Cellular Indices and Outcome in Patients with Acute Venous Thromboembolism

Abstract

Background Cellular indices provide integrative information about systemic inflammation status which is readily available from routine laboratory parameters. This study aimed to evaluate the prognostic role of three cellular indices in patients with venous thromboembolism (VTE). Methods The RIETE registry database was used to determine the association between the baseline neutrophil-to-lymphocyte-ratio (NLR), platelet-to-lymphocyte-ratio (PLR) and systemic-immune-inflammation-index (SII) for 90-day adverse outcomes in patients with acute VTE. Results From January 2020 to April 2021, 4487 patients with acute VTE were recruited in the RIETE registry. Of these, 2683 presented with symptomatic pulmonary embolism (PE); 283 with incidental PE; 1129 with lower-limb deep vein thrombosis (DVT); 175 with upper-limb DVT; 69 with splanchnic vein thrombosis; 142 with superficial vein thrombosis and 20 with retinal vein thrombosis. Mean values were: NLR 5.9 ± 7.1, PLR 190 ± 158 and SII 1459 ± 2028. During the first 90-days, 38 patients (0.8%) developed recurrent DVT, 45 (1.0%) had recurrent PE, 152 (3.4%) suffered major bleeding, and 484 (11%) died. On multivariable analysis, patients with NLR >4.41 were at an increased risk for major bleeding and patients with NLR >4.96 were at the risk of death, while those with SII >1134.5 were at increased risk for death. Conclusions This study reports the results of a large cohort to date which evaluate the prognostic value of three cellular indices simultaneously in patients with acute VTE. Results support that none of the three baseline cellular indices were sufficient for prediction of VTE recurrences in acute VTE patients. The patients with higher baseline NLR values were at an increased risk of major bleeding or death, those with high SII values were only at an increased risk for mortality.

The Diagnostic Value of the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Deep Venous Thrombosis: A Systematic Review and Meta-Analysis

“…Siddiqui et al found that of 4487 patients, 152 (3.4%) suffered major bleeding and 484 (11%) died, indicating there may be an increased risk of major bleeding or death with higher baseline NLR values among patients with VTE. 41 In addition, a large population-based cohort showed similar associations between mortality and VTE. 42 Higher NLRs and PLRs have also been shown to be associated with poorer short-term and long-term prognosis, increased mortality, and longer hospitalization in patients with PE.…”

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as predictors of mortality in acute pulmonary embolism: A systematic review and meta-analysis

“…Duplicates amongst those were removed leaving 1568 results. One thousand five hundred forty of those were excluded due to non-relevance and 28 studies were selected for full-text analysis and 15 9,[13][14][15][16][20][21][22][23][24][25][26][27][28][29] were included.…”

“…[7][8][9][10][11][12] Similarly, numerous studies have examined the relationship between NLR and PLR and the outcomes of PE. [13][14][15][16] While some studies 15,16 indicate that these indices are predictive of mortality, few suggest otherwise. 13,14 Given the variable results, there is a need for a comprehensive systematic review.…”

The Association of Neutrophil–Lymphocyte Ratio with Venous Thromboembolism: A Systematic Review and Meta-Analysis

“… 29 Siddiqui et al found VTE patients with higher baseline NLR values were at an increased risk of major bleeding or death. 30 In addition to predicting mortality, Jia et al found NLR was predictive of right ventricular dysfunction. 31 A previous meta-analysis including 1424 patients from 6 retrospective studies found high NLR has a sensitivity of 77% and a specificity of 74% in predicting short-term mortality.…”