Neutrophil to lymphocyte ratio: a novel marker for predicting hospital mortality of patients with acute type A aortic dissection

Kalkan, Mehmet; Kalkan, Ali Kemal; Gündeş, Ahmet; Yanartaş, Mehmed; Öztürk, Şule; Gürbüz, Ahmet Seyfeddin; Öztürk, Derya; İyigün, Taner; Akçakoyun, Mustafa; Emiroğlu, Mehmet Yunus; Tunçer, Mehmet Altuğ; Köksal, Cengiz

doi:10.1177/0267659115590625

Cited by 43 publications

(50 citation statements)

References 34 publications

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“…In previous studies, an increase in NLR level was shown to be associated with increased mortality in patients with Stanford type B and DeBakey type 1 acute aortic dissection (15,16). In this study, although higher NLR values were obtained in DeBakey type 2 cases compared to other types, the difference was not statistically significant (p=0.549).…”

Section: Discussioncontrasting

confidence: 74%

Analysis of Relationship Between Imaging Features of Aortic Dissection and Blood Parameters

Algın¹,

Akça²,

Özdemir³

et al. 2020

Haseki

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Aimed to evaluate the relationship of serum biochemical and blood parameters with aortic rupture and dissection types according to the DeBakey classification. Methods: Forty-three patients, who were admitted to the emergency department between 01.01.2011 and 01.01.2019 with the diagnosis of aortic dissection, were retrospectively evaluated. Gender, age, symptoms at presentation, vital parameters, creatinine and, troponin levels, and hemogram parameters were recorded after blood tests. Neutrophil-tolymphocyte ratio and monocyte-to-platelet ratio were obtained from these values. These results were compared with the presence of aortic rupture and the DeBakey classification. Results: Of the 43 patients included in the study, 30 were male (69.8%), and 13 were female (30.2%). Aortic rupture was seen in two of the 30 male patients (6.7%) and none of the females (p=1.000). There was a significant difference only in blood urine nitrogen and monocyte-to-platelet ratio between patients with and without aortic rupture (p=0.035 and p=0.015, respectively). Conclusion: Most of the routinely evaluated blood and biochemical parameters in aortic dissection cases did not yield significant results in comparison to the DeBakey classification and the presence of rupture. Only blood urea nitrogen and monocyte-to-platelet ratio values were lower in patients with aortic rupture.

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Section: Discussioncontrasting

confidence: 74%

Analysis of Relationship Between Imaging Features of Aortic Dissection and Blood Parameters

Algın¹,

Akça²,

Özdemir³

et al. 2020

Haseki

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“…Elevation of the WBC count is a well-known acute phase reaction in patients with aortic dissection and several studies have already investigated the effect of WBC count elevation in ATAAD [12][13][14]. Fan et al used a cut-off value of 11.0 x 10 3 /μL to define WBC elevation and reported that in-hospital mortality was worse for patients with an elevated WBC count (n = 216) than for patients with a normal WBC count (n = 354) [14].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with ATAAD, hemodynamic instability can occur as a result of cardiac tamponade or aortic insufficiency, and emergency aortic repair under cardiopulmonary bypass induces a strong perioperative inflammatory response, making investigation of the early inflammatory response more complicated. Nevertheless, there is evidence that systemic inflammation characterized by elevation of the white blood cell (WBC) count [12][13][14] or an increased neutrophil/lymphocyte ratio [13,15,16] influences outcomes in patients with ATAAD. Although biomarkers of disordered coagulation and fibrinolysis D-dimer and fibrin degradation products have been well studied in relation to acute aortic dissection [17][18][19], WBC count elevation and its etiology in cases of acute aortic dissection have not been fully elucidated, and the relation between WBC elevation and dissection morphology is poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Factors related to white blood cell elevation in acute type A aortic dissection

