Heart failure & cardiomyopathiesCohort study
Neutrophil-to-Lymphocyte Ratio for Risk Stratification in Acute Myocarditis Across the Left Ventricular Ejection Fraction Spectrum
- Multicentre cohort study
- 10 hospitals in six countries
Authors' conclusion
While traditional definitions of high-risk AM remain valuable, NLR ≥4 is a simple and cost-effective marker that aids in risk stratification. NLR ≥4 is particularly robust in patients with preserved LVEF, supporting its use across the LVEF spectrum.
Study context
- Population
- Patients with biopsy- or cardiac magnetic resonance (CMR)-proven acute myocarditis10 hospitals, six countries
- Participants
- 1,150 patients
- Exposure
- Neutrophil-to-lymphocyte ratio (NLR) ≥4 vs complicated, fulminant and high-risk acute myocarditis (AM) definitions for risk prediction
- Outcome
- All-cause mortality and heart transplantation
- Follow-up
- Median 228 weeks (IQR 114-339)
Main finding
As reported in the abstract
Prediction of primary outcome
| Group | AUC |
|---|---|
| NLR ≥4 | 0.72 |
| Complicated | 0.73 |
| High-risk | 0.73 |
| Fulminant | 0.62 |
- Fulminant classification significantly inferior predictive accuracy
- P = 0.02
Observational data: associations, not effects.
Further findings
| Outcome | Complicated | Fulminant | High-risk | NLR ≥4 | P value |
|---|---|---|---|---|---|
| Prediction of primary outcome, preserved LVEF (≥50%) (subgroup) — NLR ≥4 vs Complicated | P = 0.001 | ||||
| AUC | 0.52 | Not reported in the abstract | 0.52 | 0.73 | |
| Prediction of primary outcome, preserved LVEF (≥50%) (subgroup) — NLR ≥4 vs High-risk | P = 0.002 |
Multivariable analysis
- Each classification independently associated with the primary outcome
Original publication
Neutrophil-to-Lymphocyte Ratio for Risk Stratification in Acute Myocarditis Across the Left Ventricular Ejection Fraction Spectrum. Eur J Heart Fail. Published 16 October 2025. doi:10.1002/ejhf.70072
Summarised from the published abstract; every number is checked against it