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

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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Neutrophil-to-lymphocyte ratio associated with an increased risk of mortality in patients with critical limb ischemia

PLoS ONE ◽

10.1371/journal.pone.0252030 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0252030

Author(s):

Min-I. Su ◽

Cheng-Wei Liu

Keyword(s):

Hospital Mortality ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Neutrophil To Lymphocyte Ratio ◽

Major Adverse Cardiovascular Events ◽

Acute Limb Ischemia ◽

Male Body ◽

Lymphocyte Ratio ◽

Increased Risk ◽

Related Mortality

Purpose Association of the neutrophil-to-lymphocyte ratio (NLR) with mortality has not been comprehensively explored in critical limb ischemia (CLI) patients. We investigated the association between the NLR and clinical outcomes in CLI. Materials and methods We retrospectively enrolled consecutive CLI patients between 1/1/2013 and 12/31/2018. Receiver operating characteristic curve analysis determined NLR cutoffs for 1-year in-hospital, all-cause and cardiac-related mortality; major adverse cardiovascular events (MACEs); and major adverse limb events (MALEs). Results Among 195 patients (age, 74.0 years, SD: 11.5; 51.8% male; body mass index, 23.4 kg/m2, SD: 4.2), 14.4% exhibited acute limb ischemia. After 1 year, patients with NLR>8 had higher in-hospital mortality (21.1% vs. 3.6%, P<0.001), all-cause mortality (54.4% vs. 13.8%, P<0.001), cardiac-related mortality (28.1% vs. 6.5%, P<0.001), MACE (29.8% vs. 13.0%, P = 0.008), and MALE (28.1% vs. 13.0%, P = 0.021) rates than those with NLR<8. In multivariate logistic regression, NLR≥8 was significantly associated with all-cause (P<0.001) and cardiac-related (adjusted HR: 5.286, 95% CI: 2.075–13.47, P<0.001) mortality, and NLR≥6 was significantly associated with MALEs (adjusted HR: 2.804, 95% CI: 1.292–6.088, P = 0.009). Each increase in the NLR was associated with increases in all-cause (adjusted HR: 1.028, 95% CI: 1.008–1.049, P = 0.007) and cardiac-related (adjusted HR:1.027, 95% CI: 0.998–1.057, P = 0.073) mortality but not in-hospital mortality or MACEs. Conclusion CLI patients with high NLRs had significantly higher risks of 1-year all-cause and cardiac-related mortality and MALEs. The NLR can be used for prognostic prediction in these patients.

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Neutrophil-to-lymphocyte Ratio Associated With an Increased Risk of Mortality in Patients With Critical Limb Ischemia

10.21203/rs.3.rs-243462/v1 ◽

2021 ◽

Author(s):

Min-I Su ◽

Cheng-Wei Liu

Keyword(s):

