Internal and Emergency Medicine

, Volume 13, Issue 4, pp 603–608 | Cite as

Prognostic role of neutrophils to lymphocytes ratio in patients with acute pulmonary embolism: a systematic review and meta-analysis of the literature

  • Silvia Galliazzo
  • Olga Nigro
  • Lorenza Bertù
  • Luigina Guasti
  • Anna Maria Grandi
  • Walter Ageno
  • Francesco Dentali


The prognostic assessment of patients with acute pulmonary embolism (PE) is essential to drive its management. The search for new prognostic factors is a central issue for a more accurate estimate of short-term adverse events. Circulating neutrophils/lymphocytes ratio (NLR) has been suggested as prognostic biomarker for different cardiovascular diseases. Given the central role of inflammation, and in particular of neutrophils in the pathogenesis of VTE and its clinical history, NLR might represent a prognostic tool also in this setting. We performed a systematic review and meta-analysis of the literature to assess the prognostic role of NLR in patients with acute PE. MEDLINE and EMBASE were searched up to 2017, week 21. A bivariate random-effects regression approach was used to obtain summary estimate of accuracy of the high NLR adjusting for inter-study variability. Six studies for a total of 1424 patient are included. High NLR has a weighted mean sensitivity of 77% (95% CI 68–83) and a weighted mean specificity of 74% (95% CI 68–79). High NLR positive and negative predictive values are 24.4% (95% CI 20.4–28.3) and 96.7% (95% CI 95.6–97.8), respectively. The relevant impact of NLR on short-term mortality after an acute PE makes it a promising biomarker to better stratify patient prognosis.


Lymphocytes Mortality Neutrophils Prognosis Pulmonary embolism 


Compliance with ethical standards

Conflict of interest

The authors state that they have no conflict of interest.

Statement of human and animal rights

All procedures involving human participants were performed in accordance with ethical standards of local committee. This article does not contain any studies with human or animal subjects performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Supplementary material

11739_2018_1805_MOESM1_ESM.tif (181 kb)
Supplementary material 1 (TIFF 181 kb)


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Copyright information

© SIMI 2018

Authors and Affiliations

  • Silvia Galliazzo
    • 1
  • Olga Nigro
    • 2
  • Lorenza Bertù
    • 1
  • Luigina Guasti
    • 1
  • Anna Maria Grandi
    • 1
  • Walter Ageno
    • 1
  • Francesco Dentali
    • 1
  1. 1.Department of Medicine and SurgeryUniversity of Insubria, Ospedale di CircoloVareseItaly
  2. 2.Department of OncologyUniversity of Insubria, Ospedale di CircoloVareseItaly

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