The relation between neutrophil/lymphocyte and platelet/lymphocyte ratios with mortality and limb amputation after acute limb ischaemia

Pasqui, Edoardo; Donato, Gianmarco de; Giannace, Giovanni; Panzano, Claudia; Alba, Giuseppe; Cappelli, Alessandro; Setacci, Carlo; Palasciano, Giancarlo

doi:10.1177/17085381211010012

Cited by 25 publications

(20 citation statements)

References 37 publications

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“…Moreover, acute limb ischemia represents a medical and surgical challenge, and decision-making remains difficult even after the developing and diffusion of endovascular therapy. Our data, according to previously published experience, confirm the necessity of a tailored approach, possibly reserving a more aggressive strategy for those presenting an elevated NLR baseline value [24].…”

Section: Discussionsupporting

confidence: 83%

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

Taurino

Aloisi

Porto

et al. 2021

JCM

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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.

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Section: Discussionsupporting

confidence: 83%

“…In their experience a NLR > 5.2 has been shown to be an independent risk factor for amputation during follow-up [20]. More recently, Pasqui et al suggested that a cut-off of 5.57 could predict mortality, and a value higher than 6.66 could be associated with amputation rate after ALI surgical or endovascular treatment [24].…”

Section: Discussionmentioning

confidence: 97%

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

Taurino

Aloisi

Porto

et al. 2021

JCM

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“…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.…”

Section: Introductionmentioning

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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“…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).…”

Section: Discussionmentioning

confidence: 99%

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

Xiu

Zheng

Wang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe hemoglobin level and red cell distribution width (RDW) have been linked to the prognosis of coronary atherosclerotic heart disease (CAHD). However, the relationship between the ratio of hemoglobin to the RDW (HRR) and clinical outcomes after percutaneous coronary intervention (PCI) is not known. Here, we explored the impact of the HRR on clinical outcomes after PCI.MethodsIn our study, we selected 6,046 CAHD patients with PCI hospitalized in the First Affiliated Hospital of Xinjiang Medical University from 2008 to 2016. The patients were grouped according to their HRR ratio: group A (HRR < 10.25, n = 2,344) and group B (HRR ≥ 10.25, n = 3,702). The difference in clinical outcomes between the two groups was compared. Patients were followed up for 35.9 ± 22.6 months.ResultsThree hundred nine patients died during follow-up. These included 166 patients (7.1%) in the HRR < 10.25 group and 143 patients (3.9%) in the HRR ≥ 10.25 group (P < 0.001). The incidences of cardiogenic death (5.7 vs. 3.2%) and major cardiovascular adverse events (16.5 vs. 12.9%) also differed significantly between the groups (both Ps < 0.001). Analysis using the multivariate Cox proportional hazard model found a significant association between a decreased HRR and post-PCI mortality (all-cause death, adjusted HR: 1.479, 95% CI: 1.156–1.893, p = 0.002; cardiac death, adjusted HR: 1.470, 95% CI: 1.116–1.936, p = 0.006).ConclusionThe HRR is predictive of post-PCI mortality among CAHD patients.

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The relation between neutrophil/lymphocyte and platelet/lymphocyte ratios with mortality and limb amputation after acute limb ischaemia

Cited by 25 publications

References 37 publications

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

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

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

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

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