Critical Limb Ischemia ◽

Characteristic Curve ◽

Limb Ischemia ◽

Neutrophil To Lymphocyte Ratio ◽

Major Adverse Cardiovascular Events ◽

Acute Limb Ischemia ◽

Lymphocyte Ratio ◽

Increased Risk ◽

Prognostic Prediction ◽

Related Mortality

Abstract Purpose: Association of the neutrophil-to-lymphocyte ratio (NLR) with mortality has not been comprehensively explored in critical limb ischemia (CLI) patients. We investigated the association between the NLR and clinical outcomes in CLI.Materials and methods: We retrospectively enrolled consecutive CLI patients during 1/1/2013–12/31/2018. Receiver operating characteristic curve analysis determined NLR cutoffs for 1-year in-hospital, all-cause and cardiac-related mortality, and major adverse cardiovascular events (MACEs) and limb events (MALEs).Results: Among 195 patients (age, 74.0 years, SD: 11.5; 51.8% male; BMI, 23.4 kg/m2, SD: 4.2), 14.4% exhibited acute limb ischemia. After 1 year, patients with an NLR>8 had higher in-hospital mortality (21.1% vs. 3.6%, P<0.001), all-cause mortality (54.4% vs. 13.8%, P<0.001), cardiac-related mortality (28.1% vs. 6.5%, P<0.001), MACE (29.8% vs. 13.0%, P=0.008), and MALE (28.1% vs. 13.0%, P=0.021) rates than those with an NLR<8. In multivariate logistic regression, an NLR≥8 was significantly associated with all-cause (P<0.001) and cardiac-related (adjusted HR: 5.286, 95% CI: 2.075-13.47, P<0.001) mortality, and an NLR≥6 was significantly associated with MALEs (adjusted HR: 2.804, 95% CI: 1.292-6.088, P=0.009).Conclusion: CLI patients with high NLRs had higher risks of 1-year all-cause and cardiac-related mortality and MALEs. The NLR can be used for prognostic prediction in these patients.

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The Neutrophil-to-Lymphocyte Ratio is a Prognostic Biomarker of Amputation and Mortality Among Patients Suffering an Acute Limb Ischemia Event

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.09.045 ◽

2019 ◽

Vol 58 (6) ◽

pp. e576

Author(s):

Carlos Ruiz Carmona ◽

Alina Velescu ◽

Andrés Galarza Tapia ◽

Eduard Casajuana Urgell ◽

Lidia Marcos García ◽

...

Keyword(s):

Prognostic Biomarker ◽

Limb Ischemia ◽

Neutrophil To Lymphocyte Ratio ◽

Acute Limb Ischemia ◽

Lymphocyte Ratio

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The Protective Effect of Vitamin E for Reducing Intra-Hospital Mortality in Acute Limb Ischemia Patients

Indonesian Journal of Cardiology ◽

10.30701/ijc.1114 ◽

2021 ◽

Author(s):

Suci Indriani ◽

Suko Adiarto ◽

Hananto Andriantoro ◽

Ismoyo Sunu ◽

Taofan Siddiq ◽

...

Keyword(s):

Vitamin E ◽

Hospital Mortality ◽

Reperfusion Injury ◽

Univariate Analysis ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Logistic Regression Models ◽

Cardiovascular Center ◽

Huge Challenge

Background Management of acute limb ischemia (ALI) is still a huge challenge. Current advances of endovascular therapeutic approach in management of ALI have decreased the overall amputation rate, nevertheless, mortality rate remains high which may be caused by metabolic consequences of reperfusion injury. Aim To understand the role of vitamin E to intra-hospital and 30-day mortality among acute limb ischemia patients. Methods This retrospective cohort study included all patients with ALI between 2015 to 2018. Vitamin E 2x400 mg orally for seven days was given based on physician preference after ALI diagnosis was confirmed. Data were collected from Vascular Registries of National Cardiovascular Center Harapan Kita (NCCHK), Jakarta, Indonesia. Univariate analysis and logistic regression models were used to explore factors that contribute to intra-hospital and 30-day mortality. Results A total of 160 patients with ALI involving 192 limbs were admitted to our hospital. Mostly were male (63.1%) and mean age were 56±13 years old. Majority of the patients had unilateral lesion (80%), and were diagnosed with Rutherford stage IIA (36.3%), followed by stage IIB (33.8%), stage I (20%), and stage III (10%) respectively. Intra-hospital and 30-day mortality were 28.1% and 36.9%, respectively. Low treatment of vitamin E increased intra-hospital mortality (HR 5,6 95%CI 1.7-18.3), however, it did not affect 30-day mortality. Other factors including IABP insertion, arrhythmia, bleeding requiring transfusion and acute renal failure were associated with higher intra-hospital and 30-day mortality. In addition, menopause (HR 3.2; CI 1.16-8.85) was also a predictor of 30-day mortality. Conclusion Vitamin E administration reduced intra-hospital mortality but not on 30-day mortality in acute limb ischemia patients. Keywords: Acute Limb Ischemia, vitamin E, mortality, reperfusion injury

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