Prognostic role of the preoperative neutrophil-to-lymphocyte ratio and albumin for 30-day mortality in patients with postoperative acute pulmonary embolism

Abstract

Background This retrospective study aimed to investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and albumin for 30-day mortality in patients with postoperative acute pulmonary embolism (PAPE). Methods We retrospectively reviewed the medical records of 101 patients with PAPE admitted from September 1, 2012, to March 31, 2019. The characteristics, surgical information, admission examination data and mortality within 30 days after PAPE were obtained from our electronic medical recording system and follow-up. The associations between the NLR, PLR, and other predictors and 30-day mortality were analyzed with univariate and multivariate analyses. Then, the nomogram including the independent predictors was established and evaluated. Results Twenty-four patients died within 30 days, corresponding to a 30-day mortality rate of 23.8%. The results of the multivariate analysis indicated that both the NLR and albumin were independent predictors for 30-day mortality in patients with PAPE. The probability of death increased by approximately 17.1% (OR = 1.171, 95% CI: 1.073–1.277, P = 0.000) with a one-unit increase in the NLR, and the probability of death decreased by approximately 15.4% (OR = 0.846, 95% CI: 0.762c–0.939, P = 0.002) with a one-unit increase in albumin. The area under the curve of the nomogram was 0.888 (95% CI: 0.812–0.964). Conclusion Our findings showed that an elevated NLR and decreased albumin were related to poor prognosis in patients with PAPE. The NLR and albumin were independent prognostic factors for PAPE.

Diagnostic and Prognostic Value of Immune/Inflammation Biomarkers for Venous Thromboembolism: Is It Reliable for Clinical Practice?

“…However, Liu et al identified that MLR was not an independent predictor of 30-day mortality in patients with PAPE (p>0.05). 17 Peng et al also identified that MLR was not an independent predictor of the occurrence of VTE after hip fracture, although MLR was higher than in patients without VTE (p=0.062). 31 The monocyte count also has some predictive value for VTE.…”

“…Liu et al found that 24 patients (23.8%) died within 30 days in 101 patients with postoperative acute pulmonary embolism (PAPE). 17 Multivariate analysis showed that NLR was an independent predictor of 30-day mortality in patients with PAPE, with a 1-unit increase in NLR related to a 17.1% increase in the probability of death (OR=1.171, 95% CI:1.073–1.277, p=0.000). ROC analysis showed that NLR had a predictive sensitivity of 62.5%, specificity of 90.9% and AUC of 0.823.…”

“… 24 Liu et al also revealed that PLR was not an independent predictor of 30-day mortality in patients with PAPE (p=0.193). 17 …”

“…24 Liu et al also revealed that PLR was not an independent predictor of 30day mortality in patients with PAPE (p=0.193). 17 PLR is a predictor of the occurrence of VTE in cancer patients. Grilz et al identified a statistically significant association between PLR and the occurrence of VTE in 1469 cancer patients, with a HR of 1.5 (95% CI:1.4-1.7, p<0.001).…”

Development and validation of a novel risk assessment model to estimate the probability of pulmonary embolism in postoperative patients

“…We developed an RAM for PE in postoperative patients who was similar but not identical to some widely used RAMs in current practice, such as the IMPROVE (International Medical Prevention Registry on Venous Thromboembolism) VTE RAM 27 – 29 . Compared with IMPROVE VTE RAM, neutrophil percentage is an additional important risk factor 30 . We identified 50 additional candidate risk factors, 4 of which were considered in our PE RAMs, respiratory failure and heart failure in the MITH VTE RAMs 15 , 29 , and thrombocytosis and leukocytosis in the MITH RAM 4 , 31 .…”