Neutrophil to Lymphocyte Ratio as a Predictor of Outcomes after Amputation

Pierre-Louis, Willythssa; Bath, Jonathan; Mikkilineni, Sesank; Scott, Michael C.; Harlander-Locke, Michael P.; Rasor, Zachary; Smeds, Matthew R.

doi:10.1016/j.avsg.2018.10.002

Cited by 13 publications

(14 citation statements)

References 27 publications

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“…The 14 studies included were published between 2010 and 2019 and together involved 5,652 participants, 20- 33 from a wide variety of ethnic backgrounds and healthcare contexts. The majority (10 out of 14) of included studies were retrospective observational cohort studies using prospectively maintained hospital databases to select and analyze data from patients meeting their study criteria over the course of pre-defined years.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies incorporated in this review were prospective observational cohort studies, reporting data relevant to our review, 20,26,30 and one study was a case-control design reporting relevant data. 28 All studies analyzed preoperatively measured NLR in patients who had undergone vascular surgery (not involving cardiac or neurosurgical operations). All studies had 80 patients or more, 2 of which had over 1,000 participants.…”

Section: Resultsmentioning

confidence: 99%

“…Otherwise there was only a small amount of uncertainty regarding outcomes, time-to-outcome, data analysis, and attrition rate in some studies; and these were deemed at an unclear risk of bias. 24,26,28,30…”

Section: Resultsmentioning

confidence: 99%

“…Otherwise there was only a small amount of uncertainty regarding outcomes, time-tooutcome, data analysis, and attrition rate in some studies; and these were deemed at an unclear risk of bias. 24,26,28,30 Long-Term Mortality Meta-analysis of 7 studies involving 3,637 patients found a moderate association between elevated preoperative NLR and long-term mortality after vascular surgery, which reached statistical significance (HR 1.40[95%CI: 1.13-1.74]) ( Figure 2-Long-term Mortality). 21,22,23,29,31,34 There was moderate between-study heterogeneity (chi-squared 60.8%).…”

Section: Methodological Qualitymentioning

confidence: 99%

“…27,29 One study looked at the mean preoperative NLR of those in the study who had died, and those who had not. 28…”

Section: Description Of Included Studiesmentioning

confidence: 99%

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Prognostic Significance of Preoperative Neutrophil-Lymphocyte Ratio in Vascular Surgery: Systematic Review and Meta-Analysis

Jackson

Perry

Borg

et al. 2020

Vasc Endovascular Surg

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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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