Original Article
Neutrophil-to-lymphocyte ratio predicts coronary artery lesion complexity and mortality after non-ST-segment elevation acute coronary syndrome
Rácio neutrófilo-linfócito prevê a complexidade da lesão arterial coronária e a mortalidade após o enfarte do miocárdio sem elevação do segmento ST
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BNP: B-type natriuretic peptide; NGAL: neutrophil gelatinase-associated lipocalin.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Humberto Villacorta, Rochele Alberto Martins Santos, Marcelle Alves Baco Marroig, Guilherme Pinella Guedes Pereira, Analucia Rampazzo Xavier, Salim Kanaan" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Humberto" "apellidos" => "Villacorta" ] 1 => array:2 [ "nombre" => "Rochele Alberto" "apellidos" => "Martins Santos" ] 2 => array:2 [ "nombre" => "Marcelle Alves" "apellidos" => "Baco Marroig" ] 3 => array:2 [ "nombre" => "Guilherme Pinella" "apellidos" => "Guedes Pereira" ] 4 => array:2 [ "nombre" => "Analucia Rampazzo" "apellidos" => "Xavier" ] 5 => array:2 [ "nombre" => "Salim" "apellidos" => "Kanaan" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204915001622" "doi" => "10.1016/j.repce.2015.07.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => 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class="elsevierStyleSimplePara elsevierViewall">Follow-up survival curve for patients with heart failure with preserved ejection fraction and heart failure with reduced ejection fraction.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lucía Martínez-Braña, Lara Mateo-Mosquera, María Bermúdez-Ramos, María de los Ángeles Valcárcel García, Lorena Fernández Hernández, Álvaro Hermida Ameijeiras, Francisco Luis Lado Lado" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Lucía" "apellidos" => "Martínez-Braña" ] 1 => array:2 [ "nombre" => "Lara" "apellidos" => "Mateo-Mosquera" ] 2 => array:2 [ "nombre" => "María" "apellidos" => "Bermúdez-Ramos" ] 3 => array:2 [ "nombre" => "María de los Ángeles" "apellidos" => "Valcárcel García" ] 4 => array:2 [ "nombre" => "Lorena" "apellidos" => "Fernández Hernández" ] 5 => array:2 [ "nombre" => "Álvaro" "apellidos" => "Hermida Ameijeiras" ] 6 => array:2 [ "nombre" => "Francisco Luis" "apellidos" => "Lado Lado" ] ] ] ] ] 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array:2 [ "paginaInicial" => "465" "paginaFinal" => "471" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Korhan Soylu, Ömer Gedikli, Göksel Dagasan, Ertan Aydin, Gökhan Aksan, Gökay Nar, Sinan İnci, Özcan Yilmaz" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Korhan" "apellidos" => "Soylu" "email" => array:1 [ 0 => "korhansoylu@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ömer" "apellidos" => "Gedikli" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Göksel" "apellidos" => "Dagasan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ 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"Department of Cardiology, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Cardiology, Artvin State Hospital, Artvin, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Cardiology, Gazi State Hospital, Samsun, Turkey" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Rácio neutrófilo-linfócito prevê a complexidade da lesão arterial coronária e a mortalidade após o enfarte do miocárdio sem elevação do segmento ST" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1234 "Ancho" => 1666 "Tamanyo" => 137193 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Study flow diagram. NLR: neutrophil-to-lymphocyte ratio.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The content and intensity of treatment, and the need for intervention, are closely linked to disease severity in the treatment of patients with coronary artery disease (CAD). Clinical and angiographic risk scores have been developed to aid decision-making. Current guidelines recommend the GRACE and SYNTAX risk scoring systems for patients diagnosed with non-ST-elevation acute coronary syndrome (NSTE-ACS).<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">1,2</span></a> The GRACE risk score includes parameters such as ECG changes, initial cardiac markers, and serum creatinine, in addition to clinical characteristics such as age, heart rate, systolic blood pressure, and degree of heart failure.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">3</span></a> The SYNTAX risk score grades the severity and complexity of lesions on coronary angiography.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">2</span></a> It also has an important role in decisions as to whether to perform percutaneous coronary intervention.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Several studies have shown the role of inflammation in the pathophysiology of atherosclerosis,<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">4,5</span></a> and inflammatory mediators such as C-reactive protein (CRP) can be used for risk stratification in CAD.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">4</span></a> The neutrophil-to-lymphocyte ratio (NLR) is a new marker recently shown to be effective in CAD and certain non-cardiac diseases. Previous studies have demonstrated that NLR is associated with adverse events in stable coronary disease,<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">6</span></a> long-term mortality in patients with ST-segment elevation myocardial infarction (STEMI),<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">7</span></a> and in-hospital and six-month mortality in acute coronary syndrome.