Neutrophil-to-Lymphocyte Ratio and Its Association with Critical Limb Ischemia in PAOD Patients

Abstract

BackgroundThe Neutrophil-to-Lymphocyte ratio (NLR) is an easy to perform test from the white blood cell count. An increase in NLR has been associated with vascular endpoints reflecting inflammation in atherosclerotic lesions. Atherosclerosis is a global threat and vascular endpoints, like myocardial infarction or critical limb ischemia (CLI), are a leading cause of death in industrialized countries. We therefore investigated NLR and its association with CLI and other vascular endpoints in peripheral arterial occlusive disease (PAOD) patients.Methods and FindingsWe evaluated 2121 PAOD patients treated at our institution from 2005 to 2010. NLR was calculated and the cohort was divided into tertiles according to the NLR. An optimal cut-off value for the continuous NLR was calculated by applying a receiver operating curve analysis to discriminate between CLI and non-CLI. In our cohort occurrence of CLI significantly increased with an increase in NLR. As an optimal cut-off a NLR of 3.95 was identified. Two groups were categorized, one containing 1441 patients (NLR≤3.95) and a second group with 680 patients (NLR>3.95). CLI was more frequent in NLR>3.95 patients (330(48.5%)) compared to NLR≤3.95 patients (350(24.3%)) (p<0.001), as were prior myocardial infarction (48(7.0%) vs. 47(3.3%), p<0.001) and stroke (73(10.7) vs. 98(6.8%), p<0.001). Regarding other inflammatory parameters, C-reactive protein (median 5.6 mg/l (2.3–19.1) vs. median 3 mg/l (1.5–5.5)) and fibrinogen (median 412 mg/dl (345.5–507.5) vs. 344 mg/dl (308–403.5)) also significantly differed in the two patient groups (both p<0.001). A NLR>3.95 was associated with an OR of 2.5 (95%CI 2.3–2.7) for CLI even after adjustment for other vascular risk factors.ConclusionsAn increased NLR is significantly associated with patients at high risk for CLI and other vascular endpoints. The NLR is an easy to perform test, which could be used to highlight patients at high risk for vascular endpoints.

Neutrophil/lymphocyte ratio as a predictor of cardiovascular events in incident dialysis patients: a Japanese prospective cohort study

“…Since increasing neutrophil count reflects inflammation and lower lymphocyte counts may reflect general stress and malnutrition, NLR is hypothesized to be more sensitive at detecting patients at high risk for CVD. Indeed, NLR has been found to be a valuable index for predicting adverse clinical outcomes and estimates survival in various clinical settings in oncology [5] and cardiology practices [6][7][8]. Moreover, recently, NLR was associated with loss of renal function [9] and endothelial dysfunction [10] in CKD patients.…”

Does Neutrophil to Lymphocyte Ratio Tell Something About Atherosclerosis in Hemodialysis Patients?

“…In a study, NLR was found to be associated with the severity of coronary artery disease and 30year survival (7). In patients with peripheral arterial disease NLR was associated with ischemic event risk (9). In a cross-sectional study in 2013, NLR was positively correlated with IL-6 and CRP while negatively correlated with serum albumin levels in predialysis and dialysis patients.…”

“…Inflammation has a central role in the pathogenesis of atherosclerosis (13). NLR is being used as a new inflammatory marker in many diseases to identify higher risk patients (7)(8)(9)16,17). In a study, NLR was found to be associated with the severity of coronary artery disease and 30year survival (7).…”

“…NLR may be sensitive in detecting cardiovascular risk. NLR was found to be associated with increased adverse outcomes in oncologic (6) and cardiovascular diseases (7)(8)(9). In chronic kidney disease (CKD), NLR was related to renal functional deterioration (10) and endothelial dysfunction (11).…”

Neutrophil/lymphocyte ratio: A promising prognostic marker in patients with chronic kidney disease

“…NLR is being widely used to identify high-risk patients with various illnesses, including cancer [39] and CVD [39][40][41][42] . In our paper, we discussed NLR and clinical outcomes in patients with ESRD.…”