A new study suggests that the neutrophil-to-lymphocyte ratio (NLR) in patients with polycythemia vera (PV) at the time of diagnosis may serve as a predictor of thrombotic events. The study’s findings were reported in the journal BioMed Research International.
PV and other myeloproliferative neoplasms carry risks of thrombotic events, which may result in mortality. NLR has previously demonstrated utility in assessing systemic inflammation, and evidence suggests it can aid in predicting progression of thrombotic events in patients with essential thrombocytosis, the study investigators explained in their report. However, research on a possible role of NLR in patients with PVs is limited.
The study included hospitalized patients receiving an initial diagnosis of PV who had not received prior antiplatelet, anticoagulant, or blood cell-lowering related medications. Patient demographic and clinical data were obtained from electronic medical records and follow-up visits that occurred either in person or by telephone. The research team conducting the study analyzed data for risk factors involved with the occurrence and development of thrombotic events.
There were 170 patients evaluated in this study, and they had a median age at onset of PV of 56 years. A history of prior thrombosis was present in 31.8% of patients. Most (62.9%) patients tested positive for the presence of the JAK2V617F mutation.
A multifactorial analysis identified a few independent risk factors for thrombotic events at the time of initial diagnosis. These included a history of prior thrombosis (P <.001), NLR (P =.030), and white blood cell count (P =.045).
The median follow-up time for this population was 20.33 months, with 30.0% of patients having progressed to thrombotic events. Multifactorial analysis identified independent risk factors for the progression of future thrombotic events. These were a history of prior thrombosis (P <.001), age ≥60 years (P =.004), NLR (P =.025), and fibrinogen level (P =.042).
Additionally, NLR demonstrated greater diagnostic efficacy regarding the progression of future thrombotic events than did age, history of prior thrombosis, JAK2V617F mutation, and fibrinogen level in a receiver operating characteristic curve analysis. The sensitivity of NLR as a predictor of the progression of thrombotic events was 74.5%, and the specificity was 79.8%, when the NLR was set to 4.713 in this analysis.
In a survival analysis of patients split into categories by high NLR (≥4.713) and low NLR (<4.713), those with high NLR had a median overall survival duration of 22.033 months (95% CI, 4.226-35.840). This was significantly below the median overall survival duration of 66.000 months (95% CI, 50.670-81.330) for the patients with low NLR (P <.001). Progression-free survival rates at 60 months were 32.8% with high NLR and 58.8% with low NLR.
“Peripheral blood NLR levels at the time of initial diagnosis and treatment had better diagnostic and predictive value for the progression of future thrombotic events in patients with PV than age ≥ 60 years, history of previous thrombosis, and fibrinogen,” the study investigators concluded in their report.
Wang X, Tu Y, Cao M, et al. The predictive value of neutrophil-lymphocyte ratio in patients with polycythemia vera at the time of initial diagnosis for thrombotic events. Biomed Res Int. 2022;2022:9343951. doi:10.1155/2022/9343951