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">8</span></a> NLR has also been shown to be a predictor of poor prognosis in patients with NSTE-ACS.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">9</span></a> However, the association between NLR and clinical risk scores, and whether it is a determinant of lesion complexity, particularly in CAD, have not been investigated. In the present study, we aimed to investigate the importance of NLR in terms of hospital mortality, and its association with currently used risk scores in patients with NSTE-ACS.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population</span><p id="par0015" class="elsevierStylePara elsevierViewall">In this study, patients admitted to the cardiology clinic at Ondokuz Mayis University with NSTE-ACS between January 2006 and January 2012 were retrospectively assessed. The inclusion criterion was the NSTE-ACS diagnosis code in the electronic patient database. The medical history of all patients with the NSTE-ACS diagnosis code was obtained and assessed by the investigators. Exclusion criteria included inconclusive NSTE-ACS diagnosis according to medical records, hematological disease, autoimmune disease, infectious or inflammatory disease, severe renal disease (glomerular filtration rate <30 ml/min/1.73 m<span class="elsevierStyleSup">2</span>), severe liver disease, and ongoing treatment with immunosuppressive agents.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Definition of non-ST-elevation acute coronary syndrome</span><p id="par0020" class="elsevierStylePara elsevierViewall">NSTE-ACS was defined as the presence of T-wave inversion or ST-segment depression and/or positive troponin I in the absence of electrocardiographic (ECG) ST elevation in patients presenting with angina or equivalent. Positive troponin was defined as troponin I >0.1 ng/ml.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Coronary angiography</span><p id="par0025" class="elsevierStylePara elsevierViewall">Coronary angiography was performed using standard techniques. Selective cine angiographic images of the coronaries were recorded with a digital angiographic system (ACOM.PC, Siemens AG, Germany).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Risk scoring</span><p id="par0030" class="elsevierStylePara elsevierViewall">For the SYNTAX score,<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a> the severity of coronary atherosclerotic lesions was assessed with at least three projections in all patients. The score for each patient was calculated by a team of two experienced cardiologists who scored all coronary lesions with ≥50% stenosis in vessels ≥1.5 mm. The online SYNTAX score calculation tool was used (<a href="http://www.syntaxscore.com/">http://www.SYNTAXscore.com</a>).</p><p id="par0035" class="elsevierStylePara elsevierViewall">The principle of the GRACE risk score has been described elsewhere.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">3</span></a> The variables used in the calculation of the score include age, heart rate, systolic blood pressure, baseline creatinine level, history of congestive heart failure, in-hospital percutaneous coronary intervention, history of myocardial infarction, ST-segment depression on admission electrocardiography (ECG), and elevated cardiac markers. In the present study, we used a single measurement of serum cardiac troponin I, considering 0.06 ng/ml to be an elevated cardiac marker. ST-segment depression was defined as ST segment >0.5 mV below the isoelectric line in any ECG lead.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Laboratory parameters</span><p id="par0040" class="elsevierStylePara elsevierViewall">Venous blood samples, obtained from the patients within an hour of admission to the emergency room, were used for the laboratory analyses. Biochemical parameters were measured using an Abbott Architect c8000 analyzer (Abbott Laboratories, USA) with commercial kits. Total blood cell counts and subtypes were analyzed using an automated blood cell counter (Abbott Laboratories, USA). NLR values were calculated as the ratio of neutrophil to lymphocyte count obtained from the same blood sample. Patients were divided into tertiles according to NLR values (NLR <2.6, NLR=2.6–4.5, and NLR >4.5).</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Follow-up</span><p id="par0045" class="elsevierStylePara elsevierViewall">Clinical records of the patients over the course of hospitalization were reviewed and all-cause mortality before hospital discharge was recorded as in-hospital mortality.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">The dataset was analyzed using SPSS version 15. The normal distribution of the data was tested using the Kolmogorov-Smirnov test and non-normally distributed data were transformed. One-way ANOVA was used for the comparison of multiple groups. Categorical data were compared using the chi-square test or Fisher's exact test, as appropriate. Correlation between data was tested with Pearson's correlation analysis. Logistic regression analysis was used to test the significance of the data on mortality. Variables were eliminated by forward selection. NLR and the GRACE score criteria were selected as the potential variables for logistic regression analysis, excepting cardiac arrest on admission, which was not assessed because there were no patients with this parameter. Continuous data were expressed as mean ± SD (standard deviation) and categorical data were expressed as percentages. A p value of <0.05 was accepted as statistically significant. Bonferroni's correction was performed when statistical comparisons of the three groups were made as <0.016.