Date of Publication
3-2026
Document Type
Bachelor's Thesis
Degree Name
Bachelor of Science in Biology major in Medical Biology
Subject Categories
Medicine and Health Sciences
College
College of Science
Department/Unit
Biology
Thesis Advisor
Michael B. Ples
Defense Panel Chair
Patricio Elvin L. Cantiller
Defense Panel Member
Gliceria B. Ramos
Marigold O. Uba
Abstract (English)
Background
Coronary artery disease (CAD) involves the obstruction of the myocardium’s systemic perfusion leading towards cardiovascular mortality. CAD disease progression is mediated by neutrophil-directed plaque remodeling and lymphocyte-activated necrotic repair, quantified as the complementary neutrophil-to-lymphocyte ratio (NLR). The study aims to associate a consistent relationship of NLR-at-hospital admission with blood and lipid chemistries, and its correlation with CAD outcomes.
Methods
Between 2008 to 2025, 14 cohorts including patients with clinically proven CAD were identified for rigorous selection, quality, and bias assessment. The cohorts were divided into low NLR and high NLR, and reviewed through Cochrane’s RevMan software. The mean differences and risk ratios of the clinical variables were calculated using Inverse Variance Weighting under Fixed Effects and Random Effects Models, based on respective heterogeneities determined by the I2 statistic. The statistical significance was set at 5%.
Results
White blood cell count (MD: -2,80; 95% CI: [-3.36, -2.24]) and platelet count (MD: -17.31; 95% CI: [-29.87, -4.74]) were higher in patients with high NLR. As pathogenic precursors to atherosclerotic blockages, higher total cholesterol (MD: 5.15; 95% CI: [3.40, 6.90]) and low-density lipoprotein (MD: 3.83; 95% CI: [2.31, 5.36]) were observed in patients with low NLR. Similarly, the risks for acute myocardial infarction (RR: 0.61; 95% CI: [0.45, 0.83]) and atrial fibrillation (RR: 0.75; 95% CI: [0.69, 0.82]) were 39% and 15% less probable having low NLR, respectively. Moreover, the underlying condition of dyslipidemia revealed a 23% increased risk in patients with low NLR (RR: 1.23; 95% CI: [1.05, 1.45]).
Conclusion
NLR as a categorical biomarker for CAD severity is significantly demonstrative of lipid metabolism and hematological mediators. However, the evidence of NLR as a definite, independent predictor of CAD is weak. The broad confidence intervals were obscured by internal bias that was not identified by heterogeneity testing. Further research is required to strongly suggest the use of NLR in prognostic stratification of the CAD population.
Abstract Format
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Abstract (Filipino)
Ang coronary artery disease (CAD) ay ang pagkakaroon ng pagbara sa daloy ng dugo sa myocardium na humahantong sa pagkasawi dulot ng sakit sa puso. Ang paglala ng CAD ay pinapamagitan ng neutrophil-directed plaque remodeling at lymphocyte-activated necrotic repair, na nasusukat bilang neutrophil-to-lymphocyte ratio (NLR). Layunin ng pag-aaral na ito na pag-uganyin ang relasyon ng NLR-at-hospital admission sa mga kimika at dugo at taba sa katawan, at pati na rin sa mga komplikasyon ng CAD. Mula 2008 hanggang 2025, natukoy ang 14 na cohort na kinabibilangan ng mga pasyenteng nasuri na may CAD para sa mausisang pagpili, pagsuri ng kalidad, at pagsasagawa ng bias assessment. Ang mga cohort ay hinati sa mababa na NLR at mataas na NLR at nirepaso gamit ang Cochrane’s RevMan software. Ang mga mean differences at risk ratio ng mga klinikal na variable ay kinalkula sa pamamagitan ng Inverse Variance Weighting sa ilalim ng Fixed Effects at Random Effects Models, batay sa heterogeneities na resulta ng I2 statistic. Itinakdang 5% ang statistical significance. Ang bilang ng white blood cell (MD: -2,80; 95% CI: [-3.36, -2.24]) at bilang ng platelet (MD: -17.31; 95% CI: [-29.87, -4.74]) ay mas mataas sa mga pasyenteng may mataas na NLR. Bilang mga pathogenic precursor sa pagbara na sanhi ng atherosclerosis, ang mas mataas na total cholesterol (MD: 5.15; 95% CI: [3.40, 6.90]) at low-density lipoprotein (MD: 3.83; 95% CI: [2.31, 5.36]) ay naobserbahan sa mga pasyenteng may mababa na NLR. Gayundin, ang mga panganib sa acute myocardial infarction (RR: 0.61; 95% CI: [0.45, 0.83]) at atrial fibrillation (RR: 0.75; 95% CI: [0.69, 0.82]) ay mas mababa nang 39% at 15% sa mababa na NLR. Dagdag dito, ang kondisyon ng dyslipidemia ay naglantad ng 23% na pagtaas ng panganib sa mga pasyenteng may mababa na NLR (RR: 1.23; 95% CI: [1.05, 1.45]). Ang NLR bilang isang kategoryal na biomarker para sa kalubhaan ng CAD ay lubusang nagpapakita ng metabolismo ng lipid at mga hematological mediator. Subalit, ang mahina ang ebidensya ng NLR bilang isang tiyak at nagsasariling indikasyon ng CAD. Ang malawak na confidence interval ay ikinubli ng panloob na bias na hindi natukoy sa pagsusuri ng heterogeneity. Dahil dito, kinakailangan ng karagdagang pananaliksik upang patibayin ang paggamit ng NLR sa prognostic stratification ng mga pasyenteng mayroong CAD.
Abstract Format
html
Language
English
Format
Electronic
Keywords
Coronary heart disease—Diagnosis; Neutrophils; Lymphocytes
Recommended Citation
Cruz, A. D., Cual, K. T., Gutierrez, S. L., Sotto, A. B., & Topacio, P. B. (2026). Neutrophil-to-lymphocyte ratio as a screening tool for coronary artery disease: A meta-analysis. Retrieved from https://animorepository.dlsu.edu.ph/etdb_bio/197
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Embargo Period
4-10-2029
