Peripheral Vascular Disease and Intervention
Neutrophil-to-Lymphocyte Ratio Associated with an Increased Risk of Mortality in Patients with Critical Limb Ischemia
Cheng-Wei Liu1, Min-I Su2
Tri-Service General Hospital, Taiwan1, Mackay Memorial Hospital, Taiwan2
The neutrophil-to-lymphocyte ratio(NLR) is associated with poor prognoses in cancer and peripheral artery disease patients. Its association 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 patients.
We retrospectively enrolled consecutive CLI patients between 1/1/2013 and12/31/2018. Receiver operating characteristic curve analysis determined the NLRcut-offs for study outcomes, namely, 1-year in-hospital, all-cause, cardiac-related mortality, and major adverse cardiovascular events(MACEs); and major adverse limb events(MALEs).
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 a 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 a NLR<8. In multivariate logistic regression, NLR ≥8 was significantly associated with all-cause (P<0.001) andcardiac-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 increased 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. The NLR was not significantly associated with in-hospital mortality or MACEs.
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.