et al. 2020

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Aortic dissection may induce a systemic inflammatory reaction. The etiological backgrounds for elevation of the white blood cell count remain to be clarified. In 466 patients with acute type A aortic dissection treated surgically within 48 hours of symptom onset, the etiologic background of an elevated admission white blood cell count and the effect of such elevation on outcomes were assessed retrospectively. Patients' white blood cell count differed significantly in relation to the extent of dissection, with a median (25th, 75th percentile) white blood cell count of 10.4 (8.1, 13.9) x 10 3 /μL for dissection confined to the ascending aorta, 10.5 (8.2,13.) 10 3 /μL for dissection extending to the aortic arch/descending aorta, 11.1 (8.2, 13.7) x 10 3 /μL for extension to the abdominal aorta, and 13.3 (9.8, 15.9) x 10 3 /μL for extension to the iliac artery (p<0.001). With 11.0 x 10 3/ μL used as the cutoff value for white blood cell count elevation, multivariable analysis showed current smoking (p<0.001; odds ratio, 2.79), dissection extending to the iliac artery (p = 0.006; odds ratio, 1.79), age (p = 0.007, odds ratio, 0.98), and no coronary ischemia (p = 0.027, odds ratio, 2.22) to be factors related to the elevated white blood cell count. Mean age differed significantly between patients with and without an elevated white blood cell count (62.3 vs. 68.3 years, p <0.001). Although inhospital mortality was similar (7.5% vs.10.9%, p = 0.19), 5-year survival was lower in patients without an elevated count (85.7% vs. 78.6%, p = 0.019), reflecting their more advanced age. In conclusion, our data suggest that dissection morphology and patient age influence the acute phase systemic inflammatory response associated with an elevated white blood cell count in patients with ATAAD. A better understanding of this relation may help optimize diagnosis and perioperative care.

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“…[14] However, there is a growing interest in bedside risk assessment for in-hospital death, and in many current research studies, several biomarkers of vascular damage, thrombosis, and inflammation have been evaluated as contributors in the diagnosis of AAD or as risk prediction tools. [1617181920]…”

Section: Discussionmentioning

confidence: 99%

“…[29] also revealed that patients who had serious clinical symptoms and developed disease progression had higher inflammatory cell activity in the aortic wall than asymptomatic and clinically stable patients. More interestingly, there is now substantial evidence to suggest that increased circulating inflammatory markers such as CRP,[18] neutrophil-to-lymphocyte ratio,[19] and WBC count[20] could predict clinical events in patients with acute TAAD, especially death during hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Association of Plasma Pentraxin-3 Levels on Admission with In-hospital Mortality in Patients with Acute Type A Aortic Dissection

Zhou

Chai

Fang

et al. 2016

Chinese Medical Journal

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Background:Acute aortic dissection is a life-threatening cardiovascular emergency. Pentraxin-3 (PTX3) is proposed as a prognostic marker and found to be related to worse clinical outcomes in various cardiovascular diseases. This study sought to investigate the association of circulating PTX3 levels with in-hospital mortality in patients with acute Type A aortic dissection (TAAD).Methods:A total of 98 patients with TAAD between January 2012 and December 2015 were enrolled in this study. Plasma concentrations of PTX3 were measured upon admission using a high-sensitivity enzyme-linked immunosorbent assay system. Patients were divided into two groups as patients died during hospitalization (Group 1) and those who survived (Group 2). The clinical, laboratory variables, and imaging findings were analyzed between the two groups, and predictors for in-hospital mortality were evaluated using multivariate analysis.Results:During the hospital stay, 32 (33%) patients died and 66 (67%) survived. The patients who died during hospitalization had significantly higher PTX3 levels on admission compared to those who survived. Pearson's correlation analysis demonstrated that PTX3 correlated positively with high-sensitivity C-reactive protein (hsCRP), maximum white blood cell count, and aortic diameter. Multivariate logistic regression analysis demonstrated that PTX3 levels, coronary involvement, cardiac tamponade, and a conservative treatment strategy are significant independent predictors of in-hospital mortality in patients with TAAD. The receiver operating characteristic curve analysis further illustrated that PTX3 levels on admission were strong predictors of mortality with an area under the curve of 0.89. A PTX3 level ≥5.46 ng/ml showed a sensitivity of 88% and a specificity of 79%, and an hsCRP concentration ≥9.5 mg/L had a sensitivity of 80% and a specificity of 69% for predicting in-hospital mortality.Conclusion:High PTX3 levels on admission are independently associated with the in-hospital mortality in patients with TAAD.

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Neutrophil to lymphocyte ratio: a novel marker for predicting hospital mortality of patients with acute type A aortic dissection

Abstract: The novel inflammatory marker NLR may be used to predict worse outcomes and hospital mortality in patients with AAD treated by surgical repair.

Cited by 43 publications

References 34 publications

Analysis of Relationship Between Imaging Features of Aortic Dissection and Blood Parameters

Analysis of Relationship Between Imaging Features of Aortic Dissection and Blood Parameters

Factors related to white blood cell elevation in acute type A aortic dissection

Association of Plasma Pentraxin-3 Levels on Admission with In-hospital Mortality in Patients with Acute Type A Aortic Dissection

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