Table 1.
Summary of included studies reporting neutrophil to lymphocyte ratio and heart failure clinical outcomes
| Authors | Design | Sample size | Male (%) | Age | Follow-up duration | NLR | Outcomes | |
|---|---|---|---|---|---|---|---|---|
| Wu et al. 2023 [60] | Cross-sectional | Total | 1207 | 689 (57.08) | Mean ± SD: 67.3 ± 12.5 | Median (IQR): 66 (35–105.5) months |
Mean ± SD: 2.46 ± 1.18 Median (IQR): 2.4(1.7–3.3) NLR quartiles: Q1: < 1.7 Q2: 1.7–2.4 Q3: 2.4–3.3 Q4: ≥ 3.3 |
Follow-up mortality: 540 (44.73%) |
| Survived | 667 | 363 (54.42) | Mean ± SD: 63.3 ± 13 |
Mean ± SD: 2.16 ± 1.04 Median (IQR): 2.1 (1.5–2.9) |
||||
| Death | 540 | 326 (60.37) | Mean ± SD: 72.2 ± 9.9 |
Mean ± SD: 2.8 ± 1.41 Median (IQR): 2.7 (1.9–3.8) |
||||
| Tamaki et al. 2023 [61] | Cross-sectional | Total | 1026 | 462 (45.03) |
Mean ± SD: 82.33 ± 7.42 Median (IQR): 83 (77-87) |
Median: 429 days |
Mean ± SD: 4.26 ± 2.74 Median (IQR): 3.9 (2.6–6.3) NLR cut-off: 4.50 |
Follow-up mortality: 195 (19%) |
| Liu et al. 2023 [62] | Cross-sectional | Total | 1169 | 673 (57.57) | Mean ± SD: 69.51 ± 13.83 | NA |
Mean ± SD: 8.43 ± 6.21 Median (IQR): 7.46 (4.73–13.10) NLR tertiles: T1: < 5.43 T2: 5.43–10.33 T3: ≥ 10.33 |
In-hospital mortality: 183 (15.65%) |
| Survived | 986 | 556 (56.39) | Mean ± SD: 68.87 ± 13.96 |
Mean ± SD: 7.82 ± 5.44 Median (IQR): 7.11 (4.52–11.85) |
||||
| Death | 183 | 117 (63.93) | Mean ± SD: 72.95 ± 12.64 |
Mean ± SD: 13.43 ± 12.58 Median (IQR): 10.93 (6.26–23.10) |
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| Zhu et al. 2022 [63] | Prospective cohort | Total | 538 | 357 (66.36) | Mean ± SD: 61.07 ± 15.98 | Median: 34 months |
Mean ± SD: 2.97 ± 1.96 Median (IQR): 2.64 (1.82–4.47) NLR cut-off: 2.28 |
Follow-up mortality: 227 (42.19%) |
| Survived | 311 | 228 (73.31) | Mean ± SD: 58.03 ± 15.91 |
Mean ± SD: 2.69 ± 1.78 Median (IQR): 2.40 (1.64–4.04) |
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| Death | 227 | 129 (56.83) | Mean ± SD: 65.23 ± 15.16 |
Mean ± SD: 3.46 ± 2.29 Median (IQR): 3.05 (2.14–5.21) |
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| Wang et al. 2022 [64] | Cross-sectional | Total | 189 | 106 (56.08) | Mean ± SD: 67.07 ± 13.41 | NR |
Mean ± SD: 3.46 ± 2.62 NLR cut-off: 2.15 |
HF detection |
| Maeda et al. 2022 [65] | Cross-sectional | Total | 669 | 398 (59.49) | Mean ± SD: 75.8 ± 11.3 | Median (IQR): 476 (147–796) days |
Mean ± SD: 2.62 ± 1.45 Median (IQR): 2.41 (1.75–3.71) |
Follow-up mortality & rehospitalization: 255 (38.11%) |
| Liu et al. 2022 [25] | Retrospective cohort | Total | 454 | 247 (54.41) | Mean ± SD: 76 ± 8 | 18 months |
Mean ± SD: 2.74 ± 1.36 Median (IQR): 2.62 (1.89–3.72) NLR cut-off: 2.53 |
