Association of Neutrophil-to-Lymphocyte Ratio and Monocyte-to-Lymphocyte Ratio with Troponin I Levels in Patients with Acute Myocardial Infarction at Advent Hospital Bandar Lampung

Revi Amanda; Hidayat; Neno Fitriyani Hasbie; Muhammad Nur

doi:10.30872/

Authors

Revi Amanda Universitas Malahayati Author
Hidayat Universitas Malahayati Author
Neno Fitriyani Hasbie Universitas Malahayati Author
Muhammad Nur Universitas Malahayati Author

DOI:

https://doi.org/10.30872/

Keywords:

Acute Myocardial Infarction, NLR, MLR, Troponin I, inflammation

Abstract

Acute myocardial infarction (AMI) is a manifestation of acute coronary syndrome associated with high morbidity and mortality. Inflammation plays a crucial role in AMI pathogenesis, making inflammatory biomarkers potential indicators of myocardial injury. This study aimed to analyze the association between the Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), and Troponin I levels in AMI patients at Advent Hospital Bandar Lampung. A retrospective analytical observational study was conducted using medical records of 104 AMI patients from January 2024 to December 2025. Correlation analysis was performed using Spearman’s test. Most patients were male (70.2%) and aged ≥65 years (51.0%). Elevated NLR and MLR were observed in 73 (70.2%) and 55 (52.9%) patients, respectively. NLR, MLR, and Troponin I levels were significantly higher in STEMI than NSTEMI patients (p<0.05). Significant positive correlations were found between NLR and Troponin I (r=0.849; p<0.001) and between MLR and Troponin I (r=0.705; p<0.001). NLR demonstrated a stronger correlation than MLR. NLR and MLR may serve as simple, rapid, and cost-effective adjunctive inflammatory biomarkers in the clinical evaluation of AMI patients.

Author Biographies

Revi Amanda, Universitas Malahayati

Department of Medicine, Faculty of Medicine, University of Malahayati, Bandar Lampung, Indonesia
Hidayat, Universitas Malahayati

Department of Clinical Pathology, Faculty of Medicine, University of Malahayati, Bandar Lampung, Indonesia
Neno Fitriyani Hasbie, Universitas Malahayati

Public Health Program, Faculty of Medicine, University of Malahayati, Bandar Lampung, Indonesia
Muhammad Nur, Universitas Malahayati

Department of Clinical Pathology, Faculty of Medicine, University of Malahayati, Bandar Lampung, Indonesia

References

[1] S. G. Ahn, S. H. Kim, J. H. Kim, and Y. H. Kim, “Monocyte to lymphocyte ratio as a predictor of long-term outcomes in patients with acute myocardial infarction,” Korean Circulation Journal, vol. 47, no. 3, pp. 345–352, 2017.

[2] I. Aipassa, A. P. Purwanto, and I. E. K. S. Limijadi, “Hubungan jumlah leukosit, rasio neutrofil limfosit dan rasio monosit limfosit dengan derajat stenosis koroner pada penyakit jantung koroner,” Medika Alkhairaat: J. Penelitian Kedokteran dan Kesehatan, vol. 5, no. 3, pp. 172–178, 2023.

[3] I. Alwi, “Targeting inflammation and immune system in acute myocardial infarction,” Acta Medica Indonesiana, vol. 51, 2019.

[4] D. S. Arsyad, J. Westerink, M. J. Cramer, J. Ansar, Wahiduddin, F. L. J. Visseren, P. A. Doevendans, and Ansariadi, “Modifiable risk factors in adults with and without prior cardiovascular disease: Findings from the Indonesian National Basic Health Research,” BMC Public Health, vol. 22, no. 1, Art. no. 207, 2022.

[5] G. Athirah, Z. Musthafa, and A. Irmarahayu, “Hubungan kadar neutrofil dan troponin I dengan kematian pada pasien sindroma koroner akut (NSTEMI) selama masa rawat inap di RS XY,” Seminar Nasional Riset Kedokteran (SENSORIK), 2023.

[6] R. A. Byrne et al., “2023 ESC Guidelines for the management of acute coronary syndromes,” European Heart Journal, vol. 44, no. 38, pp. 3720–3826, 2023.

[7] P. P. Chmielewski, B. Strzelec, P. Mozdziak, and B. Kempisty, “Neutrophil-to-lymphocyte ratio as a prognostic biomarker for long-term survival in older adults: A historical cohort analysis,” Journal of Clinical Medicine, vol. 14, no. 7, 2025.

[8] B. G. de Liyis, A. F. Ciaves, M. H. Intizam, P. J. Jusuf, and I. J. M. R. Artha, “Hematological biomarkers of troponin, neutrophil-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio serve as effective predictive indicators of high-risk mortality in acute coronary syndrome,” BioMedicine, vol. 13, no. 4, pp. 31–43, 2023.

[9] F. Imtiaz, K. Shafique, S. S. Mirza, Z. Ayoob, and P. Vart, “Neutrophil lymphocyte ratio as a measure of systemic inflammation in acute coronary syndrome,” Pakistan Journal of Medical Sciences, vol. 28, no. 4, pp. 580–583, 2012.

[10] M. Lao, H. Liu, X. Cai, Y. Zhang, T. Liu, G. Li, K. Chen, and M. Yuan, “The monocyte-to-lymphocyte ratio exhibits a superior prognostic value in patients with newly diagnosed acute coronary syndrome,” Reviews in Cardiovascular Medicine, vol. 26, no. 10, 2025.