</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">For the present study, records were analyzed of 2135 patients admitted to the coronary intensive care unit, of whom 418 patients were admitted with an NSTE-ACS diagnosis code. On the basis of patients’ records, 33 patients with an inconclusive diagnosis, 11 with hematological disease, 21 with infectious and inflammatory disease, 14 with severe renal disease, four with severe liver disease, and 18 with missing data were excluded from the study (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). As a result, a total of 317 patients were included in the study. Following clinical assessment, 276 (86.8%) patients underwent coronary angiography.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Demographic, clinical, and laboratory characteristics of the patients are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The patients in the group with high NLR were older and had higher serum glucose levels, lower hemoglobin, lower ejection fraction, higher heart rate, higher Killip class, more ST-segment changes, and higher troponin and creatinine levels.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">GRACE risk score was significantly higher in the high NLR group than in those with moderate or low NLR (161.5±40.3, 130.5±32.3 and 123.9±34.3, respectively, p<0.001). Similarly, SYNTAX score was significantly higher in the group with high NLR (20.4±10.1, 15.5±10.5 and 13.4±7.8, respectively, p=0.003). Moreover, both GRACE risk score (r=0.457, p<0.001) and SYNTAX score (r=0.253, p=0.001) showed a significant positive correlation with NLR (<a class="elsevierStyleCrossRefs" href="#fig0010">Figures 2 and 3</a>). Analysis of the NLR subgroups revealed a correlation between NLR, GRACE and SYNTAX scores only in the high NLR group (r=0.483, p<0.001, and r=0.495, p=0.001, respectively).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The high NLR group had higher in-hospital mortality than both the low and the moderate NLR groups (35.8%, 7.5% and 1.9%, p<0.001). Receiver operating characteristic (ROC) analysis showed that NLR >4.5 had 75% specificity and 75% sensitivity for in-hospital mortality (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>), with a positive predictive value of 79.2% and a negative predictive value of 95.3% (area under the curve [AUC]=0.857). On the other hand, ROC analysis showed that a GRACE score >140 had 61% specificity and 92.2% sensitivity for in-hospital mortality, with a positive predictive value of 91.6% and a negative predictive value of 97.7% (AUC=0.926). ROC analysis showed that a CRP value of 36.7 had 78.6% specificity and 70.9% sensitivity for in-hospital mortality, with a positive predictive value of 0.79% and a negative predictive value of 96.9% (AUC=0.815). Furthermore, multivariate regression analysis showed that NLR was an independent predictor of in-hospital mortality (OR: 1.182; 95% confidence interval [CI]: 1.042–1.340; p=0.009). Additionally, NLR >4.5 had higher odds ratios for in-hospital mortality (OR: 11.457; 95% CI: 5.415–24.229; p<0.001). Other independent variables were age, Killip class, and troponin I value (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 2</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">In this study, we found higher GRACE and SYNTAX risk scores and in-hospital mortality in patients with high NLR values. In addition, NLR correlated with GRACE and SYNTAX scores. The present study is the first to demonstrate an association between coronary artery lesion complexity and NLR in patients with NSTE-ACS.</p><p id="par0080" class="elsevierStylePara elsevierViewall">An association between cardiovascular disease and NLR has been shown in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">6–9</span></a> Increased NLR has been found to be associated with increased mortality,<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">11</span></a> no-reflow,<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">12</span></a> coronary ectasia,<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">13</span></a> and coronary collateral circulation<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> in various subgroups with CAD. This is an unsurprising result, given the increased inflammatory response seen during the clinical presentation of CAD as well as in its pathophysiology. The role of neutrophils during the atherosclerotic process is well known<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">4</span></a>; in particular, proteolytic enzymes released by neutrophils and myeloperoxidase activation, as well as acid phosphatase and free oxygen radicals, have been found to be involved in this process.