Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Impact on Predicting Outcomes in Patients with Acute Limb Ischemia
Acute Limb Ischemia (ALI) of the lower limb is defined as a sudden drop in arterial limb perfusion, which is a medical emergency requiring prompt intervention with high amputation and mortality rates in the absence of revascularization. This observational, analytical, and retrospective cohort study...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-05-01
|
| Series: | Life |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-1729/12/6/822 |
| _version_ | 1797485243156922368 |
|---|---|
| author | Emil Marian Arbănași Adrian Vasile Mureșan Cătălin Mircea Coșarcă Réka Kaller Theodor Ioan Bud Ioan Hosu Septimiu Toader Voidăzan Eliza Mihaela Arbănași Eliza Russu |
| author_facet | Emil Marian Arbănași Adrian Vasile Mureșan Cătălin Mircea Coșarcă Réka Kaller Theodor Ioan Bud Ioan Hosu Septimiu Toader Voidăzan Eliza Mihaela Arbănași Eliza Russu |
| author_sort | Emil Marian Arbănași |
| collection | DOAJ |
| description | Acute Limb Ischemia (ALI) of the lower limb is defined as a sudden drop in arterial limb perfusion, which is a medical emergency requiring prompt intervention with high amputation and mortality rates in the absence of revascularization. This observational, analytical, and retrospective cohort study with longitudinal follow-up aimed to confirm the relevance of the preoperative inflammatory biomarkers neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting the 30-day poor prognosis of patients with Rutherford classification (RC) grades II and III ALI. The ROC analysis found a strong association of an NLR > 4.33 with all studied outcomes, while a PLR > 143.34 was associated with all studied outcomes, except the composite endpoint in all RC stages. Depending on the optimal cut-off value, the ROC analysis found a higher incidence of all adverse outcomes in all high NLR (>4.33) and high PLR (>143.34) groups. A multivariate analysis showed that a high baseline value for NLR and PLR was an independent predictor of amputation (OR:11.09; 95% CI: 5.48–22.42; <i>p</i> < 0.0001; and OR:8.97; 95% CI: 4.44–18.16; <i>p</i> < 0.0001), mortality (OR:22.24; 95% CI: 9.61–51.47; <i>p</i> < 0.0001; and OR:8.32; 95% CI: 3.90–17.73; <i>p</i> < 0.0001), and composite endpoint (OR:21.93; 95% CI: 7.91–60.79; <i>p</i> < 0.0001; and OR:9.98; 95% CI: 3.89–25.55; <i>p</i> < 0.0001), respectively. Furthermore, for all hospitalized patients, the RC grade III (OR:7.33; 95% CI: 3.73–14.26; <i>p</i> < 0.0001) was an independent predictor of amputation (OR:7.33; 95% CI: 3.73–14.26; <i>p</i> < 0.0001), mortality (OR:8.40; 95% CI: 4.08–17.31; <i>p</i> < 0.0001), and composite endpoint (OR: 10.70; 95% CI: 4.48–25.56; <i>p</i> < 0.0001), respectively. The NLR and PLR are excellent predictors of risks associated with ALI for primary and secondary prevention. Our study showed that increased pre-operative values for NLR and PLR are indicators of a poor outcome in patients with RC grades II and III ALI. |
| first_indexed | 2024-03-09T23:15:59Z |
| format | Article |
| id | doaj.art-c66c5279fa61400a98287f4013cf911c |
| institution | Directory Open Access Journal |
| issn | 2075-1729 |
| language | English |
| last_indexed | 2024-03-09T23:15:59Z |
| publishDate | 2022-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Life |
