Researchers have proposed that, among novel systemic inflammatory markers, monocyte to high-density lipoprotein (HDL) cholesterol ratio (MHR) and neutrophil to lymphocyte ratio (NLR) might be better than lymphocyte to monocyte ratio (LMR) in the prediction of pulmonary arterial hypertension (PAH).

A single-center, cross-sectional study was conducted in Turkey between January 2016 and December 2019 in which data were retrospectively collected from patients with PAH. Results of the analysis were recently published in Medicine.

The study enrolled 73 patients with PAH and 77 control individuals. The mean ages of the participants were 49.52±17.03 years in the PAH arm and 48.95±16.16 years in the control arm.

Continue Reading

Patients with PAH were more likely to have higher monocyte counts, systolic pulmonary arterial pressure, right atrial diameters, RV diameters, NLR, and MHR, as well as lower lymphocyte counts, HDL levels, and LMR. These findings are indicative of enhanced inflammation in patients with PAH compared to controls.

Learn more about experimental therapies for PAH

On multivariate logistic regression analysis, MHR, LMR, and NLR remained statistically significant predictors of PAH (odds ratio [OR], 2.651, 95% CI, 1.227-5.755, P =.007; OR, 0.647, 95% CI, 0.450-0.931, P =.005; and OR, 1.350, 95% CI, 1.054-1.650, P =.030, respectively).

Based on receiver operating characteristic curve analysis, an LMR of less than 3.50 had a 74% sensitivity and 63% specificity (95% CI, 0.645-0.806, P <.001), an MHR of more than 1.32 had a 60% sensitivity and 55% specificity
(95% CI, 0.550-0.728, P <.001), and an NLR of over 2.07 had a 60% sensitivity and 56% specificity (95% CI, 0.528-0.708, P =.012) in accurately predicting a diagnosis of PAH.

The results of the study demonstrated that MHR and NLR are significantly increased in patients with PAH compared to those in controls, whereas LMR is significantly decreased in patients with PAH.

According to the investigators, “Early diagnosis is very important as patients with PAH require continuous care and aggressive treatments to reduce the high risk and mortality rate.” Use of these inexpensive, noninvasive hematologic markers may be beneficial in the diagnosis of individuals with PAH.

PAH is a progressive disorder characterized by increased pulmonary vascular resistance, right ventricular (RV) failure, and eventually death if left untreated. The etiology of PAH varies widely; it can be idiopathic, familial, drug- or toxin-induced, or associated with connective tissue disorders, congenital heart disease, portal hypertension, and human immunodeficiency virus (HIV) infection.

Phosphodiesterase 5 inhibitors, endothelin receptor antagonists, prostacyclin analogs, and guanylate cyclase activators are all used as PAH-specific therapies. For patients in whom medical treatment has proven inadequate to relieve symptoms, balloon atrial septostomy and heart-lung transplantation are additional treatment options.


Bilik MZ, Oylumlu M, Oylumlu M, et al. Novel predictor of pulmonary arterial hypertension: monocyte to HDL cholesterol ratio. Medicine (Baltimore). 2022;101(34):e29973. doi:10.1097/MD.0000000000029973