ArticlePloS one2025
Association of the derived neutrophil-to-lymphocyte ratio with cardiovascular and all-cause mortality.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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1 citing paper in PubMed.
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8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeAccumulating evidence supports the important role of inflammation in disease outcomes. Derived neutrophil-to-lymphocyte ratio (dNLR) is broadly identified as potential prognostic marker in clinical trials or daily clinical practice, but dNLR has never been verified in cardiovascular and all-cause mortality.
methodsOverall, 34,392 participants from the National Health and Nutrition Examination Survey (NHANES) were included. The exposure variable was Log-dNLR (dNLR Logarithmic transformation). Participants were categorized according to Log-dNLR quartiles and followed through 31st December 2019. Weighted univariable and multivariable Cox regression were applied to assess the relationship between Log-dNLR evaluated as categorical variables, with cardiovascular and all-cause mortality. Restricted cubic spline (RCS) regression, subgroup analysis, and threshold effect were applied to assess nonlinear relationship between Log-dNLR with cardiovascular and all-cause mortality as well as the effects of special populations. We used multiple sensitivity analyses to reduce selection bias and validate these relationships. Last, the time-dependent weighted receiver operating characteristic (ROC) curve analysis was used to assess predictive accuracy of the Log-dNLR for survival outcomes.
resultsDuring a median follow-up duration of 116.90 months, a total of 4,939 all-cause deaths occurred, of which 1,327 were cardiovascular deaths. After adjusting for multiple confounders, compared to the quartile 1, the hazard ratios (HRs) (95% confidence interval, CI) for quartile 4 were 1.38 (95% CI, 1.14-1.68) for cardiovascular mortality and 1.16 (95% CI, 1.06-1.27) for all-cause mortality was identified using RCS regression, with a threshold point of 0.370. Significant differences were observed before and after this threshold point. In addition, there were significant interactions between sex, hypertension status and Log-dNLR (P for interaction = 0.025, 0.005, respectively) for the all-cause mortality risk and significant interactions between age groups, diabetes status and Log-dNLR (P for interaction = 0.007, 0.004, respectively) for the cardiovascular mortality risk. Lastly, ROC analysis revealed that Log-dNLR showed moderate predictive power for all-cause and cardiovascular mortality in the short and long term.
conclusionsIn summary, elevated dNLR levels are significantly associated with an increased risk of both cardiovascular and all-cause mortality.
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