Follow-up mortality: 42 (9.25%) Rehospitalization: 221 (48.67%) |
| Positive major cardiac events | 236 | 131 (55.51) | Mean ± SD: 77 ± 8 |
Mean ± SD: 3.17 ± 1.53 Median (IQR): 3.03 (2.21–4.27) |
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| Negative major cardiac events | 218 | 116 (53.21) | Mean ± SD: 75 ± 7 |
Mean ± SD: 2.31 ± 1.07 Median (IQR): 2.27 (1.61–3.05) |
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| Li et al. 2022 [66] | Cross-sectional | Total | 50 | 30 (60.00) | Mean ± SD: 74.16 ± 2.94 | 6 months |
Mean ± SD: 3.50 ± 1.78 NLR cut-off: 3.96 |
Major cardiac events: 13 (26%) |
| Positive major cardiac events | 13 | 8 (61.54) | Mean ± SD: 75.77 ± 3.54 | Mean ± SD: 5.12 ± 2.81 | ||||
| Negative major cardiac events | 37 | 22 (59.46) | Mean ± SD: 73.59 ± 2.51 | Mean ± SD: 2.93 ± 0.64 | ||||
| Kocaoglu et al. 2022 [67] | Cross-sectional | Total | 101 | 49 (48.51) | Mean ± SD: 73.15 ± 10.19 | 3 months |
Mean ± SD: 6.74 ± 5.44 NLR cut-off: 8.4 |
Follow-up mortality: 39 (38.61%) |
| Survived | 62 | 30 (48.39) | Mean ± SD: 72.61 ± 10.92 |
Mean ± SD: 5.54 ± 2.98 Median (IQR): 4.95 (3.88–7.81) |
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| Death | 39 | 19 (48.72) | Mean ± SD: 74.00 ± 8.96 |
Mean ± SD: 8.66 ± 7.59 Median (IQR): 6.67 (4.73–14.6) |
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| Davison et al. 2022 [68] | Cross-sectional | Total | 1823 | 1116 (61.22) | Mean ± SD: 71.40 ± 10.53 | 6 months |
NLR tertiles: T1: ≤ 3.26 T2: 3.26–5.17 T3: ≥ 5.17 |
Follow-up mortality: 183 (10.03%) |
| Davran et al. 2022 [22] | Cross-sectional | Total | 139 | 64 (46.04) | Mean ± SD: 69.2 ± 12.1 | 1 year | Mean ± SD: 6.31 ± 4.48 |
Follow-up mortality: 14 (10.07%) In-hospital mortality: 9 (6.47%) |
| Survived | 116 | 57 (49.14) | Mean ± SD: 69.3 ± 11.5 | Mean ± SD: 5.84 ± 4.05 | ||||
| Death | 23 | 7 (30.43) | Mean ± SD: 69.2 ± 15 | Mean ± SD: 8.7 ± 5.79 | ||||
| Delcea et al. 2021 [23] | Retrospective cohort | Total | 1299 | 624 (48.04) | Mean ± SD: 72.35 ± 10.45 | NA |
Mean ± SD: 3.18 ± 1.72 Median (IQR): 2.97 (2.12–4.45) NLR tertiles: T1: 0.89–2.38 T2: 2.39–3.68 T3: 3.69–26.11 NLR cut-off: 3.68 |
In-hospital mortality: 37 (2.84%) Extended length of hospital stay: 288 (22.17%) |
| Curran et al. 2021 [34] | Cross-sectional | Total | 1622 | 1086 (66.95) | Mean ± SD: 74 ± 10 | Median: 18 months | Median: 3.22 |
Follow-up mortality: 447 (27.55%) Rehospitalization: 406 (25.03%) |
| Bai et al. 2021 [35] | Cross-sectional | Total | 172 | 89 (51.74) | Mean ± SD: 71.1 ± 12.5 | NA |
Mean ± SD: 3.98 ± 2.48 Median (IQR): 3.77 (2.43–5.76) |
Heart failure detection |
| Arfsten et al. 2021 [36] | Cross-sectional | Total | 443 | 325 (73.36) |
