Routinely measured hematological parameters and prediction of recurrent vascular events in patients with clinically manifest vascular disease

• Published in: PloS one 2018-09, Vol.13 (9), p.e0202682-e0202682
• Main Authors: Kofink, Daniel, Muller, Steven A, Patel, Riyaz S, Dorresteijn, Jannick A N, Berkelmans, Gijs F N, de Groot, Mark C H, van Solinge, Wouter W, Haitjema, Saskia, Leiner, Tim, Visseren, Frank L J, Hoefer, Imo E, Asselbergs, Folkert W
• Format: Article
• Language: English
• Subjects: Aged; Angina pectoris; Atherosclerosis; Biological markers; Biology and Life Sciences; Biomarkers; Blood; Cardiology; Cardiovascular disease; Care and treatment; Clinical medicine; Coronary vessels; Disease control; Family medical history; Female; Health risk assessment; Health sciences; Heart attacks; Hematologic Tests; Hematology; Humans; Lymphocytes; Male; Medicine and Health Sciences; Middle Aged; Mortality; Neutrophils; Parameter estimation; Patients; Predictions; Predictive Value of Tests; Prognosis; Proteins; Reclassification; Recurrence; Recurrence (Disease); Risk analysis; Risk Assessment; Risk factors; Vascular diseases; Vascular Diseases - blood; Vascular Diseases - diagnosis
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0202682

The predictive value of traditional risk factors for vascular events in patients with manifest vascular disease is limited, underscoring the need for novel biomarkers to improve risk stratification. Since hematological parameters are routinely assessed in clinical practice, they are readily available candidates. We used data from 3,922 vascular patients, who participated in the Second Manifestations of ARTerial Disease (SMART) study. We first investigated associations between recurrent vascular events and 22 hematological parameters, obtained from the Utrecht Patient Oriented Database (UPOD), and then assessed whether parameters associated with outcome improved risk prediction. After adjustment for all SMART risk score (SRS) variables, lymphocyte %, neutrophil count, neutrophil % and red cell distribution width (RDW) were significantly associated with vascular events. When individually added to the SRS, lymphocyte % improved prediction of recurrent vascular events with a continuous net reclassification improvement (cNRI) of 17.4% [95% CI: 2.1, 32.1%] and an increase in c-statistic of 0.011 [0.000, 0.022]. The combination of lymphocyte % and neutrophil count resulted in a cNRI of 22.2% [3.2, 33.4%] and improved c-statistic by 0.011 [95% CI: 0.000, 0.022]. Lymphocyte % and RDW yielded a cNRI of 18.7% [3.3, 31.9%] and improved c-statistic by 0.016 [0.004, 0.028]. However, the addition of hematological parameters only modestly increased risk estimates for patients with an event during follow-up. Several hematological parameters were independently associated with recurrent vascular events. Lymphocyte % alone and in combination with other parameters enhanced discrimination and reclassification. However, the incremental value for patients with a recurrent event was limited.