of interest to report.

Correspondence: Guy A. MacGowan, Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK NE7 7DN. Email: guy.macgowan@nuth.nhs.uk.

Copyright © 2019 by the American Society for Artificial Internal Organs