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Neutrophil-to-lymphocyte ratio as a potential biomarker in predicting in-stent restenosis: A systematic review and meta-analysis

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  • Paulus Parholong Siahaan
  • Wynne Widiarti
  • Pandit Bagus Tri Saputra
  • Rendra Mahardhika Putra
  • Mario D’Oria

Abstract

Background: In-stent restenosis (ISR) remains a significant challenge despite advancements in percutaneous interventions, often leading to adverse clinical outcomes. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential biomarker for predicting ISR, offering opportunities for improved risk stratification and treatment personalization. This systematic review and meta-analysis assess the predictive value of NLR in ISR, providing insights into its clinical applicability. Methods: Systematic literature search was conducted in scientific databases until 21st July 2024. Observational studies evaluating NLR in stented patients were included. Random effect meta-analysis and linear regression model were used to investigate odds ratios (OR) as predictor and linear dose-response relationship of ISR. Sensitivity and specificity of NLR to predict this outcome were pooled and a summary receiver operating characteristics (sROC) curve was generated. This study was already registered in the PROSPERO (ID: CRD42024555123). Results: 15 studies with 3 889 patients were included. High NLR was associated with increased risk of ISR in coronary and non-coronary stenting [aOR = 1.61 (95%CI 1.14–2.25); aOR = 1.69 (95%CI 1.52–1.87)]. One unit increase of NLR is equal to 30% and 44% increased risk of ISR in coronary and non-coronary patients. Included studies showing NLR as a robust predictor of ISR with sensitivity and specificity of 70.5% (95%CI 60.1%-79.2%) and 74.1% (95%CI 56.7%-86.2%) for coronary stenting and 77.7% (95%CI 69.8%-84.0%) and 66.4% (95%CI 49.6%-79.8%) non-coronary stenting, with AUC of 0.77 (0.70–0.82) in the coronary and 0.79 (0.70–0.85) in the non-coronary sub-groups. Conclusion: In conclusion, NLR yields promising predictive and prognostic potentials in predicting ISR in coronary and non-coronary stents. Additionally, NLR appears to be more proficient in predicting early ISR compared to late ISR in both coronary and non-coronary stents.

Suggested Citation

  • Paulus Parholong Siahaan & Wynne Widiarti & Pandit Bagus Tri Saputra & Rendra Mahardhika Putra & Mario D’Oria, 2025. "Neutrophil-to-lymphocyte ratio as a potential biomarker in predicting in-stent restenosis: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 20(5), pages 1-13, May.
    • Handle: RePEc:plo:pone00:0322461
    DOI: 10.1371/journal.pone.0322461
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