Mean ± SD: 63 ± 14.13 Median (IQR): 64 (53-72) |
Median (IQR): 21 (10-28) months |
Mean ± SD: 4.03 ± 2.3 Median (IQR): 3.8 (2.6–5.7) |
Follow-up mortality: 75 (16.93%) |
| Angkananard et al. 2021 [37] | Retrospective cohort | Total | 321 | 144 (44.86) | Mean ± SD: 67.4 ± 14.9 | Median (IQR): 23 (2-33) months |
Mean ± SD: 3.7 ± 2.45 Median (IQR): 3.2 (2.3–5.6) NLR cut-off: In-hospital mortality: 3.29 Rehospitalization: 3.58 Cardiovascular event: 3.29 Composite outcome: 3.32 |
Follow-up mortality: 106 (33.02%) In-hospital mortality: 21 (6.54%) Rehospitalization: 62 (19.31%) |
| Urbanowicz et al. 2020 [38] | Cross-sectional | Total | 41 | 36 (87.80) | Mean ± SD: 50 ± 10 | NA |
Mean ± SD: 3.46 ± 1.69 Median (IQR): 3.2 (2.5–4.7) |
Pulmonary vascular resistance Right ventricular systolic pressure |
| Sadeghi et al. 2020 [33] | Cross-sectional | Total | 197 | 121 (61.42) | Mean ± SD: 66.31 ± 14.9 | 6 months |
Mean ± SD: 4.41 ± 3.64 NLR cut-off: 7.50 |
Follow-up mortality: 30 (15.22%) |
| Survived | 167 | 110 (65.87) | Mean ± SD: 65.9 ± 14.64 | Mean ± SD: 3.84 ± 2.82 | ||||
| Death | 30 | 11 (36.67) | Mean ± SD: 68.63 ± 16.82 | Mean ± SD: 7.61 ± 5.62 | ||||
| Kose et al. 2020 [39] | Retrospective cohort | Total | 200 | 146 (73.00) | Mean ± SD: 65 ± 13.6 | Mean: 12 months |
Mean ± SD: 4.25 ± 3.52 NLR cut-off: 3.70 |
Follow-up mortality: 38 (19%) |
| Survived | 162 | 116 (71.60) | Mean ± SD: 64.6 ± 13.5 | Mean ± SD: 3.84 ± 3.28 | ||||
| Death | 38 | 30 (78.95) | Mean ± SD: 66.6 ± 13.73 | Mean ± SD: 5.98 ± 4.01 | ||||
| Cho et al. 2020 [40] | Retrospective cohort | Total | 5580 | 2964 (53.12) | Mean ± SD: 68.47 ± 14.4 | Mean: 3 years |
NLR quartiles: Q1: 0.2–2.0 Q2: 2.1–3.2 Q3: 3.3–5.8 Q4: 5.9–192.4 NLR cut-off: Positive infection and/or ischemia: 7.0 Negative infection and/or ischemia: 5.0 |
Follow-up mortality: 1891/5301 (35.67%) In-hospital mortality: 331 (5.93%) |
| Turcato et al. 2019 [41] | Cross-sectional | Total | 439 | 247 (56.26) | Mean ± SD: 81.51 ± 8.2 | 30 days |
Mean ± SD: 5.48 ± 6.61 NLR cut-off: 5.70 |
Follow-up mortality: 45 (10.25%) |
| Survived | 394 | 221 (56.09) |
Mean ± SD: 81 ± 8.18 Median (IQR): 82 (75-86) |
Mean ± SD: 4.43 ± 2.97 Median (IQR): 4.1 (2.6–6.6) |
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| Death | 45 | 26 (57.78) |
Mean ± SD: 86 ± 7.65 Median (IQR): 86 (81-91) |
Mean ± SD: 14.76 ± 16.08 Median (IQR): 11.7 (5.8–26.8) |
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| Kone et al. 2019 [42] | Cross-sectional | Total | 105 | 68 (64.76) | Mean ± SD: 63.18 ± 12.8 | NA | Mean ± SD: 2.64 ± 1.9 | Severe HF prediction |
| Moderate HF | 81 | 56 (69.14) | Mean ± SD: 64.3 ± 12.9 | Mean ± SD: 2.32 ± 1.07 | ||||
