High neutrophil to lymphocyte ratio in type A acute aortic dissection facilitates diagnosis and predicts worse outcome

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.

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Neutrophil to lymphocyte ratio: a novel marker for predicting hospital mortality of patients with acute type A aortic dissection

Perfusion ◽

10.1177/0267659115590625 ◽

2015 ◽

Vol 32 (4) ◽

pp. 321-327 ◽

Cited By ~ 14

Author(s):

Mehmet Emin Kalkan ◽

Ali Kemal Kalkan ◽

Ahmet Gündeş ◽

Mehmed Yanartaş ◽

Semi Oztürk ◽

...

Keyword(s):

Aortic Dissection ◽

Hospital Mortality ◽

Surgical Repair ◽

Inflammatory Marker ◽

Type A ◽

Neutrophil To Lymphocyte Ratio ◽

Acute Type ◽

Lymphocyte Ratio ◽

Tertiary Hospitals ◽

Wbc Count

Introduction: The inflammatory process has been reported to be associated with aortic dissection (AD) from the development to the prognosis. The aim of the study was to investigate a relationship between the neutrophil to lymphocyte ratio (NLR) and in-hospital outcomes in patients with acute aortic dissection (AAD) who underwent surgical repair. Methods: One hundred and eighty-four patients who were admitted with the diagnosis of type A AAD who underwent surgical repair at two large tertiary hospitals. According to their NLR, 91 patients had high NLR (>6.0) and 93 patients had low NLR (⩽6.0). Results: The frequency of major bleeding, hospital-related infection, multi-organ dysfunction and mortality in hospital were higher in the high NLR group compared to the low NLR group. NLR, WBC count and operation duration were found to be independent predictors for in-hospital mortality. Conclusions: The novel inflammatory marker NLR may be used to predict worse outcomes and hospital mortality in patients with AAD treated by surgical repair.

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C-Reactive Protein and Neutrophil to Lymphocyte Ratio Values in Predicting Inhospital Death in Patients with Stanford Type A Acute Aortic Dissection

The Heart Surgery Forum ◽

10.1532/hsf.3055 ◽

2020 ◽

Vol 23 (4) ◽

pp. E488-E492

Author(s):

Burak Erdolu ◽

Ahmet Kagan As

Keyword(s):

Aortic Dissection ◽

Hospital Mortality ◽

Type A ◽

Neutrophil To Lymphocyte Ratio ◽

Study Patient ◽

C Reactive Protein ◽

Type A Aortic Dissection ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Group 2

Background: Aortic dissection is a cardiovascular disease with high mortality and morbidity rates. The aim of this study is to investigate the role of C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) in predicting in-hospital mortality in patients undergoing emergent surgery for Stanford type A aortic dissection. Methods: Patients operated for acute Stanford type A aortic dissection between January 2010 and December 2018 were included in the study. Patients without in-hospital mortality were classified as Group 1, and patients with mortality were classified as Group 2. Results: One-hundred-eighteen patients were involved in the study. Patient mean age was 57 ± 11.7 years, and 89 patients (75.4%) were male. Neutrophil-to-lymphocyte ratio (NLR), white blood cell (WBC), neutrophil counts, and C-reactive protein (CRP) values at the time of admission also were found to be high in Group 2 (P = .001, .021, < .001, < .001 respectively). Total perfusion times (TPt), antegrade cerebral perfusion time (ACPt), cross-clamp time (CCt), and intensive care unit (ICU) stay periods significantly were higher in the mortality group (P < .001, < .001, = .01, and < .001, respectively). In receiver-operating characteristic (ROC) curve analysis, a cut-off level of 23 mg/L was determined for CRP levels that predict progression to mortality (area under the curve (AUC): 0.879, P < .001, 75.0% sensitivity and 58.0% specificity). Similarly, a cut-off level of 8.8 was found for NLR that predicts progression to mortality (AUC: 0.835, P < .001, 76.0% sensitivity and 61.0% specificity). Conclusion: As a result, we can use CRP and NLR values, which easily can be measured or calculated from blood tests to predict mortality in patients with aortic dissections, which may have serious mortal consequences.

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