<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">15–17</span></a> Furthermore, Sonmez et al. found an association between NLR and coronary artery lesion complexity in patients with stable CAD and STEMI,<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a> and Oncel et al. demonstrated an association between GRACE score and NLR in patients with STEMI.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">19</span></a> In the present study, we have shown this association in patients with NSTE-ACS.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Neutrophil infiltration during acute coronary events is associated with impaired microvascular perfusion and expansion of the infarct area, as well as with increased risk of no-reflow in primary angioplasty among patients with STEMI,<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">12</span></a> and increased NLR has been suggested as a predictor of increased thrombus load.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">20</span></a> Furthermore, acute coronary syndrome (ACS)-associated decreased lymphocyte levels have been reported to suppress immune response, and may be a predictor of mechanical complications,<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">21</span></a> as well as being associated with adverse events and cardiac failure in patients with ACS.<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">22,23</span></a> In this regard, NLR is associated with increased inflammation as well as inadequate immune response. The present study shows significantly higher in-hospital mortality in the groups with increased NLR. Furthermore, patients with high NLR also suffer from more severely depressed left ventricular function. On ROC analysis, NLR with a threshold of 4.5 has a high positive and negative predictive value. However, the higher negative predictive value is particularly important; considering that NLR is a non-specific marker, low NLR may be interpreted as a good predictor of good prognosis and survival, which may be more useful than the positive role of increased NLR. Sawant et al.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">24</span></a> have shown an association of NLR and CRP with post-revascularization prognosis in patients with ST-elevation ACS.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The GRACE risk score is a scoring method based on criteria also recommended by current guidelines. It is a good indicator of in-hospital and subsequent prognosis.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a> Inflammatory markers such as CRP and dickkopf-1 have been associated with GRACE score in patients with ACS.<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">26,27</span></a> Also in our study, higher CRP values were observed in the high NLR group. The present study shows that the GRACE risk score has high positive and negative predictive values, and also correlates well with NLR. An earlier study also demonstrated a significant correlation between NLR and GRACE risk score in patients with STEMI.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">19</span></a> The GRACE risk score includes a series of clinical and laboratory criteria, and the comparison of its ROC curve against the ROC curve of NLR indicates that NLR may be a simple and valuable marker of early survival. In the present study, higher specificity was determined for an NLR value of 4.5 as compared to a GRACE risk score of 140. This might be particularly helpful in identifying patients with low GRACE risk score who are likely to have poor prognosis.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The SYNTAX score provides information on the severity of CAD as well as the complexity of lesions. It is thus important in terms of eligibility of patients for percutaneous intervention.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">28</span></a> Altun et al.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">29</span></a> found a significant association between SYNTAX score and NLR in patients presenting with acute MI. Furthermore, Sonmez et al.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">30</span></a> demonstrated a correlation between NLR and SYNTAX score in patients with stable CAD, while Sahin et al.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a> showed an association between SYNTAX score and NLR in patients with STEMI. However, the present study is the first to demonstrate an association between NLR and SYNTAX score in isolated patients with NSTE-ACS. This is most likely related to the sensitivity of coronary lesions and myocardial damage. Histopathological studies have shown increased neutrophils in unstable and ruptured plaques,<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">31,32</span></a> while increased neutrophils are thought to impair microvascular circulation, leading to infarct expansion after reperfusion.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">32</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In the present study, a strong correlation between NLR with GRACE and SYNTAX scores has been demonstrated, particularly in the high NLR group. Therefore, in addition to the relation of low and moderate NLR values with low morbidity, it may be assumed that a high NLR would be associated with increased morbidity and a higher atherosclerotic plaque burden.