Tesis

Peran Rasio Netrofil-Limfosit sebagai Prediktor Major Adverse Cardiac Events Tujuh Hari dalam Perawatan pada Pasien Sindrom Koroner Akut = Role of Neutrophil-Lymphocyte Ratio as Major Adverse Cardiac Events Predictor in Acute Coronary Syndrome During First Seven Days of Hospitalization.

Pendahuluan: Rasio Netrofil-Limfosit (RNL) adalah pemeriksaan laboratorium murah dan mudah didapatkan dimanapun, serta saat ini berkembang menjadi penanda luaran pada berbagai kondisi, termasuk pada Sindrom Koroner Akut (SKA). RNL menggabungkan dua jalur inflamasi berbeda (netrofil dan limfosit) untuk memprediksi luarannya. Beberapa studi telah menunjukkan manfaatnya dalam memprediksi Major Adverse Cardiac Events (MACE) pada pasien SKA. Penelitian ini bertujuan untuk membuktikan manfaat RNL dalam stratifikasi risiko SKA pada populasi Indonesia, dan menentukan nilai titik potong RNL untuk peningkatan risiko MACE. Metode: 380 rekam medis pasien SKA dari Januari 2012-Agustus 2015 diikutsertakan dalam studi ini. Karakteristik, faktor risiko kardiovaskular, dan hasil pemeriksaan laboratorium subjek dikumpulkan dan diikuti untuk menilai kemunculan MACE (aritmia, infark ulang, in stent thrombosis, gagal jantung, stroke, syok kardiogenik, revaskularisasi ulang dan kematian) selama tujuh hari perawatan. Nilai RNL didapatkan dari pembagian hitung netrofil dan limfosit absolut. Analisis statistik untuk menentukan nilai titik potong RNL dan penyesuaian untuk faktor perancu dilakukan untuk memvalidasi hasil. Hasil: Subjek mayoritas merupakan laki-laki, dengan rerata usia 57,92 tahun. Hipertensi dan merokok merupakan faktor risiko yang paling sering ditemukan. Rerata RNL subjek adalah 4,72, dan MACE ditemukan pada 73 kasus (19,2%). Setelah analisis ROC, didapatkan nilai titik potong sebesar 3,55 (sensitivitas 72,6%, spesitifitas 60,6%, AUC 0.702). Ditemukan bahwa terdapat peningkatan insidens MACE pada kelompok RNL>3,55 (30,46% vs 9,71% pada ≤3,55, p3,55 tetap signifikan dalam memprediksi MACE (p=0,02, adjusted OR 2,626 (IK95% 1,401-4,922)). Kesimpulan: RNL>3,55 adalah prediktor independen untuk kejadian MACE tujuh hari dalam perawatan.
Kata kunci: Rasio netrofil limfosit, sindrom koroner akut, major adverse cardiac events



Background: Neutrophil-Lymphocyte Ratio (NLR) is a low-cost, readily available laboratory examination in various places, and is currently emerging as a prognostic marker for various conditions, including Acute Coronary Syndrome (ACS). NLR, which combines two different inflammatory pathways (neutrophil and lymphocyte), have been shown by several studies to be useful in predicting Major Adverse Cardiac Events (MACE). This study aims to prove NLR’s use in ACS risk stratification in Indonesians and determine a cut off level for MACE risk increase. Methods: 380 ACS patients’ medical records from January 2012 to August 2015 were included in this study. Subjects’ characteristics, cardiovascular risk factors and laboratory findings were collected, and followed to evaluate for MACE (arrhythmia, reinfarction, instent thrombosis, acute decompensated heart failure, stroke, cardiogenic shock, repeated intervention, death) during 7 days hospitalization. NLR value was calculated from neutrophil and lymphocyte counts division. Statistical analysis to determine NLR cutoff point for MACE risks, and adjustment for confounding factors were done for results validation. Results: Subjects were predominantly male, with average age of 57.92 years old. Hypertension and smoking were the most frequent risk factors found. Average NLR was 4.72, and MACE was found in 73 cases (19.2%). After ROC analysis, a cut off of 3.55 was determined to be satisfactory (sensitivity 72.6%, spesitivity 60.6%, AUC 0.702). It was found that there is a significant increase in MACE incidence in NLR>3.55 (30.47% vs 9.71% in ≤3.55, p3.55 was still significant in predicting MACE (p=0.02, adujsted OR 2,626 (CI95% 1,401-4,922)). Conclusion: NLR>3.55 is an independent predictor of 7-day in hospital MACE.
Keywords: Neutrophil-Lymphocyte Ratio, Acute coronary syndrome, major adverse cardiac events