Neutrophil-Lymphocyte Ratio Predicts Medium-Term Survival Following Elective Major Vascular Surgery: A Cross-Sectional Study

Abstract

Background: The systemic nature of atherosclerosis compromises medium-term survival following major vascular surgery. Neutrophil—lymphocyte ratio (NLR) is a simple index of systemic inflammatory burden which correlates with survival following percutaneous coronary intervention. Methods: Patients undergoing elective major vascular surgery in 2 tertiary vascular units were identified from prospectively maintained databases. Factors associated with 2-year mortality were assessed by univariate and multivariate analyses. Results: Over a 4-year period, 1021 patients underwent elective major vascular surgery (carotid endarterectomy, abdominal aortic aneurysm repair, lower limb revascularization). Two-year mortality was 11.2%. In multivariate analysis, preoperative NLR > 5 was independently associated with 2-year mortality (multivariate odds ratio [OR] 2.21; 95% confidence interval [CI] 1.22-4.01). Conclusion: Preoperative NLR identifies patients at increased risk of death within 2 years of major vascular surgery. This simple index may facilitate targeted preventive measures for high-risk patients.

Keywords

inflammation vascular surgery outcome studies

Get full access to this article

View all access options for this article.

References

Aronow WS , Ahn C. Prevalence of coexistence of coronary artery disease, peripheral arterial disease and atherothrombotic brain infarction in men and women > 62 years of age. Am J Cardiol. 1994;74(1):64-65.

Sukhija R. , Aronow WS , Yalamanchili K. , Sinha N. , Babu S. Prevalence of coexistence of coronary artery disease, lower extremity peripheral arterial disease and cerebrovascular disease in 110 men with an abdominal aortic aneurysm. Am J Cardiol. 2004;94(10): 1358-1359.

Mautner GC , Mautner SL , Roberts WC Amounts of coronary arterial narrowing by atherosclerotic plaque at necropsy in patients with lower extremity amputation. Am J Cardiol . 1992; 70(13):1147-1151.

Pereira IA , Borba EF The role of inflammation, humoral and cell mediated autoimmunity in the pathogenesis of atherosclerosis. Swiss Med Wkly. 2008;138(37,38):534-539.

Makita S. , Nakamura M. , Satoh K. , et al. Serum C-reactive protein levels can be used to predict future ischemic stroke and mortality in Japanese men from the general population . Atherosclerosis. 2009;204(1):234-238.

Walsh SR , Cook EJ , Goulder F. , Justin TA , Keeling NJ Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol. 2005;91(3):181-184.

Gomez D. , Farid S. , Malik HZ , et al. Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative resection for hepatocelular carcinoma. World J Surg. 2008;32(8):1757-1762.

Sarraf KM , Belcher E. , Raevsky E. , Nicholson AG , Goldstraw P. , Lim E. Neutrophil/lymphocyte ratio and its association with survival after complete resection in non-small lung cancer. J Thorac Cardiovasc Surg. 2009;137(2):425-428.

Cho H. , Hur HW , Kim SW , et al. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother. 2009; 58(1):15-23.

10.

Duffy BK , Gurm HS , Rajagopal V. , Gupta R. , Ellis SG , Bhatt DL Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol . 2006;97(7):993-996.

11.

Gibson PH , Croal BL , Cuthbertson BH , et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J. 2007;154(5):995-1002.

12.

Spark JI , Sarveswaran J. , Blest N. , Charalaabidis P. , Asthana S. An elevated neutrophil-lymphocyte ratio independently predicts mortality in chronic critical limb ischemia. J Vasc Surg. 2010;52(3): 632-636.

13.

Wolfe JH , Wyatt MG Critical and subcritical ischaemia. Eur J Vasc Endovasc Surg. 1997;13(6):578-582.

14.

Pernerstorfer T. , Stohlawetz P. , Kapiotis S. , Eichler HG , Jilma B. Partial inhibition of nitric oxide synthase primes the stimulated pathway of vWF-secretion in man. Atherosclerosis . 2000;148(1):43-47.

15.

