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Bradley NA, Roxburgh CSD, McMillan DC, Guthrie GJK. A systematic review of the role of systemic inflammation-based prognostic scores in patients with abdominal aortic aneurysm. Surgeon 2024:S1479-666X(24)00095-7. [PMID: 39191632 DOI: 10.1016/j.surge.2024.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND AND AIMS Activation of the systemic inflammatory response (SIR) is associated with inferior outcomes across a spectrum of disease. Routinely available measures of the SIR (neutrophil:lymphocyte ratio (NLR), platelet:lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), systemic inflammatory grade (SIG)) have been shown to provide prognostic value in patients undergoing surgical intervention. The present study aimed to review the literature describing the prognostic association of NLR, PLR, SII and SIG in patients undergoing intervention for abdominal aortic aneurysm (AAA). METHODS This PRISMA guidelines were followed. The MEDLINE database was interrogated for relevant studies investigating the effect of peri-operative systemic inflammation-based prognostic systems on all-cause mortality in patients undergoing OSR and EVAR for AAA. Inter-study heterogeneity precluded meaningful meta-analysis; qualitative analysis was instead performed. RESULTS There were 9 studies included in the final review reporting outcomes on a total of 4571 patients; 1256 (27 %) patients underwent OSR, and 3315 (73 %) patients underwent EVAR. 4356 (95 %) patients underwent a procedure for unruptured AAA, 215 (5 %) patients underwent an emergency procedure for ruptured AAA0.5 studies reported early (inpatient or 30-day) mortality; 2 of these found that elevated NLR predicted inferior survival, however PLR did not provide prognostic value. 6 studies reported long-term mortality; elevated NLR (5 studies), PLR (1 study), and SIG (1 study) predicted inferior survival. CONCLUSIONS It appears that activation of the SIR is associated with inferior prognosis in patients undergoing intervention for AAA, however the evidence is limited by heterogenous methodology and lack of consensus regarding optimal cutoff. PROSPERO DATABASE REGISTRATION NUMBER CRD42022363765.
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Serban D, Papanas N, Dascalu AM, Kempler P, Raz I, Rizvi AA, Rizzo M, Tudor C, Silviu Tudosie M, Tanasescu D, Pantea Stoian A, Gouveri E, Ovidiu Costea D. Significance of Neutrophil to Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) in Diabetic Foot Ulcer and Potential New Therapeutic Targets. INT J LOW EXTR WOUND 2024; 23:205-216. [PMID: 34791913 DOI: 10.1177/15347346211057742] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diabetic foot ulcer (DFU) is a well-known complication of diabetes and a significant burden on the national health systems. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio are inexpensive and easily accessible biomarkers that have proved to be useful in several inflammatory, infectious and cardiovascular diseases. We carried out a comprehensive review examining the association of NLR and PLR with the onset and progression of DFU. PLR and NLR were significantly increased in patients with DFU, compared with a control group of T2DM patients without DFU, and correlate well with DFU severity, evaluated by Wagner and IWGDF grading scales. In patients with diabetic foot infections (DFI), elevated NLR and PLR were correlated with osteomyelitis, increased risk of amputation, and septic complications. The significance of the elevated value of these biomarkers in DFU is related to chronic hyperglycemia and low-grade systemic inflammation, atherosclerotic and vascular complications, and also the associated septic factor. Serial, dynamic follow-up can provide useful information in planning and monitoring DFU treatment, as well as in risk stratification of these vulnerable patients. Further randomized studies are needed to set the cut-off values with clinical significance.
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Affiliation(s)
- Dragos Serban
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania, ; ;
- Fourth Department of General Surgery, Emergency University Hospital, Romania,
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece,
| | - Ana Maria Dascalu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania, ; ;
- Department of Ophthalmology, Emergency University Hospital Bucharest, Romania
| | | | | | - Ali A Rizvi
- Emory University, Atlanta, GA, USA,
- University of South Carolina School of Medicine Columbia, SC, USA
| | - Manfredi Rizzo
- University of South Carolina School of Medicine Columbia, SC, USA
- Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Italy,
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,
| | - Corneliu Tudor
- Fourth Department of General Surgery, Emergency University Hospital, Romania,
| | - Mihail Silviu Tudosie
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania, ; ;
- Clinical Emergency Hospital, Bucharest, Romania
| | | | | | | | - Daniel Ovidiu Costea
- Ovidius University, Constanta, Romania,
- Emergency County Hospital, Constanta, Romania
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Lu J, Karwoski A, Abdulrahman L, Chaparala S, Chaudhary M, Nagarsheth K. Neutrophil-to-Lymphocyte Ratio as a Predictor of Mortality for COVID-19-Related Acute Respiratory Distress Syndrome (ARDS) Patients Requiring Extracorporeal Membrane Oxygenation Therapy. Cureus 2023; 15:e46238. [PMID: 37908950 PMCID: PMC10613713 DOI: 10.7759/cureus.46238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) has been studied as an indicator of systemic inflammation and as a prognostic tool in multiple areas of medicine. Previous research has suggested that higher NLR and rapid increase to peak NLR are associated with poorer outcomes in patients with coronavirus disease 2019 (COVID-19), particularly in those experiencing acute respiratory distress syndrome (ARDS). Within vascular surgery, there is data to suggest a positive correlation between elevated pre-extracorporeal membrane oxygenation (ECMO) NLR and higher rates of mortality following major procedures. This study explores the prognostic value of peri-ECMO NLR in patients requiring veno-venous ECMO (VV-ECMO) therapy for COVID-19-related ARDS. The objective of this study was to explore the utility of pre-ECMO NLR as an easily accessible prognostic factor for patients suffering from COVID-19-associated ARDS that require VV-ECMO. METHODS This was a retrospective cohort study within a tertiary care hospital conducted between April 2020 and January 2021. Patients requiring VV-ECMO therapy for COVID-19-associated ARDS were included. Peri-ECMO NLR values, length of stay (LOS), duration on VV-ECMO, and discharge status were recorded. Receiver operating characteristic (ROC) curve analysis and Youden's J statistics were performed to calculate a cut-off value of 11.005 for pre-ECMO NLR and 17.616 for on-ECMO NLR. Pre-ECMO and on-ECMO Kaplan-Meyer curves were generated for two groups of patients, those above and below NLR cutoff thresholds. Two-sample T-test was performed to test for significant differences in LOS and duration on VV-ECMO. RESULTS Twenty-six patients were included in the study for final analyses. There was an overall mortality of 39% (n = 10). ROC curve analysis and Youden's J statistic revealed an optimal cut-off value of pre-ECMO NLR = 11.005 and on-ECMO NLR = 17.616. Results showed that the patient group placed on VV-ECMO with a pre-ECMO NLR less than 11.005 experienced no mortality (n = 7) and a median LOS of 28 days (IQR = 14.5-64.5 days). The patient group on VV-ECMO with a pre-ECMO NLR greater than 11.005 (n = 19) included all mortality (n = 10) and had a median LOS of 49 days (IQR = 25.5-63.5 days). The patient group with on-ECMO NLR less than 17.616 also conferred a survival advantage. There was no significant difference in LOS or duration on VV-ECMO between the two groups, pre-ECMO or on-ECMO. CONCLUSIONS A pre-ECMO NLR cutoff was identified and offered statistically significant prognostic value in predicting mortality. A lower on-ECMO NLR value also indicated a survival advantage. Future studies should include NLR within multivariate models to better discern the effect of NLR and elucidate how it can be factored into clinical decision-making. Importantly, this data can be expanded to assess the predictive value of NLR pertaining to the COVID-19-induced ARDS population and matched cohorts.