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Study limitations</span><p id="par0105" class="elsevierStylePara elsevierViewall">Although a total of 2135 patients admitted to the coronary intensive care unit were screened in the present study, only 418 (19.6%) of them were coded with the diagnosis of NST-ACS. Our study demonstrates an association between NLR and in-hospital mortality, though its role in post-discharge survival and other adverse events could not be assessed due to insufficient retrospective data. Furthermore, since there were a limited number of patients with CRP values in our database, CRP could not be included in the multivariate regression analysis.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusion</span><p id="par0110" class="elsevierStylePara elsevierViewall">In our study, NLR, a new marker, was tested in a large group of patients, and increased NLR was associated with short-term survival in patients with NSTE-ACS. In addition, NLR was found to be correlated with clinical and angiographic risk scores. These results support the relation of low NLR with improved short-term survival and of increased NLR with massive atherosclerotic burden and inflammation.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Ethical disclosures</span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Protection of human and animal subjects</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Confidentiality of data</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Right to privacy and informed consent</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres536198" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec556473" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres536199" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec556474" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Definition of non-ST-elevation acute coronary syndrome" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Coronary angiography" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Risk scoring" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Laboratory parameters" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Follow-up" ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Study limitations" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conclusion" ] 10 => array:3 [ "identificador" => "sec0070" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0075" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0080" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0085" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0090" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-08-13" "fechaAceptado" => "2015-01-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec556473" "palabras" => array:4 [ 0 => "Non-ST-segment acute coronary syndrome" 1 => "Neutrophil-to-lymphocyte ratio" 2 => "SYNTAX score" 3 => "GRACE score" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec556474" "palabras" => array:4 [ 0 => "Síndrome coronária aguda sem elevação do segmento ST" 1 => "Rácio neutrófilo/linfócito" 2 => "<span class="elsevierStyleItalic">Score</span> SYNTAX" 3 => "<span class="elsevierStyleItalic">Score</span> GRACE" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Inflammatory mechanisms are known to play an important role in coronary artery disease. The present study aimed to investigate the importance of the neutrophil-to-lymphocyte ratio (NLR) in terms of in-hospital mortality and its association with currently used risk scores in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Three hundred and seventeen patients with NSTE-ACS were included. The patients were divided into tertiles according to their NLR values (NLR <2.6, NLR=2.6–4.5, and NLR >4.5). Clinical and angiographic risk was evaluated by the SYNTAX and GRACE risk scores.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The GRACE risk score was significantly higher in the group with high NLR values compared to those with moderate or low NLR (161.5±40.3, 130.5±32.3, and 123.9±34.3, respectively, p<0.001). Similarly, the SYNTAX score was significantly higher in the group with high NLR values (20.4±10.1, 15.5±10.5, and 13.4±7.8, respectively, p=0.003). Moreover, both GRACE (r=0.457, p<0.001) and SYNTAX scores (r=0.253, p=0.001) showed a significant positive correlation with NLR.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">NLR has been found to be correlated with clinical and angiographic risk scores. Low NLR might be a good predictor for low in-hospital mortality and simple coronary anatomy in NSTE-ACS patients.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Sabe-se que os mecanismos inflamatórios têm um papel importante na doença arterial coronária. O presente estudo visa investigar a importância do rácio neutrófilo/linfócito (RNL) relativamente à mortalidade hospitalar e à sua associação com os <span class="elsevierStyleItalic">scores</span> de risco atuais em doentes com síndromes coronárias agudas sem elevação do segmento-ST (SCA-NSTE).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foram incluídos 317 doentes com SCA-NSTE. Os doentes foram divididos em tercis de acordo com os seus valores de RNL (RNL < 2,6, RNL = 2,6-4,5 e RNL > 4,5). Os <span class="elsevierStyleItalic">scores</span> de risco clínicos e angiográficos foram avaliados pelos métodos de risco SYNTAX e GRACE.