Prognostic Value of Neutrophil to Lymphocyte Ratio and Risk Factors for Mortality in Patients with Stanford Type A Aortic Dissection

Abstract

Background: Neutrophil to lymphocyte ratio (NLR) is a prognostic predictor in a wide range of cardiovascular disease. Acute aortic dissection (AD) is an uncommon but fatal cardiovascular disease. In this study, we investigated both prognostic factors in patients with AD and whether NLR can be a predictor for mortality. Methods: We analyzed retrospectively the data of 57 patients with AD who had undergone emergent surgery in our hospital and included 128 consecutive patients with chest pain admitted to the emergency room as a control group. Also, patients who were operated on due to aortic dissection as another subgroup were compared to NLR values. Baseline clinical features, cardiovascular risk factors, and surgical and laboratory parameters were obtained from the hospital database. Results: Patients with AD had higher NLR than the control group (1.7 ± 0.5 versus 7.6 ± 3.3, P < .001). In the AD group, 15 deaths occurred and non-survivors had significantly higher NLR, compared to survivors (11.6 ± 2.4 versus 6.6 ± 2.3, P < .001). In multivariate analysis, high NLR (odds ratio [OR] 1.913, 95% CI 1.030-1.081, P = .04) and cross-clamp time (OR 1.265, 95% CI 1.003-1.596, P = .04) were determined as independent predictors of in-hospital mortality. In receiver operating characteristics curve analyses, the NLR > 9.3 predicted the mortality in AD with a specificity of 91% and a sensitivity of 86% (P < .001).Conclusion: This study shows that high NLR can be used as a marker for prognosis in short-term mortality of patient with AD. Additionally, increased lactate level in perioperative period, prolonged cardiopulmonary bypass time, and additional cardiac procedures are strong independent predictors of short-term mortality in patients with acute AD.

Relationship of Platelet Counts and Inflammatory Markers to 30-Day Mortality Risk in Patients with Acute Type A Aortic Dissection

“…Previous studies have demonstrated the neutrophil/lymphocyte ratio (NLR) to be a good predictor of inhospital mortality [6,11,29]. In Karakoyun et al's study [11], they found that an NLR >8.51 yielded an AUC value of 0.829.…”

Factors related to white blood cell elevation in acute type A aortic dissection

“…In patients with ATAAD, hemodynamic instability can occur as a result of cardiac tamponade or aortic insufficiency, and emergency aortic repair under cardiopulmonary bypass induces a strong perioperative inflammatory response, making investigation of the early inflammatory response more complicated. Nevertheless, there is evidence that systemic inflammation characterized by elevation of the white blood cell (WBC) count [12][13][14] or an increased neutrophil/lymphocyte ratio [13,15,16] influences outcomes in patients with ATAAD. Although biomarkers of disordered coagulation and fibrinolysis D-dimer and fibrin degradation products have been well studied in relation to acute aortic dissection [17][18][19], WBC count elevation and its etiology in cases of acute aortic dissection have not been fully elucidated, and the relation between WBC elevation and dissection morphology is poorly understood.…”

The effect of neutrophil-lymphocyte ratio on the postoperative course of coronary artery bypass graft surgery

“…A study of patients who had Stanford A type acute aortic dissection claimed that increased NLR is useful to predict short-term mortality along with other parameters (16). In a study evaluating patients with endocarditis, it was shown that increased NLR alone directly affects the symptoms of endocarditis and is a good predictor of prognosis (17).…”