Leukocyte indices: A possible marker of subclinical inflammation in very elderly patients and centenarians

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Topolyanskaya SV, Eliseeva TA, Turna OI, Vakulenko ON, Romanova MA, Lytkina
KA, Ratchina SA, Dvoretski LI and Melkonyan GG

Sechenov University, Russia
War Veterans Hospital, Russia

: J Aging Geriatr Med

Abstract

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Aim: To study the possibility of using leukocyte indices as markers of subclinical inflammation in very elderly patients and centenarians with Coronary Artery Disease (CAD). Materials and methods: The cross-sectional study enrolled 127 patients; 93 patients with CAD–in the study group, 34 patients without CAD–in the control group. The mean age of patients reached 88.2 ± 5.3 years (76-98 years); 48.8% were over 90 years of age. The majority of patients (68.5%) were women. The ratio of the number of neutrophils to lymphocytes (NLR), neutrophils to monocytes (NMR), platelets to lymphocytes (PLR) and the Systemic Immune-Inflammation Index (SII) were determined. Along with this, Interleukin-6 (IL-6) was determined in all patients, Tumor Necrosis Factor-α (TNF-α)–in 49 patients, by enzyme-linked immunoassay. Results: The mean content of leukocytes was 5.9 ± 1.5x109/l, neutrophils–3.7 ± 1.3x109/l, lymphocytes– 1.6 ± 0.5x109/l, monocytes–0.4 ± 0.2x109/l, platelets–224 ± 78x109/l. The neutrophil-lymphocyte ratio reached 2.7 ± 1.2, NMR–14.5 ± 16.3, TLR–158.3 ± 82.2, SII–591 ± 374. In patients with coronary artery disease, the mean content of leukocytes was significantly higher than in the control group (6.1 ± 1.5 and 5.4 ± 1.5x109/l, respectively, p=0.02), and platelets were less (212 ± 60 and 243 ± 78x109/l, respectively, p=0.02). The plateletlymphocyte ratio (139 ± 54 and 185 ± 87, p=0.001) and neutrophils-monocytes ratio (12.4 ± 13.4 and 20.8 ± 22.0; Ñ?=0.04) were lower in patients with coronary artery disease. In the group of patients with CAD the systemic immune-inflammatory index was also lower (554 ± 345 and 762 ± 616; p=0.02). In patients with heart failure, a significantly higher content of leukocytes was revealed (6.5 ± 1.7 and 5.7 ± 1.4x109/l, respectively, p=0.009). Along with this, a tendency to a higher content of neutrophils (4.1 ± 1.4 and 3.6 ± 1.2, p=0.06), lymphocytes (1.7 ± 0.6 and 1.5 ± 0,5, p=0.08) and monocytes (0.5 ± 0.2 and 0.4 ± 0.2, p=0.09) was found in patients with heart failure. A direct correlation was established between NLR and the concentration of IL-6 (r=0.26; p=0.003), as well as an inverse correlation with the content of TNF-α (r=-0.3; p=0.03). A highly significant correlation was registered between the NLR and functional abilities of patients, assessed using the Barthel index (r=-0.35; p<0.0001) and the IADL scale (r=-0.34; p<0.0001). In addition, there was a direct correlation between NLR and the risk of falls by the Morse scale (r=0.38; p=0.001) and a trend towards inverse correlation with vitamin D content (r=-0.22; p=0.05). There was a direct relationship between TLR and the level of IL-6 (r=0.18; p=0.04), ESR (r=0.20; p=0.02) and the values of the Morse Fall Scale (r=0.43; p<0.0001). An inverse correlation was registered between TLR and TNF-α (r=-0.43; p=0.002), Barthel index (r=-0.20; p=0.02), IADL scale (r=-0.21; p=0.01), hemoglobin (r=-0.29; p=0.001), indicators of bone mineral density in the proximal femur (r=-0.2; p=0.03). No significant relationships were found for the neutrophils-monocytes ratio, except for an inverse correlation with ESR (r=-0.21; p=0.02). In relation to systemic immune-inflammation index, a direct correlation of this indicator with IL-6 (r=0.39; p<0.0001) and the values of the Morse Fall Scale (r=0.45; p<0.0001), as well as an inverse relationship with TNF-α (r=-0.35; p=0.01), Barthel index (r=-0.2; p=0.02) and IADL scale (r=-0.27; p=0.002) were registered. Conclusion: The study results suggest that various leukocyte indices can be used as markers of subclinical inflammation in patients with coronary artery disease in old age and in centenarians.

Biography

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Topolyanskaya SV, Moscow State Medical University (Sechenov University), RF Health Ministry, Russia