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Affiliation(s)
- Jeffrey Lu
- Vascular Surgery, University of Maryland School of Medicine, Baltimore, USA
| | - Allison Karwoski
- Vascular Surgery, University of Maryland School of Medicine, Baltimore, USA
| | - Lena Abdulrahman
- Vascular Surgery, University of Maryland School of Medicine, Baltimore, USA
| | - Swati Chaparala
- Vascular Surgery, University of Maryland School of Medicine, Baltimore, USA
| | - Mirnal Chaudhary
- Vascular Surgery, University of Maryland School of Medicine, Baltimore, USA
| | - Khanjan Nagarsheth
- Vascular Surgery, University of Maryland School of Medicine, Baltimore, USA
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The Predictive Value of Systemic Inflammatory Markers, the Prognostic Nutritional Index, and Measured Vessels' Diameters in Arteriovenous Fistula Maturation Failure. Life (Basel) 2022; 12:life12091447. [PMID: 36143483 PMCID: PMC9506395 DOI: 10.3390/life12091447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 12/31/2022] Open
Abstract
Background: An arteriovenous fistula (AVF) is the first-line vascular access pathway for patients diagnosed with end-stage renal disease (ESRD). In planning vascular access, it is necessary to check the diameters of the venous and arterial components for satisfactory long-term results. Furthermore, the mechanism underlying the maturation failure and short-term patency in cases of AVFs is not fully known. This study aims to verify the predictive role of inflammatory biomarkers (the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory index (SII), and C-reactive protein (CRP)), Ca-P product, the prognostic nutritional index (PNI), and the diameters of the venous and arterial components in the failure of AVF maturation. Methods: The present study was designed as an observational, analytical, and retrospective cohort study with a longitudinal follow-up, and included all patients with a diagnosis of ESRD that were admitted to the Vascular Surgery Clinic of the Targu Mures Emergency County Hospital, Romania, between January 2019 and December 2021. Results: The maturation of AVF at 6 weeks was clearly lower in cases of patients in the high-NLR (31.88% vs. 91.36%; p < 0.0001), high-PLR (46.94% vs. 85.55%; p < 0.0001), high-SII (44.28% vs. 88.89%; p < 0.0001), high-CRP (46.30% vs. 88.73%; p < 0.0001), high-Ca-P product (40.43% vs. 88.46%; p < 0.0001), and low-PNI (34.78% vs. 91.14%; p < 0.0001) groups, as well as in patients with a lower radial artery (RA) diameter (40% vs. 94.87%; p = 0.0009), cephalic vein (CV) diameter (44.82% vs. 97.14%; p = 0.0001) for a radio-cephalic AVF (RC-AVF), and brachial artery (BA) diameter (30.43% vs. 89.47%; p < 0.0001) in addition to CV diameter (40% vs. 94.59%; p < 0.0001) for a brachio-cephalic AVF (BC-AVF), respectively. There was also a significant increase in early thrombosis and short-time mortality in the same patients. A multivariate analysis showed that a baseline value for the NLR, PLR, SII, CRP, Ca-P product, and PNI was an independent predictor of adverse outcomes for all of the recruited patients. Furthermore, for all patients, a high baseline value for vessel diameter was a protective factor against any negative events during the study period, except for RA diameter in mortality (p = 0.16). Conclusion: Our findings concluded that higher NLR, PLR, SII, CRP, Ca-P product, and PNI values determined preoperatively were strongly predictive of AVF maturation failure, early thrombosis, and short-time mortality. Moreover, a lower baseline value for vessel diameter was strongly predictive of AVF maturation failure and early thrombosis.
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The Neutrophil-to-Lymphocyte Ratio’s Predictive Utility in Acute Pulmonary Embolism: Systematic Review. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2022. [DOI: 10.2478/jce-2022-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abstract
Acute pulmonary embolism is a cardiovascular emergency with a significant morbidity and mortality. In the last decade, attempts have been made to find prognostic markers for pulmonary embolism. We conducted a systematic review of the literature for studies that assess the relationship between the neutrophil-to-lymphocyte ratio (NLR) and disease progression in patients with pulmonary embolism. We included a total of seven studies published between 2016 and 2021, reporting on a total of 4,272 patients. The mean NLR observed in these studies was 5.93, with values ranging from 5.12 to 7.3. Elevated NLR was significantly associated with an increased rate of mortality in all studies. Furthermore, the collected data revealed a 2-to-15 times higher mortality rate in the group with NLR values higher than the mean. Due to its accessibility and the simplicity with which it can be calculated, as well as the outcomes revealed in this review, we strongly emphasize that NLR should be used more in medical practice.
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Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Impact on Predicting Outcomes in Patients with Acute Limb Ischemia. Life (Basel) 2022; 12:life12060822. [PMID: 35743853 PMCID: PMC9225565 DOI: 10.3390/life12060822] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/21/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Acute Limb Ischemia (ALI) of the lower limb is defined as a sudden drop in arterial limb perfusion, which is a medical emergency requiring prompt intervention with high amputation and mortality rates in the absence of revascularization. This observational, analytical, and retrospective cohort study with longitudinal follow-up aimed to confirm the relevance of the preoperative inflammatory biomarkers neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting the 30-day poor prognosis of patients with Rutherford classification (RC) grades II and III ALI. The ROC analysis found a strong association of an NLR > 4.33 with all studied outcomes, while a PLR > 143.34 was associated with all studied outcomes, except the composite endpoint in all RC stages. Depending on the optimal cut-off value, the ROC analysis found a higher incidence of all adverse outcomes in all high NLR (>4.33) and high PLR (>143.34) groups. A multivariate analysis showed that a high baseline value for NLR and PLR was an independent predictor of amputation (OR:11.09; 95% CI: 5.48−22.42; p < 0.0001; and OR:8.97; 95% CI: 4.44−18.16; p < 0.0001), mortality (OR:22.24; 95% CI: 9.61−51.47; p < 0.0001; and OR:8.32; 95% CI: 3.90−17.73; p < 0.0001), and composite endpoint (OR:21.93; 95% CI: 7.91−60.79; p < 0.0001; and OR:9.98; 95% CI: 3.89−25.55; p < 0.0001), respectively. Furthermore, for all hospitalized patients, the RC grade III (OR:7.33; 95% CI: 3.73−14.26; p < 0.0001) was an independent predictor of amputation (OR:7.33; 95% CI: 3.73−14.26; p < 0.0001), mortality (OR:8.40; 95% CI: 4.08−17.31; p < 0.0001), and composite endpoint (OR: 10.70; 95% CI: 4.48−25.56; p < 0.0001), respectively. The NLR and PLR are excellent predictors of risks associated with ALI for primary and secondary prevention. Our study showed that increased pre-operative values for NLR and PLR are indicators of a poor outcome in patients with RC grades II and III ALI.
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Russu E, Mureșan AV, Arbănași EM, Kaller R, Hosu I, Voidăzan S, Arbănași EM, Coșarcă CM. The Predictive Role of NLR and PLR in Outcome and Patency of Lower Limb Revascularization in Patients with Femoropopliteal Disease. J Clin Med 2022; 11:2620. [PMID: 35566745 PMCID: PMC9103104 DOI: 10.3390/jcm11092620] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD) changes the arterial structure and function, and is the most common manifestation of the atherosclerotic process, except for the coronary and cerebral arterial systems. Inflammation is well known to have a role in the progression of atherosclerosis and, by extension, in PAD. Among the recently studied markers in the literature, we list the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). This study aims to analyze the preoperative role of NLR and PLR in the medium-term outcome of patients surgically revascularized for femoropopliteal disease. METHODS A retrospective study included patients admitted to the Vascular Surgery Clinic of the County Emergency Clinical Hospital of Târgu-Mureș, Romania, between January 2017 and December 2019, diagnosed with femoropopliteal disease and having presented an indication for surgical revascularization. The patients included in the study were classified according to the 12 months primary patency in two groups: "patency" and "nonpatency". RESULTS Depending on the Rutherford classification (RC), there was a higher incidence of stages II and III in the patency group and a higher incidence of stage V in the nonpatency group. Depending on the optimal cut-off value according to ROC for the 12 months primary patency, obtained from Youden's index (3.95 for NLR (82.6% sensitivity and 89.9% specificity), and 142.13 for PLR (79.1% sensitivity and 82.6% specificity)), in all high-NLR and high-PLR groups, there was a higher incidence of all adverse outcomes. Moreover, a multivariate analysis showed that a high baseline value for NLR and PLR was an independent predictor of all outcomes for all recruited patients. Furthermore, for all hospitalized patients, RC 5 was an independent predictor of poor prognosis. CONCLUSIONS Our findings establish that a high value of preoperative NLR and PLR determined at hospital admission is strongly predictive of primary patency failure (12 months after revascularization). Additionally, elevated ratio values are an independent predictor for a higher amputation rate and death for all patients enrolled in the study, except for mortality in RC 2, and both amputation and mortality in RC 5.