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">O <span class="elsevierStyleItalic">score</span> de risco GRACE foi significativamente mais elevado no grupo com valores RNL elevados comparado com os grupos com RNL moderado ou baixo (161,5 ± 40,3, 130,5 ± 32,3 e 123,9 ± 34,3, respetivamente, p<0,001). Do mesmo modo, o <span class="elsevierStyleItalic">score</span> SYNTAX foi significativamente superior no grupo com valores RNL elevados (20,4 ± 10,1, 15,5 ± 10,5 e 13,4 ± 7,8, respetivamente, p=0,003). Por outro lado, tanto o <span class="elsevierStyleItalic">score</span> de risco GRACE (r=0,457, p<0,001) como o <span class="elsevierStyleItalic">score</span> SYNTAX (r=0,253, p=0,001) mostraram uma correlação positiva significativa com RNL.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusão</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Verificou-se que o RNL está correlacionado com os <span class="elsevierStyleItalic">scores</span> de risco clínicos e angiográficos. Um RNL baixo pode ser um bom fator preditor de mortalidade intra-hospitalar e de anatomia coronária simples em doentes com enfarte do miocárdio sem elevação do segmento ST.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1234 "Ancho" => 1666 "Tamanyo" => 137193 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Study flow diagram. NLR: neutrophil-to-lymphocyte ratio.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1480 "Ancho" => 1659 "Tamanyo" => 137628 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Correlation of neutrophil-to-lymphocyte ratio with GRACE risk score.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1313 "Ancho" => 1664 "Tamanyo" => 112350 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlation of neutrophil-to-lymphocyte ratio with SYNTAX score.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1345 "Ancho" => 1614 "Tamanyo" => 64712 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristic curve analysis of neutrophil-to-lymphocyte ratio (area under the curve=0.857) and GRACE risk score (area under the curve=0.926) for in-hospital mortality. NLR: neutrophil-to-lymphocyte ratio.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">CABG: coronary artery bypass grafting; CRP: C-reactive protein; HDL: high-density lipoprotein; hs-CRP: high-sensitivity C-reactive protein; LDL: low-density lipoprotein; NLR: neutrophil-to-lymphocyte ratio; PCI: percutaneous coronary intervention; SBP: systolic blood pressure.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Low NLR (<2.6), n=105 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Medium NLR (2.6–4.5), n=106 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">High NLR (>4.5), n=106 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Age, years</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62.8±11.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60.9±13.6<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67.6±12.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Gender, male (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76 (72.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">78 (73.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83 (79.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.578 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Hypertension (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45 (42.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39 (36.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52 (49.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.196 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Diabetes (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 (22.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 (19.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 (35.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.019 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">hs-CRP (mg/l)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38.9±51.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44.7±60.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80.3±17.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.423 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Serum glucose (mg/dl)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">157.1±89.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">143.5±68.7<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">171.0±83.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.017 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Total cholesterol (mg/dl)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">182.8±48.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">188.2±41.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">169.9±44.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.027 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">LDL cholesterol (mg/dl)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">116.9±47.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">115.9±33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">104.3±36.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.075 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">HDL cholesterol (mg/dl)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37.6±10.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37.6±9.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36.3±11.