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Peripheral Blood Myeloid/Platelet:Lymphoid Ratios Predict Mortality Risk Amongst 70,917 Emergency Medical Admissions: A Cohort Study

29 Pages Posted: 10 Jul 2019

See all articles by Vivek Naranbhai

Vivek Naranbhai

University of Oxford - Nuffield Department of Medicine; University of KwaZulu-Natal - Centre for the AIDS Programme of Research in South Africa; Harvard University - Dana Farber Cancer Institute

Adrian V. S. Hill

University of Oxford - The Jenner Institute; University of Oxford - Wellcome Trust Centre for Human Genetics; University of Oxford - Centre for Clinical Vaccinology and Tropical Medicine

A. Sarah Walker

University of Oxford, Nuffield Department of Medicine, John Radcliffe Hospital

David Wyllie

Imperial College London - NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance; NHS Foundation Trust - Addenbrooke's Hospital

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Abstract

Background: Historical and recent studies find that elevation in the monocyte:lymphocyte(ML), neutrophil:lymphocyte(NL) or platelet:lymphocyte(PL) ratios are associated with impaired outcomes for a variety of infectious, malignant and cardiovascular diseases.

Methods: We jointly considered absolute or relative blood counts amongst 70,917 adults admitted as emergency medical admissions to two centers in Oxfordshire between 2006-2010, for predicting all-cause mortality within 28 days of admission. Peripheral blood lymphocyte, monocyte, neutrophil and platelet counts or NL, ML and PL ratios were modeled as predictors of 28-day survival in Cox-proportional hazards models adjusting for sex and age using fractional polynomials to allow for non-linear associations.

Results: Blood count variables improved the predictive power of a null model including age and sex only; NL, ML and PL ratio outperformed the respective constituent measures alone. Moreover, NL, ML and PL ratios are highly correlated. Amongst the three ratios, the NL ratio was of greatest discriminatory value (100-fold bootstrapped C-index=0.76), with elevation in the NL ratio associated with elevated hazards of death across age and sex strata and regardless of intercurrent infection or of extreme values.

Discussion: Myeloid or platelet to lymphoid cell ratios are predictors of mortality. The peripheral blood NL ratio is superior to other measures for predicting mortality risk in adult emergency medical admissions. Our results reconcile the pleiotropic associations of the ML, NL and PL ratios in suggesting that the activity of platelet/myeloid-biased HSC may be an inherent feature of males and females across the adult age spectrum at elevated risk of death.

Funding Statement: This study was supported by the NIHR Biomedical Research Centre, Oxford.

Declaration of Interests: The authors have no competing interests to declare.

Ethics Approval Statement: The Infections in Oxfordshire Research Database project has Research Ethics Committee and Health Research Authority approval (14/SC/1069, ECC5-07(a)/2009).

Keywords: leucocyte differential, ratio, myeloid:lymphoid, neutrophil:lymphocyte, monocyte:lymphocyte, platelet:lymphocyte,mortality

Suggested Citation

Naranbhai, Vivek and Hill, Adrian V. S. and Walker, A. Sarah and Wyllie, David, Peripheral Blood Myeloid/Platelet:Lymphoid Ratios Predict Mortality Risk Amongst 70,917 Emergency Medical Admissions: A Cohort Study (July 8, 2019). Available at SSRN: https://ssrn.com/abstract=3416689 or http://dx.doi.org/10.2139/ssrn.3416689

Vivek Naranbhai (Contact Author)

University of Oxford - Nuffield Department of Medicine ( email )

Old Road Campus
Roosevelt Drive
Oxford, OX3 7FZ
United Kingdom

University of KwaZulu-Natal - Centre for the AIDS Programme of Research in South Africa ( email )

Durban
South Africa

Harvard University - Dana Farber Cancer Institute ( email )

United States

Adrian V. S. Hill

University of Oxford - The Jenner Institute

Old Road Campus Research Building Roosevelt Drive
Oxford, Oxfordshire OX3 7DQ
United Kingdom

University of Oxford - Wellcome Trust Centre for Human Genetics ( email )

Old Road Campus
Roosevelt Drive
Oxford, OX3 7FZ
United Kingdom

University of Oxford - Centre for Clinical Vaccinology and Tropical Medicine ( email )

Oxford
United Kingdom

A. Sarah Walker

University of Oxford, Nuffield Department of Medicine, John Radcliffe Hospital ( email )

Oxford, Oxfordshire, England
United Kingdom

David Wyllie

Imperial College London - NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance ( email )

London
United Kingdom

NHS Foundation Trust - Addenbrooke's Hospital ( email )

Cambridge Biomedical Campus
Hills Road
Cambridge, CB2 0QQ
United Kingdom

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