[11] P. Libby, G. Pasterkamp, F. Crea, and I. K. Jang, “Reassessing the mechanisms of acute coronary syndromes: The vulnerable plaque and superficial erosion,” Circulation Research, vol. 124, no. 1, pp. 150–160, 2019.

[12] G. Lin, C. Dai, K. Xu, and M. Wu, “Predictive value of neutrophil to lymphocyte ratio and red cell distribution width on death for ST segment elevation myocardial infarction,” Scientific Reports, vol. 11, no. 1, 2021.

[13] E. I. Nikulina, A. L. Bausheva, P. G. Volosatova, O. I. Burovnikova, D. A. Shomakhova, and E. V. Khe, “Prognostic significance of biomarkers of inflammation in acute coronary syndrome,” Journal of Rare Cardiovascular Diseases, 2025.

[14] J. Odeberg, A. Halling, M. Ringborn, M. Freitag, M. L. Persson, I. Vaara, L. Råstam, H. Odeberg, and U. Lindblad, “Markers of inflammation predicts long-term mortality in patients with acute coronary syndrome: A cohort study,” BMC Cardiovascular Disorders, vol. 25, no. 1, 2025.

[15] N. J. Stone et al., “2018 ACC/AHA Guideline on the Management of Blood Cholesterol: A Focused Update,” Journal of the American College of Cardiology, 2018.

[16] C. G. Tessari, A. Lefi, and Y. Hernaningsih, “Correlation of neutrophil-lymphocyte ratio, vessel score based on Sullivan scoring system, and troponin in acute coronary syndrome patients,” Cardiovascular and Cardiometabolic Journal, vol. 3, no. 2, pp. 75–86, 2022.

[17] A. Timmis et al., “European Society of Cardiology: Cardiovascular disease statistics 2019,” European Heart Journal, vol. 41, no. 1, pp. 12–85, 2020.

[18] World Health Organization, “Cardiovascular diseases (CVDs),” World Health Organization, Geneva, Switzerland, 2021.

[19] R. Zahorec, “Neutrophil-to-lymphocyte ratio, past, present and future perspectives,” Bratislavske Lekarske Listy, vol. 122, no. 7, pp. 474–488, 2021.

[20] T. Y. Zhang, Q. Zhao, Z. S. Liu, C. Y. Zhang, J. Yang, and K. Meng, “Relationship between monocyte/lymphocyte ratio and non-culprit plaque vulnerability in patients with acute coronary syndrome: An optical coherence tomography study,” Medicine, vol. 99, no. 41, 2020.

[21] T. Easmin, M. Khalequzzaman, M. Ahmed, and M. M. Hasan, “Association between neutrophil to lymphocyte ratio and severity of coronary artery disease in acute myocardial infarction patients,” Bangladesh Heart Journal, vol. 39, no. 1, pp. 1–9, Jan. 2024, doi: 10.3329/bhj.v39i1.70655.

[22] F. Ö. Karadeniz, Y. Karadeniz, and E. Altuntaş, “Systemic immune-inflammation index, and neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios can predict clinical outcomes in patients with acute coronary syndrome,” CVJA, vol. 35, no. 2, pp. 18–24, Sept. 2024, doi: 10.5830/cvja-2023-011.

[23] Y. Wang and H. Cao, “Research advances on the role of immune cells and inflammatory mediators in atherosclerosis,” JCMP, vol. 8, no. 3, pp. 7–12, Mar. 2026, doi: 10.53469/jcmp.2026.08(03).02.

[24] K. Jakubowska, M. Koda, M. Grudzińska, L. Kańczuga-Koda, and W. Famulski, “Monocyte-to-lymphocyte ratio as a prognostic factor in peripheral whole blood samples of colorectal cancer patients,” WJG, vol. 26, no. 31, pp. 4639–4655, Aug. 2020, doi: 10.3748/wjg.v26.i31.4639.

[25] D. et al., “Lymphocyte to monocyte ratio from the cohort of this study,” Figshare, Oct. 2025, doi: 10.1371/journal.pone.0333523.g001.

[26] S. M. Mahmoud, B. Sobhy, and R. Raymond, “Prediction of troponin elevation in non-ST acute coronary syndrome patients presenting to the emergency department using neutrophil-lymphocyte ratio,” QJM, vol. 114, no. Suppl. 1, Oct. 2021, doi: 10.1093/qjmed/hcab090.035.

[27] A. M. Shumilah, A. M. Othman, and A. K. Al-Madhagi, “Accuracy of neutrophil to lymphocyte and monocyte to lymphocyte ratios as new inflammatory markers in acute coronary syndrome,” BMC Cardiovascular Disorders, vol. 21, no. 1, 2021.

[28] M. Węgiel, K. Glądys, B. Zdzierak, A. Dziewierz, S. Bartuś, and T. Rakowski, “Neutrophil-to-lymphocyte ratio as a predictor of left ventricle function and mortality in patients with myocardial infarction,” pwki, vol. 21, no. 2, pp. 171–177, Jan. 2025, doi: 10.5114/aic.2025.151724.

[29] M. M. Mostafa, T. A. Alburaiki, S. S. Al-Siari, M. A. Al-Siari, and W. M. Safhi, “Neutrophil-lymphocyte ratio in patients with acute myocardial infarction: A retrospective study,” Pakistan Heart Journal., vol. 58, no. 4, pp. 403–410, Jan. 2026, doi: 10.47144/phj.v58i4.2895.