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Affiliation(s)
- Eliza Russu
- Clinic of Vascular Surgery, Mureș County Emergency Hospital, 540136 Targu Mures, Romania; (E.R.); (A.V.M.); (C.M.C.)
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Adrian Vasile Mureșan
- Clinic of Vascular Surgery, Mureș County Emergency Hospital, 540136 Targu Mures, Romania; (E.R.); (A.V.M.); (C.M.C.)
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Emil Marian Arbănași
- Clinic of Vascular Surgery, Mureș County Emergency Hospital, 540136 Targu Mures, Romania; (E.R.); (A.V.M.); (C.M.C.)
| | - Réka Kaller
- Clinic of Vascular Surgery, Mureș County Emergency Hospital, 540136 Targu Mures, Romania; (E.R.); (A.V.M.); (C.M.C.)
| | - Ioan Hosu
- Department of Nephrology, Mureș County Emergency Hospital, 540136 Targu Mures, Romania;
| | - Septimiu Voidăzan
- Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania; (S.V.); (E.M.A.)
| | - Eliza Mihaela Arbănași
- Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania; (S.V.); (E.M.A.)
| | - Cătălin Mircea Coșarcă
- Clinic of Vascular Surgery, Mureș County Emergency Hospital, 540136 Targu Mures, Romania; (E.R.); (A.V.M.); (C.M.C.)
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Nishibe T, Kano M, Maekawa K, Matsumoto R, Fujiyoshi T, Iwahashi T, Kamiya K, Ogino H. Association of neutrophils, lymphocytes, and neutrophil-lymphocyte ratio to overall mortality after endovascular abdominal aortic aneurysm repair. INT ANGIOL 2022; 41:136-142. [PMID: 35138074 DOI: 10.23736/s0392-9590.22.04795-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study was to determine the predictive ability of neutrophilia, lymphocytopenia, and neutrophil-lymphocyte ratio (NLR) for overall mortality after EVAR for AAA. METHODS Data on patients with AAA treated by EVAR between March 2012 and December 2016 were obtained from a prospectively maintained EVAR database at Tokyo Medical University Hospital. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. A cut-off value of total WBC count, neutrophil count, lymphocyte count, and NLR was determined according to a receiver operating characteristic (ROC) curve. Univariate and multivariate analyses were performed using the Cox proportional hazard analyses to account for the time at risk. RESULTS 178 patients were included in this study after selection based on the exclusion criteria. The subjects consisted of 150 men and 28 women with a mean age of 77.5 years (range, 51-89 years). A ROC curve analysis determined the optimal cut-off values of preoperative total WBC, neutrophils, lymphocytes, and NLR for predicting overall mortality with 7,050 /μL, 4,012 /μL, 1,312 /μL, and 3.19, respectively. On univariate analysis and multivariate analyses, octogenarian, obesity, COPD, active cancer, and lymphocytopenia or NLR were detected as independent predictors for overall mortality. CONCLUSIONS Specific leukocyte populations, such as lymphocyte count and NLR, are useful biomarkers to predict overall mortality in patients undergoing EVAR for AAA, suggesting that WBC count and its subsets, which are easy to perform a test, may be used to stratify patients at risk for poor prognosis following EVAR.
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Affiliation(s)
- Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan -
| | - Masaki Kano
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Koki Maekawa
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Ryumon Matsumoto
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshiki Fujiyoshi
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
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Preoperative Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio, and Mean Platelet Volume as Predictors of 1-Year Mortality in Patients Undergoing an Open Repair of Abdominal Aortic Aneurysms: A Retrospective Study. J Clin Med 2021; 10:jcm10225410. [PMID: 34830692 PMCID: PMC8625427 DOI: 10.3390/jcm10225410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/10/2021] [Accepted: 11/17/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives: To investigate if preoperative neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), or mean platelet volume (MPV) could be used to predict 1-year mortality in patients undergoing open abdominal aortic aneurysm (AAA) repair. Methods: We retrospectively reviewed 382 patients who underwent open AAA repair between January 2008 and July 2019. We divided the patients into two groups based on 1-year mortality and compared the preoperative NLR, PLR, and MPV. The patients were then classified into tertiles based on their preoperative NLR (first tertile: <2.41 (n = 111); second tertile: 2.41 ≤ NLR ≤ 6.07 (n = 111); and third tertile: >6.07 (n = 112)). We compared the incidence of mortality and morbidity across the aforementioned tertiles. We performed a stepwise logistic regression analysis to evaluate the predictors for mortality. An additional subgroup analysis was performed by dividing the cases into non-ruptured and ruptured cases. Results: The preoperative NLR was significantly higher in the non-survivor group than in the survivor group (10.53 ± 7.60 vs. 5.76 ± 6.44, respectively, p = 0.003). The PLR and MPV were similar between the groups (145.35 ± 91.11 vs. 154.20 ± 113.19, p = 0.626, 9.38 ± 1.20 vs. 9.11 ± 1.39, p = 0.267, respectively). The incidence of 1-year mortality was 2.7%, 9.0%, and 14.3% in the first, second, and third NLR tertiles, respectively (p = 0.009). Higher NLR (odds ratio 1.085, 95% confidence interval 1.016–1.159, p = 0.015) and ruptured AAA (odds ratio 2.706, 95% confidence interval 1.097–6.673, p = 0.031) were the independent predictors of 1-year mortality in all patients. Moreover, the preoperative NLR was significantly higher in the ruptured AAA than in the non-ruptured AAA group (11.17 ± 7.90 vs. 4.10 ± 4.75, p < 0.001). In subgroup analysis, preoperative NLR (odds ratio 1.144, 95% confidence interval 1.031–1.271, p = 0.012) and PLR (odds ratio 0.986, 95% confidence interval 16 0.975–0.998, p = 0.017) was an independent predictor for 1-year mortality in ruptured cases. Conclusions: We demonstrated an independent relationship between the preoperative NLR and 1-year mortality in patients undergoing open AAA repair, besides PLR and MPV. Furthermore, the NLR and PLR had predictive power for 1-year mortality in ruptured cases.