| Severe HF | 24 | 12 (50.00) | Mean ± SD: 59.43 ± 12 | Mean ± SD: 3.75 ± 3.29 | ||||
| Boralkar et al. 2019 [43] | Cross-sectional | Total | 443 | 184 (41.53) | Mean ± SD: 76.7 ± 15.5 | Median (IQR): 2.2 (0.3–4.9) years |
Mean ± SD: 7.06 ± 5.57 Median (IQR): 6.5 (3.6–11.1) |
Follow-up mortality: 121 (27.31%) |
| Yurtdas et al. 2018 [44] | Cross-sectional | Total | 40 | 19 (47.50) | Mean ± SD: 69 ± 12 | NA | Mean ± SD: 3.2 ± 1.4 | HF detection |
| Yan et al. 2017 & 2016 [45, 46] | Cross-sectional | Total | 1355 | 816 (60.22) | Mean ± SD: 72.6 ± 8 | Median (IQR): 18 (12-29) months |
Mean ± SD: 3.2 ± 3.1 NLR tertiles: T1: < 1.96 T2: 1.96–2.90 T3: > 2.90 |
Follow-up mortality: 92 (6.78%) Rehospitalization: 334 (24.64%) Atrial fibrillation prediction Chronic kidney disease prediction |
| Positive major cardiac events | 422 | 280 (66.35) | Mean ± SD: 73.9 ± 8.2 | Mean ± SD: 3.6 ± 3.1 | ||||
| Negative major cardiac events | 933 | 536 (57.45) | Mean ± SD: 71.9 ± 7.8 | Mean ± SD: 3 ± 3 | ||||
| Pourafkari et al. 2017 [24] | Cross-sectional | Total (In-hospital) | 554 | 531 (95.85) | Mean ± SD: 76.47 ± 11.6 | NA | Mean ± SD: 6.3 ± 4.99 | In-hospital Mortality: 31 (5.59%) |
| Survived | 523 | 500 (95.60) | Mean ± SD: 76 ± 11.6 | Mean ± SD: 6.2 ± 4.8 | ||||
| Death | 31 | 31 (100.00) | Mean ± SD: 84.5 ± 8.8 | Mean ± SD: 8 ± 7.5 | ||||
| Total (long-term) | 333 | 319 (95.80) | Mean ± SD: 76.64 ± 11.4 | NR | Mean ± SD: 6.13 ± 4.51 | Follow-up mortality: 198 (59.45%) | ||
| Survived | 135 | 127 (94.07) | Mean ± SD: 72.9 ± 11 | Mean ± SD: 5.6 ± 4.2 | ||||
| Death | 198 | 192 (96.97) | Mean ± SD: 79.2 ± 11.1 | Mean ± SD: 6.5 ± 4.7 | ||||
| Huang et al. 2017 [47] | Cross-sectional | Total | 1923 | 1307 (67.97) | Mean ± SD: 76 ± 12 | Mean ± SD: 28.6 ± 20.7 months | Mean ± SD: 5.44 ± 6.09 | Follow-up mortality: 875 (45.50%) |
| Survived | 1048 | 697 (66.51) | Mean ± SD: 74.8 ± 13.9 | Mean ± SD: 4.76 ± 5.35 | ||||
| Death | 875 | 610 (69.71) | Mean ± SD: 78.3 ± 10.7 | Mean ± SD: 6.26 ± 6.8 | ||||
| Siniorakis et al. 2017 [48] | Cross-sectional | Total | 72 | 31 (43.06) | Mean ± SD: 77 ± 10 | NA |
Mean ± SD: 3.13 ± 2.38 NLR cut-off: 3.15 |
In-hospital mortality: 3 (4%) HF differentiation from respiratory infection |
| Wasilewski et al. 2016 [49] | Cross-sectional | Total | 1734 | 1387 (79.99) |
Mean ± SD: 61.66 ± 13.3 Median (IQR): 61 (53-71) |
Median (IQR): 660 (331–1074) days |
Mean ± SD: 2.93 ± 1.81 NLR tertiles: T1: ≤ 2.04 T2: 2.05–3.1 T3: > 3.1 |
Follow-up mortality: 443 (25.54%) |
| Liu et al. 2016 [50] | Cross-sectional | Total | 179 | 96 (53.63) | Mean ± SD: 67.48 ± 13.1 | NA |
Mean ± SD: 4.26 ± 5.45 NLR cut-off: In-hospital mortality: 3.31 Severe HF: 2.18 |
