Pre-operative Neutrophil to Lymphocyte Ratio is Associated With 30 Day Death or Amputation After Revascularisation for Acute Limb Ischaemia

Coelho, Nuno; Coelho, Andreia; Augusto, Rita; Semião, Carolina; Peixoto, João; Fernandes, Luís; Martins, Victor; Canedo, Alexandra; Gregório, Tiago

doi:10.1016/j.ejvs.2021.03.011

Cited by 27 publications

(17 citation statements)

References 27 publications

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“…In a study by Coelho et al, an NLR ≥ 5.4 was associated with a higher incidence of amputation and mortality (90.5% sensitivity and 73.6% specificity) in 345 RC IIA and IIB ALI [ 50 ]. Similarly, Pasqui et al proposed NLR cut-off values of 5.57 and 6.66 as prognostic factors for mortality and amputation, respectively, in 168 RC IIA and IIB ALI [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

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

Arbănași¹,

Mureșan

Coșarcă³

et al. 2022

Life

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Acute Limb Ischemia (ALI) of the lower limb is defined as a sudden drop in arterial limb perfusion, which is a medical emergency requiring prompt intervention with high amputation and mortality rates in the absence of revascularization. This observational, analytical, and retrospective cohort study with longitudinal follow-up aimed to confirm the relevance of the preoperative inflammatory biomarkers neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting the 30-day poor prognosis of patients with Rutherford classification (RC) grades II and III ALI. The ROC analysis found a strong association of an NLR > 4.33 with all studied outcomes, while a PLR > 143.34 was associated with all studied outcomes, except the composite endpoint in all RC stages. Depending on the optimal cut-off value, the ROC analysis found a higher incidence of all adverse outcomes in all high NLR (>4.33) and high PLR (>143.34) groups. A multivariate analysis showed that a high baseline value for NLR and PLR was an independent predictor of amputation (OR:11.09; 95% CI: 5.48–22.42; p < 0.0001; and OR:8.97; 95% CI: 4.44–18.16; p < 0.0001), mortality (OR:22.24; 95% CI: 9.61–51.47; p < 0.0001; and OR:8.32; 95% CI: 3.90–17.73; p < 0.0001), and composite endpoint (OR:21.93; 95% CI: 7.91–60.79; p < 0.0001; and OR:9.98; 95% CI: 3.89–25.55; p < 0.0001), respectively. Furthermore, for all hospitalized patients, the RC grade III (OR:7.33; 95% CI: 3.73–14.26; p < 0.0001) was an independent predictor of amputation (OR:7.33; 95% CI: 3.73–14.26; p < 0.0001), mortality (OR:8.40; 95% CI: 4.08–17.31; p < 0.0001), and composite endpoint (OR: 10.70; 95% CI: 4.48–25.56; p < 0.0001), respectively. The NLR and PLR are excellent predictors of risks associated with ALI for primary and secondary prevention. Our study showed that increased pre-operative values for NLR and PLR are indicators of a poor outcome in patients with RC grades II and III ALI.

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Section: Discussionmentioning

confidence: 99%

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

Arbănași¹,

Mureșan

Coșarcă³

et al. 2022

Life

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“…Last but not least, we obtained relevant data on some plasma biomarkers and mortality. NLR has been proposed as a marker of adverse complications in CV disease, malignancy, and infection [ 56 ]. In PAD, NLR was incorporated into the ERICVA score for the prediction of poor prognosis in patients with CLTI [ 57 ].…”

Section: Discussionmentioning

confidence: 99%

“…This observed value was very close to the average NLR value in the series (3.5). Perhaps, in studies with acute limb ischemia, where NLR is normally higher, the threshold seems to be 5.4 [ 56 ], and in those studies performed in patients with intermittent claudication, the cutoff point was 5 [ 57 ]. It makes sense that the higher the level of inflammation, the lower the NLR cutoff point could be for predicting mortality, and that this cutoff point might be different depending on the morbid condition and the level of inflammation.…”

Section: Discussionmentioning

confidence: 99%

The Inflammatory Pattern of Chronic Limb-Threatening Ischemia in Muscles: The TNF-α Hypothesis