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Coelho NH, Coelho A, Augusto R, Semião C, Peixoto J, Fernandes L, Martins V, Canedo A, Gregório T. Pre-operative Neutrophil to Lymphocyte Ratio is Associated With 30 Day Death or Amputation After Revascularisation for Acute Limb Ischaemia. Eur J Vasc Endovasc Surg 2021; 62:74-80. [PMID: 34112572 DOI: 10.1016/j.ejvs.2021.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 03/04/2021] [Accepted: 03/13/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Inflammation is an early feature of acute limb ischaemia (ALI), hence the potential prognostic significance of inflammatory biomarkers. This study aimed to assess the value of pre-operative inflammatory biomarkers, specifically the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR), for predicting an adverse outcome after revascularisation for ALI. METHODS All patients submitted to lower limb revascularisation for Rutherford IIa or IIb ALI at the authors' institution between 2009 and 2019 were screened retrospectively. Pre-operative NLR and PLR were analysed, along with other known prognostic factors. Primary outcome was the composite endpoint of 30 day death or amputation. RESULTS A total of 345 patients were included, 84 of whom suffered the primary outcome (24.3%). The median follow up was 23.1 months (3.1 - 52.2). Higher age (OR 1.05 per year increase, 95% CI 1.01 - 1.09), diabetes (OR 2.63, 95% CI 1.14 - 6.06), Rutherford grade IIb vs. IIa (OR 5.51, 95% CI 2.11 - 14.42), higher NLR (OR 1.28 per unit increase, 95% CI 1.12 - 1.47), and fasciotomy need (OR 3.44, 95% CI 1.14 - 10.34) were independently associated with 30 day death or amputation, whereas pre-operative statin or anticoagulant medication were associated with a risk reduction (OR 0.23, 95% CI 0.53 - 0.96 and OR 0.20, 95% CI 0.05 - 0.84, respectively). PLR did not show an independent effect on this population. Pre-operative NLR presented a good discriminative ability (AUC 0.86, 95% CI 0.82 - 0.90). A cut off NLR level ≥ 5.4 demonstrated a 90.5% sensitivity and 73.6% specificity for 30 day death or amputation. Kaplan-Meier analysis showed that patients with pre-operative NLR ≥ 5.4 had significantly lower 30 day, six month and one year amputation free survival when compared with those with NLR < 5.4 (64.8 ± 4.0%, 44.1 ± 4.1%, and 37.5 ± 4.1% vs. 98.5 ± 0.9%, 91.9 ± 2.0%, and 85.9 ± 2.5%, log rank p < .001). CONCLUSION In this study, higher pre-operative NLR was associated with 30 day death or amputation following intervention for Rutherford grade IIa or IIb ALI. NLR potentially stands as a simple, widely available and inexpensive biomarker that can refine decision making and possibly contribute to ALI morbidity and mortality reduction.
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Affiliation(s)
- Nuno H Coelho
- Angiology and Vascular Surgery Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal.
| | - Andreia Coelho
- Angiology and Vascular Surgery Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - Rita Augusto
- Angiology and Vascular Surgery Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - Carolina Semião
- Angiology and Vascular Surgery Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - João Peixoto
- Angiology and Vascular Surgery Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - Luís Fernandes
- Angiology and Vascular Surgery Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - Victor Martins
- Angiology and Vascular Surgery Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - Alexandra Canedo
- Angiology and Vascular Surgery Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - Tiago Gregório
- Internal Medicine Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Departamento de Medicina da Comunidade, Informação e Decisão em Saúde (MEDCIDS), Faculty of Medicine of Porto University, Portugal
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11
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Octeau D, Faries C, Barnes H, Nakazawa KR, Rao AJ, Ting W, Marin ML, Vouyouka AG, Faries PL, Tadros RO. Neutrophil-to-Lymphocyte Ratio Associated With Adverse Events After Endovascular Aneurysm Repair (EVAR). Ann Vasc Surg 2021; 75:45-54. [PMID: 33865942 DOI: 10.1016/j.avsg.2021.02.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The blood neutrophil-to-lymphocyte ratio (NLR) is a surrogate biomarker of systemic inflammation with important prognostic significance in multiple disease processes, including cardiovascular diseases. It is inexpensive, widely available, and may be related to the outcomes of patients after surgery. We aimed to investigate the possible association of NLR with the outcomes of patients following endovascular aneurysm repair (EVAR). METHODS This single-center, retrospective study of a prospectively maintained database evaluated 777 patients with a diagnosed abdominal aortic aneurysm (AAA) who underwent EVAR and were longitudinally followed between 2001 and 2017. NLR was defined as the ratio of absolute neutrophil count to absolute lymphocyte count. The mortality and reinterventions were used to evaluate outcomes using the appropriate univariate models, and the effect of clinical variables on NLR was further investigated using multivariate modelling. RESULTS The median NLR for all patients was 3 IQR [2.2 - 4.6]. A cut-off point of 3.6 was uncovered in a training set of 388 patients using the maximally ranked statistic method. Patients with NLR < 3.6 had significantly improved mortality rates (P< 0.0001) in the training set, and results were internally validated in a testing set of 389 patients (P = 0.042). Multivariate analysis revealed that high NLR (HR 1.4 95% CI [1.0 - 2.0]; P< 0.05) remained an independent predictor of mortality in a multivariate analysis controlling for characteristics such as comorbidities, age, and maximal aortic diameter. 5-year mortality and 30-day, 1-year and 5-year reinterventions were all higher in the high NLR group. CONCLUSION High NLR was significantly associated with higher rates of death at 5 years as well as higher rates of reinterventions at 30 days, 1 year and 5 years. We also suggest that an internally validated cut-off point of NLR >3.6 may be clinically important to help segregate patients into high and low NLR categories. It remains unclear whether NLR is directly linked to adverse events post-EVAR or whether it is a surrogate for an inflammatory state that predisposes patients to higher risk of death or reinterventions.
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Affiliation(s)
- David Octeau
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Christopher Faries
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hanna Barnes
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kenneth R Nakazawa
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ajit J Rao
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Windsor Ting
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael L Marin
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ageliki G Vouyouka
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter L Faries
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rami O Tadros
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
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12
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Prognostic Value of Inflammatory Biomarkers in 5-Year Survival After Endovascular Repair of Abdominal Aortic Aneurysms in a Predominantly Male Cohort: Implications for Practice. World J Surg 2021; 45:1949-1955. [PMID: 33721070 DOI: 10.1007/s00268-021-06051-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prognostic factors of long-term survival can guide selection of patients for endovascular repair of abdominal aortic aneurysms (EVAR). The aim of this study was to evaluate the relationship between the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the lymphocyte-to-monocyte ratio (LMR) and the systemic immune-inflammation index (SIII) with survival after EVAR and to assess whether the addition of these biomarkers improved the prediction of survival after surgery. METHODS Retrospective analysis of 284 consecutive patients who underwent an EVAR at a single institution. The association between biomarkers and survival was explored using generalized additive models with penalized smoothing splines and multivariate Cox models. C-statistics and continuous net reclassification indexes (c-NRI) were used to assess the improvement in prediction. RESULTS Survival rates at 2 and 5 years were 83.9% and 66.2%, respectively. The predictive score of survival included hemoglobin (HR = 0.849, p = 0.004), statin intake (HR = 0.538, p = 0.004), atrial fibrillation (HR = 2.515, p < 0.001), heart failure (HR = 2.542, p = 0.017) and the non-revascularized coronary artery disease (HR = 2.163, p = 0.004). Spline analyses showed a linear relationship between survival and NLR, PLR, LMR and SII. After adjusting for the predictive score, there was an independent relationship between survival and NLR (HR = 1.072, p = 0.006), PLR (HR = 1.002, p = 0.014) and SII (HR = 1.000, p = 0.043). However, only the addition of NLR improved moderately the c-NRI. A NLR ≥ 3 was independently associated with lower survival rates at 2-years (HR 1.98; 95% CI 1.07-3.66) and 5-years (HR 1.84, 95% CI 1.22-2.78) of follow-up. CONCLUSIONS Most inflammatory biomarkers are linear and independently associated with survival after EVAR, but only the NLR improved moderately the prediction of a survival score. Therefore, a NLR ≥ 3 may be used to identify patients with a low survival rate and help in decision-making.
