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ISSN: 0953-7104 (print), 1369-1635 (electronic)

Platelets, Early Online: 1–2

! 2014 Informa UK Ltd. DOI: 10.3109/09537104.2014.979340

SPOTLIGHT ARTICLE

The platelet-lymphocyte ratio: A simple, inexpensive and rapid

prognostic marker for cardiovascular events
Sevket Balta1 & Cengiz Ozturk2
1
Department of Cardiology, Eskişehir Military Hospital, Eskişehir, Turkey and 2Department of Cardiology, Gulhane Medical Academy,
Ankara, Turkey

Abstract Keywords
Platelets Downloaded from informahealthcare.com by Selcuk Universitesi on 01/13/15

A full blood count is a routine, inexpensive and easy test that provides information about Atherosclerosis, inflammation, mortality,
formed blood contents. The platelet-lymphocyte ratio (PLR) is a novel inflammatory marker, platelet-lymphocyte ratio
which may be used in many diseases for predicting inflammation and mortality. The PLR can be
easily calculated and is widely available but it may be affected by several inflammatory History
conditions. Recent studies show that a high PLR reflects inflammation, atherosclerosis
and platelet activation. More research is needed to determine how the PLR may be used Received 14 October 2014
in clinical practice. Accepted 15 October 2014
Published online 26 December 2014
For personal use only.

Cardiovascular diseases and PLR
A full blood count is a routine, automated, inexpensive, easy test
that provides information about red and white cells as well as
platelets. The platelet-lymphocyte ratio (PLR) is calculated as the
ratio of the platelet to lymphocyte count (obtained from the same
blood sample) [1]. Platelets release proinflammatory mediators,
such as chemokines and cytokines [2]. Activated platelets
stimulate thrombus formation in response to rupture of athero-
sclerotic plaques or endothelial cell erosion, promoting athero-
thrombotic disease [3]. Platelet activation plays an important role
in coronary artery disease (CAD) and cardiovascular (CV) events
[4]. A higher baseline platelet count in patients with acute
myocardial infarction is a powerful predictor of death [5].
Azab et al. [6] found that the PLR predicted long-term
mortality after non-ST segment elevation myocardial infarction
(NSTEMI). Ciçek et al. [7] concluded that the PLR can predict
in-hospital and long-term mortality in patients undergoing
primary percutaneous coronary intervention (pPCI). Yildiz et al.
[8] reported that a high pre-procedural PLR is a significant and
independent predictor of no reflow in patients undergoing pPCI.
In this issue of Platelets, Ayca et al. [9] concluded that the
PLR could predict development of no-reflow, severity of CAD
and in-hospital mortality in patients undergoing pPCI.
The PLR was assessed in several diseases and in relation to CV
risk factors [10]. An increased PLR was found in non-dipper
hypertensive patients [11]. Ferroni et al. [12] showed that the PLR
was associated with a 3-fold increased risk of symptomatic venous
thromboembolism. Patients with critical limb ischemia (CLI)
usually have generalized atherosclerotic disease. Stratification
of patients with CLI according to admission PLR should be
considered in limb survival analyses of future adjuvant and
neoadjuvant trials [13]. Patients with renal disease have higher
levels of inflammation and the PLR predicted mortality and CV
events [14]. Obstructive sleep apnoea syndrome (OSAS) is
associated with hypertension, heart failure, arrhythmias and
CAD. Platelet parameters, such as mean platelet volume (MPV)
and PLR, are associated with the severity of OSAS [15] and CV
disease in these patients [16]. Sensorineural hearing loss
(SSNHL) appears to be characterised by inflammation or
thrombotic events [17]. MPV reflects platelet production rate,
activation and function [18]. MPV and PLR are elevated in
patients with SSNHL [19].
Major confounding factors
The PLR may be raised in non-vascular conditions involving
inflammation and has been associated with poor prognosis
in patients with different types of cancer [20, 21]. Malignancy
is a common condition that may co-exist with CV disease. Cancer
itself may be associated with an increased risk of thrombosis [12].
Plasma cortisol levels are elevated as a response to stress
and pain related to infarction and acute ischeamia. Elevated
cortisol levels might be of prognostic value in the CV disease [22]
and lymphocytopenia reflects depression of innate cellular
immunity by cortisol [23].
Because the PLR is a ratio, it is relatively more stable than
individual blood parameters that can be altered by several
variables (e.g. dehydration, over-hydration and blood specimen
handling). However, standardised laboratory methods are
essential.
Conclusions

Correspondence: Dr Sevket Balta, MD, Department of Cardiology,

Current evidence shows that a high PLR reflects inflammation,
Eskişehir Military Hospital, VişnelikMah, Atatürk Cd. 26020, Akarbaşı, atherosclerosis and platelet activation. The PLR can be easily
Eskişehir, Turkey. Tel: +90 222 220 45 30. Fax: +90 222 230 34 33. calculated and is widely available. More research is needed to
E-mail: drsevketb@gmail.com determine how the PLR may be used in clinical practice.
 2 S. Balta & C. Ozturk
Declaration of interest
The authors report no declaration of interests.
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