U-shaped relationship between platelet–lymphocyte ratio and postoperative in-hospital mortality in patients with type A acute aortic dissection

Abstract

Background The platelet-lymphocyte ratio (PLR), a novel inflammatory marker, is generally associated with increased in-hospital mortality risk. We aimed to investigate the association between PLR and postoperative in-hospital mortality risk in patients with type A acute aortic dissection (AAAD). Methods Patients (n = 270) who underwent emergency surgery for AAAD at Xiangya Hospital of Central South University between January 2014 and May 2019 were divided into three PLR-based tertiles. We used multiple regression analyses to evaluate the independent effect of PLR on in-hospital mortality, and smooth curve fitting and a segmented regression model with adjustment of confounding factors to analyze the threshold effect between PLR and in-hospital mortality risk. Results The overall postoperative in-hospital mortality was 13.33%. After adjusting for confounders, in-hospital mortality risk in the medium PLR tertile was the lowest (Odds ratio [OR] = 0.20, 95% confidence interval [CI] = 0.06–0.66). We observed a U-shaped relationship between PLR and in-hospital mortality risk after smoothing spline fitting was applied. When PLR < 108, the in-hospital mortality risk increased by 10% per unit decrease in PLR (OR = 0.90, P = 0.001). When the PLR was between 108 and 188, the mortality risk was the lowest (OR = 1.02, P = 0.288). When PLR > 188, the in-hospital mortality risk increased by 6% per unit increase in PLR (OR = 1.06, P = 0.045). Conclusions There was a U-shaped relationship between PLR and in-hospital mortality in patients with AAAD, with an optimal PLR range for the lowest in-hospital mortality risk of 108–188. PLR may be a useful preoperative prognostic tool for predicting in-hospital mortality risk in patients with AAAD and can ensure risk stratification and early treatment initiation.

High platelet distribution width is an independent risk factor of postoperative pneumonia in patients with type A acute aortic dissection

“…A previous study from our group indicated that low platelet count was a risk factor of postoperative pneumonia in AAAD patients, possibly due to platelet activation and high consumption (2). Besides, we found a U-shaped relationship between platelet-lymphocyte ratio and in-hospital mortality in patients with AAAD (22), which also revealed a role for platelets in poor prognosis. In the present study, our findings manifested that PDW was positively correlated with the risk of postoperative pneumonia, supporting our previous conjecture.…”

Demographic and Social Patterns of the Mean Values of Inflammatory Markers in U.S. Adults: A 2009–2016 NHANES Analysis

“…Generally, a higher NLR value and a higher PLR value have been correlated with high mortality and poor prognosis in non-healthy populations [ 27 , 28 , 29 , 30 ]. However, in the general, healthy population there are not yet standardized values for a normal range of NLR and PLR values that consider various modifiable and nonmodifiable factors.…”

Relationship between the red cell distribution width-to-platelet ratio and in-hospital mortality among critically ill patients with acute myocardial infarction: a retrospective analysis of the MIMIC-IV database

“…13 Relationships between platelet ratio and chronic obstructive pulmonary disease, acute aortic dissection, peritoneal dialysis, haemodialysis, and severe pneumonia have been reported in numerous studies. [14][15][16][17][18] Decreased platelet count in severe disease is a predictor of mortality. 19 This suggests that platelet ratio may be used as a tool for predicting the prognosis of patients with AMI.…”

“…Studies have shown that platelets are markers of chronic inflammation and are associated with poor clinical outcomes in various cardiovascular diseases 13. Relationships between platelet ratio and chronic obstructive pulmonary disease, acute aortic dissection, peritoneal dialysis, haemodialysis, and severe pneumonia have been reported in numerous studies 14–18. Decreased platelet count in severe disease is a predictor of mortality 19.…”