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13
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Ntalouka MP, Nana P, Kouvelos GN, Stamoulis K, Spanos K, Giannoukas A, Matsagkas M, Arnaoutoglou E. Association of Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratio with Adverse Events in Endovascular Repair for Abdominal Aortic Aneurysm. J Clin Med 2021; 10:jcm10051083. [PMID: 33807721 PMCID: PMC7961355 DOI: 10.3390/jcm10051083] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/21/2021] [Accepted: 03/01/2021] [Indexed: 12/29/2022] Open
Abstract
The association of chronic inflammatory markers with the clinical outcome after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) was investigated. We included 230 patients, treated electively with EVAR. The values of neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) were measured pre- and postoperatively. Any major adverse cardiovascular event (MACE) and acute kidney injury (AKI) were recorded. Adverse events occurred in 12 patients (5.2%). Seven patients suffered from MACE and five from AKI. Median NLR and PLR values were significantly increased after the procedure (NLR: from 3.34 to 8.64, p < 0.001 and PLR: from 11.37 to 17.21, p < 0.001). None of the patients or procedure characteristics were associated with the occurrence of either a MACE or AKI. Receiver operating characteristic curve analysis showed that postoperative NLR and PLR were strongly associated with AKI. A threshold postoperative NLR value of 9.9 was associated with the occurrence of AKI, with a sensitivity of 80% and specificity of 81%. A threshold postoperative PLR value of 22.8 was associated with the occurrence of AKI, with a sensitivity of 80% and specificity of 83%. Postoperative NLR and PLR have been associated with the occurrence of AKI after EVAR for AAA.
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Affiliation(s)
- Maria P. Ntalouka
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (K.S.); (E.A.)
- Correspondence: ; Tel.: +30-2413-502154
| | - Petroula Nana
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.N.); (G.N.K.); (K.S.); (A.G.); (M.M.)
| | - George N. Kouvelos
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.N.); (G.N.K.); (K.S.); (A.G.); (M.M.)
| | - Konstantinos Stamoulis
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (K.S.); (E.A.)
| | - Konstantinos Spanos
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.N.); (G.N.K.); (K.S.); (A.G.); (M.M.)
| | - Athanasios Giannoukas
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.N.); (G.N.K.); (K.S.); (A.G.); (M.M.)
| | - Miltiadis Matsagkas
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (P.N.); (G.N.K.); (K.S.); (A.G.); (M.M.)
| | - Eleni Arnaoutoglou
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece; (K.S.); (E.A.)
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14
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Zhu H, Zhang L, Liang T, Li Y, Zhou J, Jing Z. Elevated preoperative neutrophil-to-lymphocyte ratio predicts early adverse outcomes in uncomplicated type B aortic dissection undergoing TEVAR. BMC Cardiovasc Disord 2021; 21:95. [PMID: 33593284 PMCID: PMC7885432 DOI: 10.1186/s12872-021-01904-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/03/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Thoracic aortic endovascular repair (TEVAR) of uncomplicated type B aortic dissection (uTBAD) has favorable long-term outcomes but higher early adverse events compared with the optimal medical treatment. Recently, clinical evidence concerning vascular surgery indicates that elevated preoperative systemic inflammatory response predicts adverse clinical events. The aim of our study was to evaluate the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR) and early outcomes of uTBAD patients undergoing TEVAR. RESULTS 216 patients diagnosed with uTBAD were included in this retrospective study between January 2015 and December 2018. The median (IQR) follow-up period was 21 (15-33) months. An early adverse event was defined as occurring within 2 years after the procedure. Median patient age was 60 (IQR, 48-68) years and 78.7 % were male. Early adverse events occurred in 24 patients (11.1 %). In the multivariable analysis, preoperative NLR (HR per SD, 1.98; 95 % CI, 1.14-3.44; P = 0.015) was associated with 2-year adverse events. CONCLUSIONS NLR is an independent predictive factor of early adverse events in uTBAD patients undergoing TEVAR.
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Affiliation(s)
- Hongqiao Zhu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China
| | - Taiping Liang
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China
| | - Yiming Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, 200433, China.
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15
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Jackson SM, Perry LA, Borg C, Ramson DM, Campbell R, Liu Z, Nguyen J, Douglas N, Kok J, Penny-Dimri J. Prognostic Significance of Preoperative Neutrophil-Lymphocyte Ratio in Vascular Surgery: Systematic Review and Meta-Analysis. Vasc Endovascular Surg 2020; 54:697-706. [PMID: 32840176 DOI: 10.1177/1538574420951315] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The global burden of surgical vascular disease is increasing and with it, the need for cost-effective, accessible prognostic biomarkers to aid optimization of peri-operative outcomes. The neutrophil-lymphocyte ratio (NLR) is emerging as a potential candidate biomarker for perioperative risk stratification. We therefore performed this systematic review and meta-analysis on the prognostic value of elevated preoperative NLR in vascular surgery. METHODS We searched Embase (Ovid), Medline (Ovid), and the Cochrane Library database from inception to June 2019. Screening was performed, and included all peer-reviewed original research studies reporting preoperative NLR in adult emergent and elective vascular surgical patients. Studies were assessed for bias and quality of evidence using a standardized tool. Meta-analysis was performed by general linear (mixed-effects) modelling where possible, and otherwise a narrative review was conducted. Between-study heterogeneity was estimated using the Chi-squared statistic and explored qualitatively. RESULTS Fourteen studies involving 5,652 patients were included. The overall methodological quality was good. Elevated preoperative NLR was associated with increased risk of long-term mortality (HR 1.40 [95%CI: 1.13-1.74], Chi-squared 60.3%, 7 studies, 3,637 people) and short-term mortality (OR: 3.08; 95%CI: 1.91-4.95), Chi-squared 66.59%, 4 studies, 945 people). Outcome measures used by fewer studies such as graft patency and amputation free survival were assessed via narrative review. CONCLUSIONS NLR is a promising, readily obtainable, prognostic biomarker for mortality outcomes following vascular surgery. Heterogeneity in patient factors, severity of vascular disease, and type of vascular surgery performed renders direct comparison of outcomes from the current literature challenging. This systematic review supports further investigation for NLR measurement in pre-vascular surgical risk stratification. In particular, the establishment of a universally accepted NLR cut-off value is of importance in real-world implementation of this biomarker.
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Affiliation(s)
- Sarah M Jackson
- Department of Anaesthesia, 90134Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Luke A Perry
- Department of Anaesthesia, 90134Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Carla Borg
- Department of Surgery, 22457Monash University, Clayton, Victoria, Australia
| | - Dhruvesh M Ramson
- Department of Surgery, 22457Monash University, Clayton, Victoria, Australia
| | - Ryan Campbell
- Department of Anaesthesia, 90134Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Zhengyang Liu
- Department of Anaesthesia, 90134Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Jacqueline Nguyen
- Department of Anaesthesia, 90134Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Ned Douglas
- Department of Anaesthesia, 90134Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Juliana Kok
- Department of Anaesthesia, 90134Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jahan Penny-Dimri
- Department of Surgery, 22457Monash University, Clayton, Victoria, Australia
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16
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Xu Y, Fang H, Qiu Z, Cheng X. Prognostic role of neutrophil-to-lymphocyte ratio in aortic disease: a meta-analysis of observational studies. J Cardiothorac Surg 2020; 15:215. [PMID: 32778122 PMCID: PMC7419193 DOI: 10.1186/s13019-020-01263-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/03/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Recent studies have reported that neutrophil-to-lymphocyte ratio (NLR) is associated with cardiovascular disease. The aim of the present study was to investigate the prognostic value of NLR in aortic disease. METHODS We systematically searched electronic databases (Cochrane, PubMed, Elsevier, Medline, and Embase) from their inception to March 2020. Observational studies that evaluated the relationship between NLR and aortic disease were eligible for critical appraisal. Data were extracted from applicable articles, risk ratio (RR), weighted mean differences (MD) and 95% confidence intervals (CI) were calculated by RevMan 5.3, and statistical heterogeneity was assessed by the I2 statistic. RESULTS Fourteen studies enrolling 4066 individuals were included in the meta-analysis. Compared with the control group, NLR was significantly higher in the aortic disease group (MD 3.44, 95%CI: 0.81-6.07, P = 0.01, I2 = 99%). The NLR was also significantly higher in non-survivors with aortic disease, compared to the survivors (MD 4.62, 95%CI: 2.75-6.50, P < 0.00001, I2 = 60%). Compared with the aortic disease patients with a low NLR, mortality was significantly higher in those with a high NLR (RR 2.63, 95%CI: 1.79-3.86, P < 0.00001, I2 = 67%). CONCLUSION Based on current evidence, an elevated NLR was associated with aortic disease and in-hospital mortality. Raised NLR also demonstrated a significantly increased the risk of mortality after surgical repair in aortic disease patients. NLR may be a good prognostic biomarker in aortic disease and deserve further research in this area.
