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Published on: September 22, 2020
Predictive value of elevated neutrophil to lymphocyte ratio for long-term cardiovascular mortality in peripheral
Mehmet Erturk1, Huseyin Altug Cakmak1, Ozgur Surgit1
1Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
Insights
Elevated neutrophil to lymphocyte ratio (NLR) is linked to increased cardiovascular mortality in peripheral arterial occlusive disease (PAOD) patients. This inexpensive biomarker aids in risk stratification for long-term outcomes.
Area of Science:
- Vascular Medicine
- Cardiology
- Inflammation Biomarkers
Background:
- Peripheral arterial occlusive disease (PAOD) is prevalent in elderly males and associated with heightened cardiovascular risks.
- Neutrophil to lymphocyte ratio (NLR) is an established predictor of cardiovascular mortality in atherosclerosis.
- The study investigated the association between NLR and cardiovascular mortality in PAOD patients with intermittent claudication and critical limb ischemia.
Purpose of the Study:
- To determine the relationship between NLR and cardiovascular mortality in patients diagnosed with symptomatic PAOD.
- To assess the predictive value of NLR for long-term cardiovascular mortality in this patient cohort.
Main Methods:
- Retrospective analysis of 593 consecutive PAOD patients admitted between May 2009 and September 2012.
- Patients were stratified into two groups: high NLR (NLR > 3.0) and low NLR (NLR ≤ 3.0).
- Median follow-up was 20 months, with 508 patients analyzed for mortality outcomes.
Main Results:
- A total of 75 deaths (14.8%) occurred during the follow-up period.
- Cardiovascular mortality was significantly higher in the high NLR group (23.6%) compared to the low NLR group (9.8%) (p < 0.001).
- Cox regression analysis identified NLR > 3 and age as independent predictors of long-term cardiovascular mortality (HR 2.04 and 1.04, respectively; p = 0.004 for both).
Conclusions:
- Increased NLR is associated with elevated cardiovascular mortality in PAOD patients presenting with critical limb ischemia or intermittent claudication.
- NLR serves as an inexpensive and accessible biomarker reflecting inflammatory status.
- NLR offers additional risk stratification for predicting long-term cardiovascular mortality in PAOD beyond conventional scores.
Background:
Peripheral arterial occlusive disease (PAOD), which is common in male gender and elderly population, is related with increased cardiovascular mortality and morbidity. Neutrophil to lymphocyte ratio (NLR) has been found to be an independent predictor of cardiovascular mortality in atherosclerosis. The aim of the present study was to investigate the association between NLR and cardiovascular mortality both in patients with intermittent claudication and critical limb ischemia.
Methods:
In a retrospective study, 593 consecutive patients who had been admitted to the inpatient ward of the vascular department of a large tertiary training and research hospital with diagnosis of symptomatic PAOD between May 2009 and September 2012 were included. Patients were divided into two groups according to their NLR as follows: high NLR (NLR>3.0) and low NLR (NLR ≤ 3.0) groups.
Results:
During the course of the present study [median follow-up period of 20 months (interquartile range, 12-27)], 75 deaths occurred out of 508 patients (14.8%). Cardiovascular mortality was found to be significantly higher in elevated NLR group (n = 43) as compared to low NLR group (n = 32) (23.6% vs 9.8%, respectively; p < 0.001). Even after adjustment of various risk factors, NLR > 3 and age were found as independent predictors of long-term cardiovascular mortality in Cox regression analysis [hazard ratios (95% confidence interval), 2.04 (1.26-3.30) and 1.04 (1.01-1.07), p = 0.004 and p = 0.004, respectively].
Conclusion:
We demonstrated that an increased NLR was related with higher cardiovascular mortality in patients with PAOD, who were admitted with critical limb ischemia or intermittent claudication. NLR, which reflects the patient's inflammatory status, is an inexpensive and readily available biomarker that provides an additional level of risk stratification beyond that provided by conventional risk scores in predicting long-term cardiovascular mortality in PAOD.