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.287 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Triglycerides (mg/dl)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">167.5±104.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">170.9±103.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">146.5±83.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.167 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Hemoglobin (g/l)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.7±1.7<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.9±1.7<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.7±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Ejection fraction (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55.6±9.0<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.4±11.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47.5±13.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Heart rate</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">74.9±15.2<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79.2±16.1<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">86.6±17.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">SBP (mmHg)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">152.3±37.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">147.5±31.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">141.0±33.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.059 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Killip class</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">99 (94.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">96 (90.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66 (62.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (5.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (7.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 (24.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (12.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.607 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">ST-segment deviation</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76 (72.4)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">92 (86.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">94 (88.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Elevated cardiac markers</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80 (76.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90 (84.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95 (89.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.028 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Troponin I (ng/ml)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.1±16.9<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19.7±27.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29.2±31.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Creatinine (mg/dl)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.04±0.83<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.5±2.5<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.05±2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">GRACE risk score</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">123.9±34.3<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">130.5±32.3<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">161.5±40.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">SYNTAX score (n=276)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.4±7.8<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.5±10.5<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20.4±10.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">CRP (mg/l) (n=146)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42.4±63.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51.1±83.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">96.8±165.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.045 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">NLR</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.89±0.44<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.53±0.54<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.63±4.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab862178.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">p<0.016 between low and medium NLR groups.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">p<0.016 between low and high NLR groups.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">p<0.016 between medium and high NLR groups.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of the study population.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">CI: confidence interval; NLR: neutrophil-to-lymphocyte ratio; OR: odds ratio; SBP: systolic blood pressure.