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Affiliation(s)
- Yan Xu
- Department of Cardiovascular Medicine, Institute of Cardiovascular disease, Second Affiliated Hospital of Nanchang University, Nan Chang, Jiang Xi, 330006, PR China
| | - Haiyang Fang
- Department of Cardiovascular Medicine, Institute of Cardiovascular disease, Second Affiliated Hospital of Nanchang University, Nan Chang, Jiang Xi, 330006, PR China
| | - Zhiqiang Qiu
- Department of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, Institute of Cardiovascular disease, Second Affiliated Hospital of Nanchang University, Nan Chang, Jiang Xi, 330006, PR China.
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17
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Cho A, Czech T, Wang WT, Dodier P, Reinprecht A, Bavinzski G. Peri-interventional Behavior of the Neutrophil to Lymphocyte Ratio in Patients with Intracranial Aneurysms. World Neurosurg 2020; 141:e223-e230. [PMID: 32434035 DOI: 10.1016/j.wneu.2020.05.084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The neutrophil-to-lymphocyte ratio (NLR) has been investigated as an independent predictive marker for clinical outcomes in vascular diseases. This study aimed to investigate the peri-interventional behavior of the NLR in patients with ruptured and unruptured intracranial aneurysms (IAs). METHODS A total of 117 patients with IAs, who were treated at our department and had available complete data, were retrospectively identified during a 10-year period. Routine laboratory parameters, including the neutrophil and lymphocytes counts, were evaluated before and after treatment. RESULTS The baseline NLR showed significant differences between patients with ruptured and unruptured IAs (6.3 vs. 1.8; P < 0.001). In patients with ruptured IAs, the baseline NLR decreased significantly during the follow-up visits, whereas in unruptured IAs, the NLR remained low. Furthermore, higher baseline NLR values could also be observed in patients with ruptured IAs and fatal outcome than in surviving patients (8.0 vs. 5.4; P = 0.220). In patients with poor functional outcome, defined as modified Rankin score ≥3, the NLR was significantly higher before treatment (P = 0.047), at day 10 (P = 0.025), and 1 month after treatment (P = 0.001). CONCLUSIONS The peri-interventional NLR was significantly different between patients with ruptured and unruptured IAs. In patients with ruptured IAs, elevated baseline NLR levels were associated with poor postoperative functional outcomes and decreased postoperatively, implying the potential prognostic value of NLR in patients with IAs.
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Affiliation(s)
- Anna Cho
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Wei-Te Wang
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Philippe Dodier
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Andrea Reinprecht
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Gerhard Bavinzski
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
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18
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King AH, Schmaier AH, Harth KC, Kumins NH, Wong VL, Zidar DA, Kashyap VS, Cho JS. Elevated neutrophil-lymphocyte ratio predicts mortality following elective endovascular aneurysm repair. J Vasc Surg 2020; 72:129-137. [PMID: 32037083 DOI: 10.1016/j.jvs.2019.10.058] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 10/06/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The neutrophil-lymphocyte ratio (NLR) is an inexpensive and useful inflammatory marker that incorporates the balance of the innate (neutrophil) and adaptive (lymphocyte) immune responses. Data exist on the association between NLR and mortality in various coronary diseases and in cancer surgery, but there is a paucity of data on the impact of preoperative NLR on vascular surgical outcomes. The aim of this study was to evaluate the relationship between preoperative NLR and elective endovascular aortic aneurysm repair (EVAR) outcome. METHODS A retrospective review of all patients who underwent elective EVAR at a single institution between 2010 and 2018 was conducted (n = 373). Only patients who had a preoperative complete blood count with differential within 30 days of their operation were included. The NLR was computed by dividing the absolute neutrophil count by the absolute lymphocyte count. A receiver operating characteristic curve was used to determine the optimal cutoff value of NLR with the strongest association with mortality. NLR was dichotomized so that patients with NLR above the threshold were at increased risk of mortality compared with those below it. Continuous variables were analyzed using Wilcoxon nonparametric signed-rank test and categorical variables with the Fisher exact test. A comparison of NLR and mortality was completed using Kaplan-Meier survival analysis. Cox regression analysis was used to evaluate factors associated with mortality through 5-year follow-up. RESULTS Overall, 108 patients were included in this study. An NLR ≥ 4.0 was found to be associated with mortality (P < .0001). Thirty-two patients composed the High-NLR (NLR ≥ 4.0) group and the remaining 76 patients formed the Low-NLR (NLR < 4.0) group. Baseline characteristics were similar between groups, except that the High-NLR group was older (77.9 vs 74.4; P = .047). At a mean of 36.4 months follow-up, the overall mortality rate was 32.4%. Although there were no differences in the perioperative period, the Kaplan-Meier estimates of mortality were significantly greater in the High-NLR group at 1, 2, and 5 years postoperatively (P < .0001). The mean preoperative NLR of the deceased was higher (5.94 ± 5.20; median, 4.75; interquartile range, 3.17-7.83) than those who survived (2.87 ± 1.61; median, 2.53; interquartile range, 1.97-3.49) (P < .0001). Secondary interventions and sac enlargement rates were similar between groups. On univariable analysis, NLR (hazard ratio [HR], 1.17; 95% confidence interval [CI], 1.10-1.23; P < .0001), age (HR, 1.06; 95% CI, 1.02-1.11; P = .004), and aneurysm diameter (HR, 1.04; 95% CI, 1.01-1.07; P = .003) were associated with mortality. On multivariable analysis, NLR (HR, 1.19; 95% CI, 1.12-1.27; P < .0001), age (HR, 1.06; 95% CI, 1.01-1.11; P = .026), and aneurysm diameter (HR, 1.04; 95% CI, 1.02-1.07; P = .003) were associated with mortality. CONCLUSIONS Patients with an elevated preoperative NLR, irrespective of other comorbidities, may represent a previously unrecognized subset of patients who are at heightened risk of mortality after elective EVAR. A complete blood count with differential is an inexpensive test that may be used as a prognostic indicator for outcome after EVAR. Further research is warranted to identify clinical, pathological, or anatomical factors associated with an elevated NLR and to determine modifiable factors, which may help improve long-term survival.
