Neutrophil-to-lymphocyte ratio is associated with 30-day mortality in acute pulmonary embolism across European Society of Cardiology risk categories
- 1Endeavor Health, Vascular Medicine, Skokie, Illinois, USA
- 2Endeavor Health, Vascular Medicine, Skokie, Illinois, USA; Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
- 3Faculty of Health Sciences, UCAM—Universidad Católica San Antonio de Murcia, CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
Abstract
Background: Pulmonary embolism (PE) remains a major cause of cardiovascular morbidity and mortality. The neutrophil-to-lymphocyte ratio (NLR) is a readily available biomarker reflecting inflammatory stress responses and has been proposed as a predictor of cardiovascular outcomes. Objectives: This study evaluated the association between elevated NLR and 30-day all-cause mortality in patients with acute PE across European Society of Cardiology (ESC) risk categories. Methods: A retrospective cohort study of adults with acute PE diagnosed by computed tomography pulmonary angiography was conducted within an integrated health system from January 2019 to January 2025. NLR was calculated from admission complete blood counts and categorized as elevated using a prespecified cutoff (≥7). Patients were stratified by ESC risk category. Multivariable logistic regression was used to assess association between elevated NLR and 30-day mortality, adjusting for age, sex, cancer status, and congestive heart failure. Results: Among 1525 patients with acute PE, 46.4% were ESC low risk, 51.7% intermediate risk, and 1.9% high risk; 30-day all-cause mortality occurred in 6.6% of patients and was markedly higher among patients with elevated NLR in the ESC low-risk (10.4% vs 1.2%) and intermediate-risk (16.2% vs 3.6%) groups. Elevated NLR was independently associated with increased mortality in ESC low-risk (odds ratio, 5.68; 95% CI, 2.09-15.44) and intermediate-risk patients (odds ratio, 4.60; 95% CI, 2.57-8.24). Addition of NLR to the ESC-based model improved discrimination for 30-day mortality (C-statistic, 0.812-0.853; P = .003). Conclusion: Elevated NLR is independently associated with increased 30-day all-cause mortality in patients with acute pulmonary embolism classified as ESC low or intermediate risk. Consequently, NLR may serve as a simple adjunctive marker for refining PE risk stratification; however, prospective validation is needed.
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BibTeX
@article{hashim2026neutrophiltolymphocyte,
title = {{Neutrophil-to-lymphocyte ratio is associated with 30-day mortality in acute pulmonary embolism across European Society of Cardiology risk categories}},
author = {Umar Hashim and Lizbeth Cabrera and Romil Patel and Mohammad Salah and Yama Sadozai and Kambiz Zorriasateyn and Arman Qamar and Manuel Monreal and Alfonso Tafur},
journal = {Research and Practice in Thrombosis and Haemostasis},
year = {2026},
month = aug,
doi = {10.1016/j.rpth.2026.106918},
url = {https://doi.org/10.1016/j.rpth.2026.106918},
note = {CC BY},
}
RIS
TY - JOUR
TI - Neutrophil-to-lymphocyte ratio is associated with 30-day mortality in acute pulmonary embolism across European Society of Cardiology risk categories
AU - Umar Hashim
AU - Lizbeth Cabrera
AU - Romil Patel
AU - Mohammad Salah
AU - Yama Sadozai
AU - Kambiz Zorriasateyn
AU - Arman Qamar
AU - Manuel Monreal
AU - Alfonso Tafur
PY - 2026
DA - 2026/08/01
JO - Research and Practice in Thrombosis and Haemostasis
DO - 10.1016/j.rpth.2026.106918
UR - https://doi.org/10.1016/j.rpth.2026.106918
AB - Background: Pulmonary embolism (PE) remains a major cause of cardiovascular morbidity and mortality. The neutrophil-to-lymphocyte ratio (NLR) is a readily available biomarker reflecting inflammatory stress responses and has been proposed as a predictor of cardiovascular outcomes. Objectives: This study evaluated the association between elevated NLR and 30-day all-cause mortality in patients with acute PE across European Society of Cardiology (ESC) risk categories. Methods: A retrospective cohort study of adults with acute PE diagnosed by computed tomography pulmonary angiography was conducted within an integrated health system from January 2019 to January 2025. NLR was calculated from admission complete blood counts and categorized as elevated using a prespecified cutoff (≥7). Patients were stratified by ESC risk category. Multivariable logistic regression was used to assess association between elevated NLR and 30-day mortality, adjusting for age, sex, cancer status, and congestive heart failure. Results: Among 1525 patients with acute PE, 46.4% were ESC low risk, 51.7% intermediate risk, and 1.9% high risk; 30-day all-cause mortality occurred in 6.6% of patients and was markedly higher among patients with elevated NLR in the ESC low-risk (10.4% vs 1.2%) and intermediate-risk (16.2% vs 3.6%) groups. Elevated NLR was independently associated with increased mortality in ESC low-risk (odds ratio, 5.68; 95% CI, 2.09-15.44) and intermediate-risk patients (odds ratio, 4.60; 95% CI, 2.57-8.24). Addition of NLR to the ESC-based model improved discrimination for 30-day mortality (C-statistic, 0.812-0.853; P = .003). Conclusion: Elevated NLR is independently associated with increased 30-day all-cause mortality in patients with acute pulmonary embolism classified as ESC low or intermediate risk. Consequently, NLR may serve as a simple adjunctive marker for refining PE risk stratification; however, prospective validation is needed.
SN - 2475-0379
ER -