Cook EJ , Walsh SR , Farooq N. , Alberts JC , Justin TA , Keeling NJ Post-operative neutrophil-lymphocyte ratio predicts complications following colorectal surgery. Int J Surg. 2007;5(1):27-30.

16.

Sarraf KM , Belcher E. , Raevsky E. , Nicholson AG , Goldstraw P. , Lim E. Neutrophil/lymphocyte ratio and its association with survival after complete resection in non-small cell lung cancer. J Thorac Cardiovasc Surg. 2009;137(2):425-428.

17.

Halazun KJ , Aldoori A. , Malik HZ , et al. Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol. 2008; 34(1):55-60.

18.

Gomez D. , Farid S. , Malik HZ , et al. Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative resection for hepatocellular carcinoma. World J Surg. 2008;32(8):1757-1762.

19.

20.

Ohno Y. , Nakashima J. , Ohori M. , Hatano T. , Tachibana M. Pre-treatment neutrophil-to-lymphocyte ratio as an independent predictor of recurrence in patients with nonmetastatic renal cell carcinoma. J Urol. 2010;184(3):873-878.

21.

Porrata LF , Ristow K. , Habermann T. , Inwards DJ , Micallef IN , Markovic SN Predicting survival for diffuse large B-cell lymphoma patients using baseline neutrophil/lymphocyte ratio. Am J Hematol. 2010;85(11):896-899.

22.

Shimada H. , Takiguchi N. , Kainuma O. , et al. High preoperative neutrophil-lymphocyte ratio predicts poor survival in patients with gastric cancer. Gastric Cancer. 2010;13(3):170-176.

23.

Ding PR , An X. , Zhang RX , et al. Elevated preoperative neutrophil to lymphocyte ratio predicts risk of recurrence following curative resection for stage IIA colon cancer . Int J Colorectal Dis. 2010; 25(12):1427-1433.

24.

Spark JI , Sarveswaran J. , Blest N. , Charalabidis P. , Asthana S. An elevated neutrophil-lymphocyte ratio independently predicts mortality in chronic critical limb ischemia. J Vasc Surg. 2010;52(3): 632-636.

25.

Tamhane UU , Aneja S. , Montgomery D. , Rogers EK , Eagle KA , Gurm HS Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol. 2008;102(6):653-657.

26.

Ott I. , Neumann FJ , Gawaz M. , Schmitt M. , Schömig A. Increased neutrophil-platelet adhesion in patients with unstable angina. Circulation. 1996;94(6):1239-1246.

27.

Sarma J. , Laan CA , Alam S. , Jha A. , Fox KA , Dransfield I. Increased platelet binding to circulating monocytes in acute coronary syndromes . Circulation. 2002;105(18):2166-2171.

28.

Azab B. , Zaher M. , Weiserbs KF , et al. Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction. Am J Cardiol. 2010; 106(4):470-476.

29.

Gennari R. , Dominioni L. , Imperatori A. , Bianchi V. , Maroni P. , Dionigi R. Alterations in lymphocyte subsets as prognosticators of postoperative infections . Eur J Surg. 1995;161(7): 493-499.

30.

Dionigi R. , Dominioni L. , Benevento A. , et al. Effects of surgical trauma of laparoscopic vs. open cholecystectomy. Hepatogastroenterology. 1994;41(5):471-476.

31.

Pechan I. , Holoman M. , Zahorec R. , et al. Parameters of energy metabolism in patients after vascular reconstructive surgical procedures. Bratisl Lek Listy. 1999 ;100(8):439-444.

32.

Gibson PH , Croal BL , Cuthbertson BH , et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J. 2007;154(5):995-1002.

33.

34.

35.

Chung J. , Corriere MA , Veeraswamy RK , et al. Risk factors for late mortality after endovascular repair of the thoracic aorta. J Vasc Surg. 2010;52(3):549-554.

36.

Haumer M. , Amighi J. , Exner M. , et al. Association of neutrophils and future cardiovascular events in patients with peripheral artery disease. J Vasc Surg. 2005;41(4):610-617.