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Affiliation(s)
- Alexander H King
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Alvin H Schmaier
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Karem C Harth
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Norman H Kumins
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Virginia L Wong
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - David A Zidar
- Division of Cardiology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Vikram S Kashyap
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jae S Cho
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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19
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Bath J, Smith JB, Kruse RL, Vogel TR. Neutrophil-lymphocyte ratio predicts disease severity and outcome after lower extremity procedures. J Vasc Surg 2019; 72:622-631. [PMID: 31882318 DOI: 10.1016/j.jvs.2019.10.094] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/28/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Neutrophil-lymphocyte ratio (NLR) has been associated with inferior outcomes after lower extremity interventions. NLR has been associated with systemic inflammation and atherosclerotic burden. We examined NLR, severity of peripheral artery disease (PAD), and outcomes after endovascular or open surgical procedures. METHODS Inpatients undergoing lower extremity procedures (2008-2016) were selected from Cerner Health Facts database (Cerner Corporation, North Kansas City, Mo) using International Classification of Diseases, Ninth Revision procedure codes. Disease severity was grouped into claudication, rest pain, and tissue loss. Outcomes were identified using International Classification of Diseases, Ninth Revision codes. NLR was calculated preoperatively and postoperatively. A χ2 analysis and multivariable logistic regression were performed. A receiver operating characteristic curve analysis was used to determine the cutoff for preoperative (low, <3.65; high, ≥3.65) and postoperative (low, <5.96; high, ≥5.96) NLR values. RESULTS There were 3687 patients evaluated; 2183 (59%) underwent endovascular procedures and 1504 (41%) had open procedures. Compared with black patients, claudication was more frequent in white patients (81.7% vs 72.7%; P < .0001), and tissue loss was less common (12.9% vs 20.9%; P < .0001). NLR values were higher for patients with tissue loss than for patients with rest pain or claudication (4.89, 4.33, and 3.11, respectively; P < .0001). Open procedures were associated with higher postoperative NLR values than endovascular procedures (6.8 vs 5.2; P < .0001). Mean preoperative and postoperative NLR values were greater in patients with more severe PAD. Multivariable analysis demonstrated that preoperative high NLR was strongly associated with in-hospital death (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.68-17.07), cardiac complications (OR, 2.9; 95% CI, 1.57-5.40), amputation (OR, 2.5; 95% CI, 1.65-3.87), renal failure (OR, 1.9; 95% CI, 1.18-2.93), respiratory complications (OR, 1.7; 95% CI, 1.09-2.76), and prolonged length of stay (OR, 1.9; 95% CI, 1.89-3.71). CONCLUSIONS Preoperative and postoperative NLR significantly increases with disease severity for PAD, providing further evidence of NLR as a biomarker of a patient's systemic inflammatory state. After adjustment for confounders, NLR still remained strongly associated with death and other adverse outcomes after intervention for PAD. Further study of the clinical association of NLR with other vascular disorders, such as symptomatic carotid stenosis and symptomatic and ruptured aortic aneurysmal disease, is planned to guide individualized treatment to prevent stroke or aneurysm rupture.
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Affiliation(s)
- Jonathan Bath
- Division of Vascular Surgery, University of Missouri, Columbia, Mo.
| | - Jamie B Smith
- Department of Family and Community Medicine, University of Missouri, Columbia, Mo
| | - Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, Columbia, Mo
| | - Todd R Vogel
- Division of Vascular Surgery, University of Missouri, Columbia, Mo
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20
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Affiliation(s)
- Juliette Raffort
- Department of Clinical Biochemistry, University Hospital of Nice, Nice, France.,Université Côte d'Azur, CHU, Inserm U1065, C3M, Nice, France
| | - Fabien Lareyre
- Université Côte d'Azur, CHU, Inserm U1065, C3M, Nice, France.,Department of Vascular Surgery, University Hospital of Nice, Nice, France
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21
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Lareyre F, Carboni J, Chikande J, Massiot N, Voury-Pons A, Umbdenstock E, Jean-Baptiste E, Hassen-Khodja R, Raffort J. Association of Platelet to Lymphocyte Ratio and Risk of 30-Day Postoperative Complications in Patients Undergoing Abdominal Aortic Surgical Repair. Vasc Endovascular Surg 2018; 53:5-11. [DOI: 10.1177/1538574418789046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: The predictive value of the platelet to lymphocyte ratio (PLR) has been demonstrated in several cardiovascular diseases. The aim of this study was to investigate the interest of the preoperative PLR as a predictor of 30-day postoperative outcome in patients with abdominal aortic aneurysm (AAA) undergoing open or endovascular surgical repair. Material and Methods: Two hundred twenty-four consecutive patients with infrarenal AAA were retrospectively included and divided into 4 quartiles according to the value of the preoperative PLR: PLR < 91.5 (group I), 91.5 < PLR < 120.8 (group II), 120.8 < PLR < 163.3 (group III), and PLR > 163.3 (group IV). Results: The AAA diameter was similar among the groups (54.9 mm vs 58.6, 57.5, and 58.7 mm; P = .4655). The proportion of symptomatic AAA and the procedural characteristics did not differ. Patients from group I and IV had significantly higher rates of all-cause postoperative complications compared to group II and III (55.4% and 64.3% vs 39.3% and 46.4%, respectively; P = .0478). The all-cause mortality tended to be higher in group I and IV (7.1% and 8.9% vs 0% and 3.6%, respectively; P = .1305). Conclusion: Extreme values of PLR are associated with a higher risk of complications following AAA surgical repair, suggesting its interest as a biomarker to evaluate the surgical risk.
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Affiliation(s)
- Fabien Lareyre
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
- Université Côte d’Azur, CHU, Inserm U1065, C3M, Nice, France
| | - Joseph Carboni
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
| | - Julien Chikande
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
| | - Nicolas Massiot
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
| | - Audrey Voury-Pons
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
| | | | - Elixène Jean-Baptiste
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
- Université Côte d’Azur, CHU, Inserm U1065, C3M, Nice, France
| | - Réda Hassen-Khodja
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
- Université Côte d’Azur, CHU, Inserm U1065, C3M, Nice, France
| | - Juliette Raffort
- Université Côte d’Azur, CHU, Inserm U1065, C3M, Nice, France
- Clinical Chemistry Laboratory, University Hospital of Nice, Nice, France
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22
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Lareyre F, Raffort J, Le D, Chan HL, Houerou TL, Cochennec F, Touma J, Desgranges P. High Neutrophil to Lymphocyte Ratio Is Associated With Symptomatic and Ruptured Thoracic Aortic Aneurysm. Angiology 2018; 69:686-691. [PMID: 29334754 DOI: 10.1177/0003319717751758] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The predictive value of the neutrophil to lymphocyte ratio (NLR) has been demonstrated in several cardiovascular diseases. The aim of our study was to investigate the association between the preoperative NLR and aneurysm characteristics as well as 30-day postoperative morbidity and mortality in patients with thoracic aortic aneurysm (TAA) undergoing aortic surgical repair. Consecutive patients (n = 75) with TAA were retrospectively included over a 10-year period. Clinical characteristics, aneurysm characteristics, and 30-day postoperative outcome were recorded. The median age of patients was 71 (67-80) years. The median preoperative NLR was 3.5 (2.3-5.8). The proportion of asymptomatic TAA was significantly lower in patients with an NLR > 3.5 compared with those with an NLR < 3.5 (52.6% vs 75.7%; P = .054). The proportion of patients with pain or with ruptured TAA was significantly higher in patients with an NLR > 3.5 compared with those with NLR < 3.5 (42.1% vs 16.2%; P = .022 and 26.3% vs 2.7%; P = .007, respectively). No significant difference was observed regarding the 30-day overall postoperative mortality and morbidity. The preoperative NLR did not correlate with TAA diameter. A high preoperative NLR is significantly associated with symptomatic and ruptured TAA, suggesting a potential interest as a marker and/or player in the disease.