In-hospital mortality: 10 (5.58%) |
| Survived | 169 | 92 (54.44) | Mean ± SD: 67.1 ± 13 | Mean ± SD: 3.9 ± 5.2 | ||||
| Death | 10 | 4 (40.00) | Mean ± SD: 74.2 ± 10.5 | Mean ± SD: 10.2 ± 6.2 | ||||
| Argan et al. 2016 [51] | Cross-sectional | Total | 68 | 37 (54.41) |
Mean ± SD: 61.33 ± 12.8 Median (IQR): 61 (53-70) |
Mean (range): 16 (1-39) months |
Mean ± SD: 2.64 ± 1.33 Median (IQR): 2.56 (1.8–3.56) NLR cut-off: 3.0 |
Progression to kidney disease: 17/48 (35.41%) All cause death and hospitalization: 32/63 (50.79%) |
| Fu et al. 2015 [52] | Cross-sectional | Total | 306 | 248 (81.05) |
Mean ± SD: 84.66 ± 6.7 Median (IQR): 85 (80-89) |
Mean: 471 days |
Mean ± SD: 3.3 ± 2.23 Median (IQR): 2.9 (2-5) |
Follow-up mortality: 104 (33.98%) |
| Durmus et al. 2015 [53] | Cross-sectional | Total | 56 | 32 (57.14) | Mean ± SD: 67.5 ± 12.6 | Mean ± SD: 12.8 ± 7.6 months |
Mean ± SD: 5.5 ± 2.8 NLR cut-off: Mortality: 5.1 HF prediction: 3.0 |
Follow-up mortality: 10 (17.85%) |
| Cakici et al. 2014 [54] | Cross-sectional | Total | 94 | 59 (62.77) | Mean ± SD: 56.7 ± 10.9 | NA |
Mean ± SD: 3.33 ± 3.91 Median (IQR): 2.6 (1.1–6.3) NLR cut-off: 2.74 |
Poor functional capacity |
| Budak et al. 2014 [55] | Cross-sectional | Total | 190 | 102 (53.68) |
Mean ± SD: 68.25 ± 7.8 Median (range): 71 (42-89) |
NA | Mean ± SD: 6.2 ± 8.6 | NR |
| Benites-Zapata et al. 2014 [56] | Cross-sectional | Total | 527 | 383 (72.68) | Mean ± SD: 55.43 ± 12.2 | Median (IQR): 11.3 (3.4–21.1) months |
Mean ± SD: 4.3 ± 2.97 Median (IQR): 3.9 (2.5–6.5) NLR tertiles: T1: < 3 T2: 3.5–5.4 T3: > 5.4 |
Mortality and heart transplantation: 263 (49.90%) |
| Turfan et al. 2013 [57] | Cross-sectional | Total | 167 | 101 (60.48) | Mean ± SD: 67.71 ± 9.1 | NA |
Mean ± SD: 5.01 ± 3.25 NLR cut-off: 4.78 |
In-hospital mortality: 15 (8.98%) |
| Survived | 152 | 95 (62.50) | Mean ± SD: 67 ± 9 | Mean ± SD: 4.83 ± 3 | ||||
| Death | 15 | 6 (40.00) | Mean ± SD: 75 ± 8 | Mean ± SD: 7.2 ± 4.8 | ||||
| Tasal et al. 2013 [58] | Cross-sectional | Total | 219 | 168 (76.71) | Mean ± SD: 63.2 ± 12.7 | NA |
Mean ± SD: 6.94 ± 6.26 NLR cut-off: 5.54 |
In-hospital mortality: 45 (20.54%) |
| Survived | 174 | 137 (78.74) | Mean ± SD: 62.5 ± 12.9 | Mean ± SD: 6.1 ± 5.3 | ||||
| Death | 45 | 31 (68.89) | Mean ± SD: 65.4 ± 11.2 | Mean ± SD: 10.2 ± 8.4 | ||||
| Uthamalingam et al. 2010 [59] | Cross-sectional | Total | 1212 | 606 (50.00) | Mean ± SD: 73.99 ± 13.5 | Median (IQR): 26 (15-36) months | Mean ± SD: 6.06 ± 3.93 |
Follow-up mortality: 284 (23.43%) In-hospital mortality: 63 (5.19%) |
NLR neutrophil to lymphocyte ratio, SD standard deviation, IQR interquartile range, HF heart failure, Q quartile, T tertile, NA not applicable, NR not reported