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Assessing the neutrophil-to-lymphocyte ratio as a biomarker for predicting the severity of coronary artery disease using Gensini Score

Muhammad Noor Ul Amin, Asad Mehmood Raja, Muhammad Javaid Asad, Abida Arshad, Ghazala Kaukab Raja, Pakeeza Arzoo Shaiq.


Abstract
Objective: To evaluate the predictive value of neutrophil-to-lymphocyte ratio in assessing the severity of coronary artery disease, as determined by the Gensini score.
Methodology: This retrospective study included 1,020 patients who underwent coronary angiography at the Rawalpindi Institute of Cardiology, Pakistan. The severity of coronary artery disease was classified using the Gensini scoring system. The association between neutrophil-to-lymphocyte ratio and disease severity was analyzed through univariate and multivariate logistic regression analysis. Receiver operating characteristic curve analysis was performed to evaluate its predictive ability.
Results: Mean age of participants was 58.3±10.48 years, with 69.59% being male. Patients with very severe coronary artery disease had significantly higher neutrophil-to-lymphocyte ratios (mean = 5.93±10.94) compared to those without disease (mean = 2.77±3.44; p<0.001). Multivariate analysis confirmed the neutrophil-to-lymphocyte ratio as an independent predictor of disease severity (odds ratio = 1.021; 95% confidence interval: 1.008–1.035; p=0.002). The area under the curve was 0.60, indicating moderate discriminative capacity. Violin plot analysis revealed broader variability in very severe cases, reflecting complex inflammatory mechanisms.
Conclusion: Neutrophil-to-lymphocyte ratio and its percentage were significantly elevated in very severe disease (p=0.0008), supporting their role as quantitative markers of coronary artery disease severity. Validation in larger, multi-center cohorts is recommended to assess utility in clinical risk stratification.

Key words: Neutrophil to lymphocyte ratio, Gensini Score, biomarker.


 
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How to Cite this Article
Pubmed Style

Amin MNU, Raja AM, Asad MJ, Arshad A, Raja GK, Shaiq PA. Assessing the neutrophil-to-lymphocyte ratio as a biomarker for predicting the severity of coronary artery disease using Gensini Score. RMJ. 2025; 50(3): 584-587. doi:10.5455/rmj.20250316102119

Web Style

Amin MNU, Raja AM, Asad MJ, Arshad A, Raja GK, Shaiq PA. Assessing the neutrophil-to-lymphocyte ratio as a biomarker for predicting the severity of coronary artery disease using Gensini Score. https://www.rmj.org.pk/?mno=247710 [Access: October 30, 2025]. doi:10.5455/rmj.20250316102119

AMA (American Medical Association) Style

Amin MNU, Raja AM, Asad MJ, Arshad A, Raja GK, Shaiq PA. Assessing the neutrophil-to-lymphocyte ratio as a biomarker for predicting the severity of coronary artery disease using Gensini Score. RMJ. 2025; 50(3): 584-587. doi:10.5455/rmj.20250316102119


Vancouver/ICMJE Style

Amin MNU, Raja AM, Asad MJ, Arshad A, Raja GK, Shaiq PA. Assessing the neutrophil-to-lymphocyte ratio as a biomarker for predicting the severity of coronary artery disease using Gensini Score. RMJ. (2025), [cited October 30, 2025]; 50(3): 584-587. doi:10.5455/rmj.20250316102119


Harvard Style

Amin, M. N. U., Raja, . A. M., Asad, . M. J., Arshad, . A., Raja, . G. K. & Shaiq, . P. A. (2025) Assessing the neutrophil-to-lymphocyte ratio as a biomarker for predicting the severity of coronary artery disease using Gensini Score. RMJ, 50 (3), 584-587. doi:10.5455/rmj.20250316102119


Turabian Style

Amin, Muhammad Noor Ul, Asad Mehmood Raja, Muhammad Javaid Asad, Abida Arshad, Ghazala Kaukab Raja, and Pakeeza Arzoo Shaiq. 2025. Assessing the neutrophil-to-lymphocyte ratio as a biomarker for predicting the severity of coronary artery disease using Gensini Score. Rawal Medical Journal, 50 (3), 584-587. doi:10.5455/rmj.20250316102119


Chicago Style

Amin, Muhammad Noor Ul, Asad Mehmood Raja, Muhammad Javaid Asad, Abida Arshad, Ghazala Kaukab Raja, and Pakeeza Arzoo Shaiq. "Assessing the neutrophil-to-lymphocyte ratio as a biomarker for predicting the severity of coronary artery disease using Gensini Score." Rawal Medical Journal 50 (2025), 584-587. doi:10.5455/rmj.20250316102119


MLA (The Modern Language Association) Style

Amin, Muhammad Noor Ul, Asad Mehmood Raja, Muhammad Javaid Asad, Abida Arshad, Ghazala Kaukab Raja, and Pakeeza Arzoo Shaiq. "Assessing the neutrophil-to-lymphocyte ratio as a biomarker for predicting the severity of coronary artery disease using Gensini Score." Rawal Medical Journal 50.3 (2025), 584-587. Print. doi:10.5455/rmj.20250316102119


APA (American Psychological Association) Style

Amin, M. N. U., Raja, . A. M., Asad, . M. J., Arshad, . A., Raja, . G. K. & Shaiq, . P. A. (2025) Assessing the neutrophil-to-lymphocyte ratio as a biomarker for predicting the severity of coronary artery disease using Gensini Score. Rawal Medical Journal, 50 (3), 584-587. doi:10.5455/rmj.20250316102119


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