et al. 2022

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Background: Vascular inflammation plays a crucial role in peripheral arterial disease (PAD), although the role of the mediators involved has not yet been properly defined. The aim of this work is to investigate gene expression and plasma biomarkers in chronic limb-threating ischemia (CLTI). Methods: Using patients from the GHAS trial, both blood and ischemic muscle samples were obtained to analyze plasma markers and mRNA expression, respectively. Statistical analysis was performed by using univariate (Spearman, t-Student, and X2) and multivariate (multiple logistic regression) tests. Results: A total of 35 patients were available at baseline (29 for mRNA expression). Baseline characteristics (mean): Age: 71.4 ± 12.4 years (79.4% male); TNF-α: 10.7 ± 4.9 pg/mL; hsCRP:1.6 ± 2.2 mg/dL; and neutrophil-to-lymphocyte ratio (NLR): 3.5 ± 2.8. Plasma TNF-α was found elevated (≥8.1) in 68.6% of patients, while high hsCRP (≥0.5) was found in 60.5%. Diabetic patients with a high level of inflammation showed significantly higher levels of NOX4 expression at baseline (p = 0.0346). Plasma TNF-α had a negative correlation with NOS3 (eNOS) expression (−0.5, p = 0.015) and plasma hsCRP with VEGFA (−0.63, p = 0.005). The expression of NOX4 was parallel to that of plasma TNF-α (0.305, p = 0.037), especially in DM. Cumulative mortality at 12 months was related to NLR ≥ 3 (p = 0.019) and TNF-α ≥ 8.1 (p = 0.048). The best cutoff point for NLR to predict mortality was 3.4. Conclusions: NOX4 and TNF-α are crucial for the development and complications of lower limb ischemia, especially in DM. hsCRP could have a negative influence on angiogenesis too. NLR and TNF-α represent suitable markers of mortality in CLTI. These results are novel because they connect muscle gene expression and plasma information in patients with advanced PAD, deepening the search for new and accurate targets for this condition.

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“…Last but not least, we have obtained relevant data on some plasma biomarkers and mortality. NLR has been proposed as a marker of adverse complications in CV disease, malignancy, and infection [54]. In PAD, NLR has been incorporated into the ERICVA score for the prediction of poor prognosis in patients with CLTI [55].…”

Section: Discussionmentioning

confidence: 99%

“…This observed value was very close to the average NLR value in the series (3.5). Perhaps, in studies with acute limb ischemia, where NLR is normally higher, the threshold seems to be 5.4 [54], and in those studies including patients mainly with intermittent claudication, who suffer a lower inflammation level, the cut-off point was 5 [55]. It makes sense that the higher the level of inflammation, the lower the NLR cut-off point could be for predicting mortality, and that this cut-off point might be different depending on the morbid condition and the level of inflammation of the same.…”

Section: Discussionmentioning

confidence: 99%

Genetics of Vascular Inflammation in Lower Limb Ischemia: The TNF-α Hypothesis in Peripheral Arterial Disease

Caicedo¹,

Álvarez²,

Pérez³

et al. 2021

Preprint

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Background: Vascular inflammation plays a crucial role in peripheral arterial disease (PAD), although the role of the mediators involved has not yet been properly defined. The aim of this work is to investigate gene expression and plasma biomarkers in chronic limb-threating ischemia (CLTI). Methods: Using patients from the GHAS trial, both blood and ischemic muscle samples were obtained to analyze plasma markers and mRNA expression, respectively. Statistical analy-sis was performed by using univariate (Spearman, t-Student, X2) and multivariate (multiple lo-gistic regression) tests. Results: 35 patients were available at baseline (29 for mRNA expression). Baseline characteristics (mean): Age:71.4±12.4 (79.4% male); TNF-α:10.7±4.9; hs-CRP:1.6±2.2; Neutrophil-to-lymphocyte ratio (NLR):3.5±2.8. Plasma TNF-α was found elevated (≥8.1) in 68.6% of patients, while high hs-CRP (≥0.5) in 60.5%. Diabetic patients with high level of inflammation showed significantly higher levels of NOX4 expression at baseline (p=0.0346). Plasma TNF-α had a negative correlation with eNOS expression (-0.5, p=0.015) and hs-CRP with VEGF-A (-0.63, p=0.005). The expression of NOX4 was parallel to that of plasma TNF-α (0.305, p=0.037), especial-ly in DM. Cumulative mortality at 12-month was related to NLR ≥3 (p=0.019) and TNF-α ≥8.1 (p=0.048). The best cut-off point for NLR to predict mortality was 3.4. Conclusions: NOX4 and TNF-α are crucial for the development and complications of lower limb ischemia, especially in DM. hs-CRP could have a negative influence on angiogenesis too. NLR and TNF-α represent suita-ble markers of mortality in CLTI. These results are novel because they connect muscle gene expres-sion and plasma information in patients with advanced PAD, deepening the search of new and ac-curate targets for this condition.

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Pre-operative Neutrophil to Lymphocyte Ratio is Associated With 30 Day Death or Amputation After Revascularisation for Acute Limb Ischaemia

Cited by 27 publications

References 27 publications

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

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

The Inflammatory Pattern of Chronic Limb-Threatening Ischemia in Muscles: The TNF-α Hypothesis

Genetics of Vascular Inflammation in Lower Limb Ischemia: The TNF-α Hypothesis in Peripheral Arterial Disease

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