Preoperative Inflammatory Indices Have Limited Predictive Value in Patients with Ruptured Abdominal Aortic Aneurysm

To assess the predictive value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammatory response index (SIRI), for short-term morbidity and mortality in patients undergoing ruptured abdominal aortic aneurysm (rAAA) open repair.

This single-center retrospective study included consecutive patients who underwent surgery between June 2024 and June 2025. The primary outcome was short-term mortality, evaluated at 1 and 6 months postoperatively. Secondary outcome was 30-day morbidity. Baseline inflammatory indices were calculated from the first preoperative venous blood sample. Associations between inflammatory indices and markers of clinical severity were explored. Univariate and multivariate analyses were performed to evaluate their predictive value for 30-day morbidity and short-term mortality.

Seventy-four rAAA patients were included (82.4% male, mean age 73.7 ± 8.9 years). Inflammatory indices did not significantly differ according to preoperative or intraoperative clinical severity. PLR was significantly lower in patients who experienced 30-day morbidity than those without complications (P = 0.032), while nonsurvivors had significantly lower baseline NLR, PLR, and SIRI values at both follow-up time points (all P < 0.05). Receiver operating characteristic analysis showed modest predictive performance for all indices. Age >74 years, hemoglobin ≤97 g/L, PLR <84.3, and SIRI ≤6.15 were significantly associated with 30-day mortality, while NLR ≤8.49 and PLR ≤131.67 were associated with 30-day morbidity. Multivariate analysis demonstrated that preoperative loss of consciousness was an independent predictor of 30-day morbidity (Odds Ratio; 0.173, 95% Confidence Interval: 0.035-0.863, P = 0.032).

Preoperative inflammatory indices have limited predictive value for short-term morbidity and mortality in rAAA patients. Their interpretation should be integrated with clinical and hemodynamic parameters, as clinical severity remains the dominant determinant of early outcomes.