Neutrophil-to-Lymphocyte Ratio Could Predict Outcome in Patients Presenting with Acute Limb Ischemia

Abstract

Introduction: Acute limb ischemia (ALI), classified according to Rutherford’s classification (RC), is a vascular emergency burdened by high rates of mortality and morbidity. The need of new and different prognostic values for ALI has emerged, and, among all, the neutrophil-to-lymphocyte ratio (NLR) has been proven as a strong outcome predictor in vascular disease. The aim of this study is to investigate the role of preoperative NLR in predicting clinical outcomes in patients presenting acute limb ischemia. Material and Methods: A single-center retrospective study was conducted between January 2015 and December 2019. Demographic and clinical characteristics, procedural technical aspects, postoperative and early (up to 30-day) outcomes were recorded. All enrolled patients were categorized into low- and high-NLR at baseline, using a cut-off value of 5. Study outcomes were 30-day all-cause mortality and amputation rates. Results: A total of 177 ALI patients were included in the final analysis (6 RC I, 44 RC IIA, 108 RC IIB, and 19 RC III), 115 males (65%), mean age 78.9 ± 10.4 years. Mean NLR at hospital presentation was 6.65 ± 6.75 (range 0.5–35.4), 108 (61.1%) patients presented a low-NLR, 69 (38.9%) a high-NLR. Immediate technical success was achieved in 90.1% of cases. At 30 days, freedom from amputation and freedom from death rates were 87.1% and 83.6%, respectively. At the univariate analysis, amputation (p < 0.0001, OR: 9.65, 95%CI: 3.7–25.19), mortality (p = 0.0001, OR: 9.88, 95%CI: 3.19–30.57), and cumulative event rates (p < 0.001, OR: 14.45, 95%CI: 6.1–34.21), were significantly different between the two groups according to NLR value. Multivariate analysis showed that a high baseline NLR value was an independent predictor of unfavorable outcomes in all enrolled patients. Consistently, at ROC analysis, a preoperative NLR > 5 was strongly associated with all outcome occurrences. Conclusion: Preoperative NLR value seems to be strongly related to ALI outcomes in this unselected population. The largest series should be evaluated to confirm present results.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Impact on Predicting Outcomes in Patients with Acute Limb Ischemia

“…Elevated NLR and PLR levels in peripheral artery disease have been linked to increased amputation rates, severe cardiovascular events, and death [ 32 , 33 ]. High values of these ratios were also associated with poor outcomes in the evolution of specific diseases, such as abdominal aortic aneurysm (AAA), chronic threatening limb ischemia (CTLI), and other cardiovascular emergencies [ 13 , 27 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. These biomarkers also proved to be predictive in oncology and oncological surgery, particularly in colorectal cancer, pancreatic cancer, gastric cancer, and cardiology and cardiac surgery [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 44 , 45 , 46 ].…”

“…Furthermore, the most extensively studied biomarker is NLR, without associating the other biomarker in acute scenarios. The most recent papers regarding the predictive role of NLR in ALI are that of Taurino et al [ 27 ], Tasoglu et al [ 28 ], and Pasqui et al [ 29 ], who established that an NLR > 5 NLR was strongly associated with poor outcomes in ALI patients.…”

Hemoglobin-to-Red-Cell Distribution Width Ratio Is a Novel Predictor of Long-Term Patient Outcomes After Percutaneous Coronary Intervention: A Retrospective Cohort Study

“…NLR can perform risk stratification and prognosis assessment for patients with ACS. Previous studies have also shown that NLR is not only a reliable marker of mortality and amputation stratification in patients with acute limb ischemia, but also an independent prognostic factor for the 30-day morbidity of ruptured abdominal aortic aneurysms (rAAA) (56)(57)(58).…”

Neutrophil-to-Lymphocyte Ratio Predicts Restenosis After Drug-Coated Balloon Therapy for Femoropopliteal Artery Lesions: A Retrospective Study

“…Teperman et al found that elevated NLR was an indicator of severe multilevel PAD (35). In another study by Taurino et al, the authors found that preoperative NLR level was related to acute limb ischemia outcomes in unselected population (36). Importantly, NLR is easy to obtain and can be directly calculated based on the data of blood cell counts in routine laboratory tests of patients, without increasing the medical expenses of patients and the workload of doctors.…”