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Affiliation(s)
- Fabien Lareyre
- 1 Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, Paris, France.,2 Department of Vascular Surgery, University Hospital of Nice, Nice, France.,3 Université Côte d'Azur, CNRS, Inserm, IRCAN, Nice, France
| | - Juliette Raffort
- 3 Université Côte d'Azur, CNRS, Inserm, IRCAN, Nice, France.,4 Clinical Chemistry Laboratory, University Hospital of Nice, Nice, France
| | - Duy Le
- 1 Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, Paris, France
| | - Hon Lai Chan
- 1 Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, Paris, France
| | - Thomas Le Houerou
- 1 Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, Paris, France
| | - Frédéric Cochennec
- 1 Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, Paris, France
| | - Joseph Touma
- 1 Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, Paris, France
| | - Pascal Desgranges
- 1 Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, Paris, France
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Preoperative White Blood Cell Count in Patients with Abdominal Aortic Aneurysms and Its Relation to Survival following Surgery. Ann Vasc Surg 2017; 41:127-134. [DOI: 10.1016/j.avsg.2016.08.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 11/22/2022]
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Szumilowicz P, Wiernicki I, Kazimierczak A, Golubinska-Szemitko E, Zurkowska J, Kasprzak P. Significant changes in combined consistent biomarkers and CTAngiography revealed during an interval of 6months before abdominal aortic aneurysm rupture. Am J Emerg Med 2017; 35:1039.e1-1039.e3. [PMID: 28274712 DOI: 10.1016/j.ajem.2017.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 02/25/2017] [Indexed: 10/20/2022] Open
Abstract
The most commonly used predictor of rupture of abdominal aortic aneurysm (AAA) is the diameter, but this does not correlate well with the risk of rupture. Therefore, in order to make further improvements in clinical decisions regarding AAA patients, the development of additional predictive tools other than aneurysm size alone is needed. We herein report a case of a 72-year-old man with AAA that underwent rupture transformation during six months. We review the morphological features changes detected by computed tomography and also observe several alters circulating biomarkers at the same time. In the study presented essentially an association of those combined parameters with the risk of AAA impending rupture.
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Affiliation(s)
- Pawel Szumilowicz
- Department of Vascular Surgery and Angiology, Pomeranian Medical University, Szczecin, Poland
| | - Ireneusz Wiernicki
- Department of Vascular Surgery and Angiology, Pomeranian Medical University, Szczecin, Poland.
| | - Arkadiusz Kazimierczak
- Department of Vascular Surgery and Angiology, Pomeranian Medical University, Szczecin, Poland
| | | | - Joanna Zurkowska
- Student's Scientific Circle of Vascular Diseases affiliated with the Department of Vascular Surgery and Angiology, Pomeranian Medical University, Szczecin, Poland
| | - Piotr Kasprzak
- Student's Scientific Circle of Vascular Diseases affiliated with the Department of Vascular Surgery and Angiology, Pomeranian Medical University, Szczecin, Poland
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25
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Balta S, Celik T, Mikhailidis DP, Ozturk C, Demirkol S, Aparci M, Iyisoy A. The Relation Between Atherosclerosis and the Neutrophil–Lymphocyte Ratio. Clin Appl Thromb Hemost 2016; 22:405-411. [DOI: 10.1177/1076029615569568] [Citation(s) in RCA: 235] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Inflammation plays an important role in the pathophysiology of vascular disease. In this review, we consider the associations between the neutrophil–lymphocyte ratio (NLR; an indicator of inflammation) and vascular disease and its associated risk factors. The NLR has received attention due to its role as an independent prognostic factor for coronary artery disease. The NLR can also be affected by atherosclerotic risk factors, such as hypercholesterolemia, metabolic syndrome, diabetes, and hypertension. Importantly, it can predict mortality in cardiovascular diseases. There are also reports of a positive correlation between the NLR and commonly used inflammatory markers. Inflammation is important not only in pathophysiology but also clinical outcomes of many diseases. The NLR is a widely available, easily derived, and reproducible marker of inflammation. Unlike many other inflammatory markers, the NLR is inexpensive and readily available and it provides additional risk stratification beyond conventional risk scores.
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Affiliation(s)
- Sevket Balta
- Department of Cardiology, Eskisehir Military Hospital, Eskişehir, Turkey
| | - Turgay Celik
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, University College London Medical School London, University College London (UCL), London, England
| | - Cengiz Ozturk
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Sait Demirkol
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Mustafa Aparci
- Department of Cardiology, Etimesgut Military Hospital, Ankara, Turkey
| | - Atila Iyisoy
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
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26
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Bhat TM, Afari ME, Garcia LA. Neutrophil lymphocyte ratio in peripheral vascular disease: a review. Expert Rev Cardiovasc Ther 2016; 14:871-5. [DOI: 10.1586/14779072.2016.1165091] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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27
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Sbarouni E, Georgiadou P, Analitis A, Voudris V. High neutrophil to lymphocyte ratio in type A acute aortic dissection facilitates diagnosis and predicts worse outcome. Expert Rev Mol Diagn 2015; 15:965-70. [PMID: 25980377 DOI: 10.1586/14737159.2015.1042367] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The authors investigated whether neutrophil to lymphocyte ratio (N/L) can contribute to the diagnosis and risk assessment in patients with type A acute aortic dissection (AAD). METHODS The authors studied 120 consecutive patients with type A AAD (group I) and compared them with 121 consecutive patients with chronic aneurysms (group II) and 121 age- and sex-matched healthy subjects (group III). RESULT It was found that white blood cell count, N/L, D-dimer and C-reactive protein were significantly higher in group I versus both groups II and III (p < 0.001 for all comparisons). White blood cell count and D-dimer were much higher in patients who died compared to survivors in group I (p = 0.023 and p = 0.033, respectively). A cutoff value of N/L >4.6 was associated with 0.89 sensitivity and 0.91 specificity for AAD. CONCLUSION High N/L may contribute to the diagnostic evaluation and prompt immediate therapy in patients with type A AAD.
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Affiliation(s)
- Eftihia Sbarouni
- Second Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
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28
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Neutrophil to lymphocyte ratio (NLR) of five predicts 30-day morbidity in ruptured abdominal aortic aneurysms (rAAA): A retrospective cohort study. Int J Surg 2015; 15:45-8. [DOI: 10.1016/j.ijsu.2015.01.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 01/15/2015] [Accepted: 01/20/2015] [Indexed: 11/18/2022]
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29
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Ikenaga H, Kurisu S, Watanabe N, Shimonaga T, Higaki T, Iwasaki T, Utsunomiya H, Mitsuba N, Ishibashi K, Dohi Y, Fukuda Y, Imai K, Sueda T, Kihara Y. Predictive value of neutrophil to lymphocyte ratio for the presence of coronary artery ectasia in patients with aortic aneurysms. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2014; 4:30-34. [PMID: 29450182 PMCID: PMC5801477 DOI: 10.1016/j.ijchv.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/05/2014] [Accepted: 08/10/2014] [Indexed: 12/13/2022]
Abstract
Background Both aortic aneurysms and coronary artery ectasia (CAE) frequently coexist and are associated with more pronounced inflammation. Neutrophil to lymphocyte ratio (NL ratio) is widely used as a marker of inflammation. However, relation between CAE and NL ratio in patients with aortic aneurysms is not fully understood. This study was undertaken to assess relation between CAE and NL ratio in patients with aortic aneurysms. Methods This study consisted of 93 consecutive patients with aortic aneurysms (AA group) and 79 patients without aortic aneurysms who had angiographically normal coronary arteries as the control group. Moreover, patients with aortic aneurysms were classified into two groups based on the presence of CAE; CAE (+) group (n = 44) and CAE (−) group (n = 49). We compared blood chemical parameters in both groups. Results In the AA group, 44 patients (47.3%) had CAE. The AA group had a significantly higher NL ratio than the control group (2.93 ± 1.43 vs. 2.45 ± 1.05, p = 0.027). Furthermore, the CAE (+) group had a significantly higher NL ratio than the CAE (−) group (3.39 ± 1.67 vs. 2.52 ± 1.04, p < 0.01). Multivariate logistic regression analysis revealed that the high NL ratio was an independent predictor for CAE in patients with aortic aneurysms (odds ratio 1.76, 95% confidence interval 1.24–2.69, p = 0.001). Conclusions Patients with aortic aneurysms had a significantly higher NL ratio than those without aortic aneurysms. Furthermore, the NL ratio might predict the presence of CAE in patients with aortic aneurysms.
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Affiliation(s)
- Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Noriaki Watanabe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takashi Shimonaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tadanao Higaki
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Toshitaka Iwasaki
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroto Utsunomiya
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Naoya Mitsuba
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ken Ishibashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshihiro Dohi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Taijiro Sueda
- Department of Cardiovascular Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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