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Univariate logistic regression</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate logistic regression</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">NLR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.183 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.030–1.359 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.182 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.042–1.340 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.114 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.055–1.176 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.115 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.057–1.175 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Heart rate (bpm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.999 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.971–1.029 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.971 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">SBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.985–1.017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.879 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Creatinine (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.847–1.209 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.899 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Killip class \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.287–90.587 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.794 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.871–89.931 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Troponin I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.018 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.001–1.036 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.042 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.019 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.002–1.036 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.024 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">ST-segment deviation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.556 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.161–15.012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.702 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab862179.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Effects of different variables on in-hospital mortality in multivariate logistic regression 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 6 | 3 | 9 |
| 2024 Outubro | 39 | 41 | 80 |
| 2024 Setembro | 39 | 24 | 63 |
| 2024 Agosto | 50 | 31 | 81 |
| 2024 Julho | 37 | 28 | 65 |
| 2024 Junho | 34 | 14 | 48 |
| 2024 Maio | 46 | 28 | 74 |
| 2024 Abril | 39 | 24 | 63 |
| 2024 Maro | 46 | 20 | 66 |
| 2024 Fevereiro | 44 | 31 | 75 |
| 2024 Janeiro | 40 | 37 | 77 |
| 2023 Dezembro | 34 | 27 | 61 |
| 2023 Novembro | 28 | 22 | 50 |
| 2023 Outubro | 21 | 41 | 62 |
| 2023 Setembro | 28 | 18 | 46 |
| 2023 Agosto | 30 | 19 | 49 |
| 2023 Julho | 20 | 8 | 28 |
| 2023 Junho | 31 | 15 | 46 |
| 2023 Maio | 37 | 23 | 60 |
| 2023 Abril | 22 | 8 | 30 |
| 2023 Maro | 45 | 20 | 65 |
| 2023 Fevereiro | 36 | 17 | 53 |
| 2023 Janeiro | 23 | 11 | 34 |
| 2022 Dezembro | 35 | 19 | 54 |
| 2022 Novembro | 48 | 18 | 66 |
| 2022 Outubro | 27 | 28 | 55 |
| 2022 Setembro | 29 | 25 | 54 |
| 2022 Agosto | 34 | 42 | 76 |
| 2022 Julho | 42 | 47 | 89 |
| 2022 Junho | 28 | 20 | 48 |
| 2022 Maio | 30 | 32 | 62 |
| 2022 Abril | 39 | 31 | 70 |
| 2022 Maro | 29 | 43 | 72 |
| 2022 Fevereiro | 22 | 34 | 56 |
| 2022 Janeiro | 37 | 35 | 72 |
| 2021 Dezembro | 32 | 30 | 62 |
| 2021 Novembro | 37 | 36 | 73 |
| 2021 Outubro | 30 | 38 | 68 |
| 2021 Setembro | 37 | 41 | 78 |
| 2021 Agosto | 40 | 29 | 69 |
| 2021 Julho | 33 | 28 | 61 |
| 2021 Junho | 38 | 20 | 58 |
| 2021 Maio | 50 | 33 | 83 |
| 2021 Abril | 72 | 45 | 117 |
| 2021 Maro | 59 | 13 | 72 |
| 2021 Fevereiro | 77 | 19 | 96 |
| 2021 Janeiro | 37 | 12 | 49 |
| 2020 Dezembro | 38 | 10 | 48 |
| 2020 Novembro | 46 | 16 | 62 |
| 2020 Outubro | 22 | 7 | 29 |
| 2020 Setembro | 51 | 7 | 58 |
| 2020 Agosto | 25 | 19 | 44 |
| 2020 Julho | 56 | 15 | 71 |
| 2020 Junho | 64 | 12 | 76 |
| 2020 Maio | 66 | 1 | 67 |
| 2020 Abril | 40 | 12 | 52 |
| 2020 Maro | 58 | 6 | 64 |
| 2020 Fevereiro | 125 | 11 | 136 |
| 2020 Janeiro | 41 | 4 | 45 |
| 2019 Dezembro | 36 | 5 | 41 |
| 2019 Novembro | 29 | 11 | 40 |
| 2019 Outubro | 45 | 5 | 50 |
| 2019 Setembro | 77 | 9 | 86 |
| 2019 Agosto | 36 | 7 | 43 |
| 2019 Julho | 33 | 11 | 44 |
| 2019 Junho | 29 | 15 | 44 |
| 2019 Maio | 44 | 3 | 47 |
| 2019 Abril | 27 | 14 | 41 |
| 2019 Maro | 69 | 9 | 78 |
| 2019 Fevereiro | 100 | 7 | 107 |
| 2019 Janeiro | 70 | 6 | 76 |
| 2018 Dezembro | 89 | 13 | 102 |
| 2018 Novembro | 212 | 10 | 222 |
| 2018 Outubro | 553 | 14 | 567 |
| 2018 Setembro | 146 | 13 | 159 |
| 2018 Agosto | 89 | 14 | 103 |
| 2018 Julho | 55 | 5 | 60 |
| 2018 Junho | 67 | 9 | 76 |
| 2018 Maio | 158 | 15 | 173 |
| 2018 Abril | 98 | 6 | 104 |
| 2018 Maro | 167 | 10 | 177 |
| 2018 Fevereiro | 87 | 7 | 94 |
| 2018 Janeiro | 137 | 6 | 143 |
| 2017 Dezembro | 193 | 10 | 203 |
| 2017 Novembro | 82 | 7 | 89 |
| 2017 Outubro | 29 | 11 | 40 |
| 2017 Setembro | 47 | 11 | 58 |
| 2017 Agosto | 52 | 16 | 68 |
| 2017 Julho | 25 | 15 | 40 |
| 2017 Junho | 47 | 15 | 62 |
| 2017 Maio | 41 | 7 | 48 |
| 2017 Abril | 21 | 2 | 23 |
| 2017 Maro | 33 | 10 | 43 |
| 2017 Fevereiro | 32 | 10 | 42 |
| 2017 Janeiro | 34 | 10 | 44 |
| 2016 Dezembro | 27 | 3 | 30 |
| 2016 Novembro | 39 | 5 | 44 |
| 2016 Outubro | 61 | 9 | 70 |
| 2016 Setembro | 131 | 11 | 142 |
| 2016 Agosto | 42 | 9 | 51 |
| 2016 Julho | 11 | 2 | 13 |
| 2016 Junho | 1 | 8 | 9 |
| 2016 Maio | 15 | 12 | 27 |
| 2016 Abril | 40 | 3 | 43 |
| 2016 Maro | 57 | 23 | 80 |
| 2016 Fevereiro | 89 | 20 | 109 |
| 2016 Janeiro | 66 | 13 | 79 |
| 2015 Dezembro | 58 | 12 | 70 |
| 2015 Novembro | 64 | 13 | 77 |
| 2015 Outubro | 70 | 17 | 87 |
| 2015 Setembro | 95 | 27 | 122 |
| 2015 Agosto | 217 | 107 | 324 |
| 2015 Julho | 22 | 15 | 37 |
Mostrar tudo
