The neutrophil to lymphocyte ratio is associated with severity of rheumatic mitral valve stenosis

Background: Rheumatic heart disease (RHD) is a serious health concern in developing - countries. Rheumatic mitral stenosis (RMS) is the most long-term sequel in RHD. The neutrophil to lymphocyte ratio (NLR) is a novel marker, and a higher NLR has been associated with poor clinical outcomes in various cardiovascular disorders. We evaluated the availability of NLR to predict severity of mitral stenosis ( MS) in patients with RHD. Methods: We analyzed 300 consecutive patients with RMS. The patients were divided into tertiles according to NLR: 0.85, NLR <= 1.85 (n=100, tertile 1), 1.86 <= NLR <= 2.46 (n=100, tertile 2), and 2.47 <= NLR <= 7.08 (n=100, tertile 3). Patients with RMS were divided into three groups based on the degree of MS as mild, moderate, and severe MS. After the initial evaluation, 187 patients with moderate-to-severe RMS (Group 1) and 113 patients with mild RMS (Group 2) were reassessed. Results: The patients with severe RMS had significantly elevated NLR, mean platelet volume, and pulmonary artery systolic pressure values compared to patients with moderate and mild MS (P< 0.001, P< 0.001, P< 0.001 respectively). Multivariate binary logistic regression analysis revealed that high levels of NLR was an independent predictor of severe RMS ( odds ratio =0.68, P=0.008). Moderate-to-severe RMS incidence was significantly higher among patients in the tertile 3 (odds ratio =2.8, P=0.001). Conclusion: NLR is a new inflammatory marker and a simple, rapid, and easily accessible prognostic parameter that can be associated with severity of RMS in patients with RHD.