Evaluation of the platelet-to-white-cell ratio (PWR) as predictor of long-term all-cause mortality in patients with acute myocardial infarction

Abstract

Abstract The platelet-to-white-cell ratio has recently gained attention as a potential prognostic indicator. This study investigated the association between platelet-to-white-cell ratio at admission and long-term mortality in acute myocardial infarction patients, in comparison to leukocyte and platelet counts alone. The study included 4,964 patients aged 25–84 years with incident acute myocardial infarction hospitalized between 2010 and 2017, as recorded in the population-based Augsburg Myocardial Infarction Register. Platelet-to-white-cell ratio was calculated from admission platelets divided by leukocyte counts. Cox proportional hazards regression models were used to assess the associations between quartiles of platelet-to-white-cell ratio, of leukocytes, and of platelets with long-term all-cause mortality. During a median follow-up time of 4.7 years, 1,224 patients died. Platelet count in the highest quartile was observed to be associated with increased mortality risk (HR 1.32 (1.06–1.63). Platelet-to-white-cell ratio values were also found to be associated with risk of mortality. Multivariable adjusted HRs for the second, third, and fourth quartiles of platelet-to-white-cell ratio (vs. lowest quartile) were 0.64 (95% CI: 0.52–0.80), 0.83 (0.67–1.03), and 0.78 (0.62–0.98), respectively. Platelet-to-white-cell ratio at admission was associated with long-term mortality in patients with acute myocardial infarction. As a simple, cost-effective biomarker, platelet-to-white-cell ratio may support individualized risk stratification and clinical decision-making in acute myocardial infarction care.