| spelling | doaj.art-c66c5279fa61400a98287f4013cf911c2023-11-23T17:36:01ZengMDPI AGLife2075-17292022-05-0112682210.3390/life12060822Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Impact on Predicting Outcomes in Patients with Acute Limb IschemiaEmil Marian Arbănași0Adrian Vasile Mureșan1Cătălin Mircea Coșarcă2Réka Kaller3Theodor Ioan Bud4Ioan Hosu5Septimiu Toader Voidăzan6Eliza Mihaela Arbănași7Eliza Russu8Clinic of Vascular Surgery, Mureș County Emergency Hospital, 540136 Targu-Mures, RomaniaClinic of Vascular Surgery, Mureș County Emergency Hospital, 540136 Targu-Mures, RomaniaClinic of Vascular Surgery, Mureș County Emergency Hospital, 540136 Targu-Mures, RomaniaClinic of Vascular Surgery, Mureș County Emergency Hospital, 540136 Targu-Mures, RomaniaClinic of Vascular Surgery, Mureș County Emergency Hospital, 540136 Targu-Mures, RomaniaDepartment of Nephrology, Mureș County Emergency Hospital, 540136 Targu-Mures, RomaniaDepartment of Epidemiology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Targu-Mures, 540139 Targu-Mures, RomaniaFaculty of Pharmacy, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Targu-Mures, 540139 Targu-Mures, RomaniaClinic of Vascular Surgery, Mureș County Emergency Hospital, 540136 Targu-Mures, RomaniaAcute Limb Ischemia (ALI) of the lower limb is defined as a sudden drop in arterial limb perfusion, which is a medical emergency requiring prompt intervention with high amputation and mortality rates in the absence of revascularization. This observational, analytical, and retrospective cohort study with longitudinal follow-up aimed to confirm the relevance of the preoperative inflammatory biomarkers neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting the 30-day poor prognosis of patients with Rutherford classification (RC) grades II and III ALI. The ROC analysis found a strong association of an NLR > 4.33 with all studied outcomes, while a PLR > 143.34 was associated with all studied outcomes, except the composite endpoint in all RC stages. Depending on the optimal cut-off value, the ROC analysis found a higher incidence of all adverse outcomes in all high NLR (>4.33) and high PLR (>143.34) groups. A multivariate analysis showed that a high baseline value for NLR and PLR was an independent predictor of amputation (OR:11.09; 95% CI: 5.48–22.42; <i>p</i> < 0.0001; and OR:8.97; 95% CI: 4.44–18.16; <i>p</i> < 0.0001), mortality (OR:22.24; 95% CI: 9.61–51.47; <i>p</i> < 0.0001; and OR:8.32; 95% CI: 3.90–17.73; <i>p</i> < 0.0001), and composite endpoint (OR:21.93; 95% CI: 7.91–60.79; <i>p</i> < 0.0001; and OR:9.98; 95% CI: 3.89–25.55; <i>p</i> < 0.0001), respectively. Furthermore, for all hospitalized patients, the RC grade III (OR:7.33; 95% CI: 3.73–14.26; <i>p</i> < 0.0001) was an independent predictor of amputation (OR:7.33; 95% CI: 3.73–14.26; <i>p</i> < 0.0001), mortality (OR:8.40; 95% CI: 4.08–17.31; <i>p</i> < 0.0001), and composite endpoint (OR: 10.70; 95% CI: 4.48–25.56; <i>p</i> < 0.0001), respectively. The NLR and PLR are excellent predictors of risks associated with ALI for primary and secondary prevention. Our study showed that increased pre-operative values for NLR and PLR are indicators of a poor outcome in patients with RC grades II and III ALI.https://www.mdpi.com/2075-1729/12/6/822acute limb ischemiavascular surgeryembolectomymortalityamputation |
| spellingShingle | Emil Marian Arbănași Adrian Vasile Mureșan Cătălin Mircea Coșarcă Réka Kaller Theodor Ioan Bud Ioan Hosu Septimiu Toader Voidăzan Eliza Mihaela Arbănași Eliza Russu Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Impact on Predicting Outcomes in Patients with Acute Limb Ischemia Life acute limb ischemia vascular surgery embolectomy mortality amputation |
| title | Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Impact on Predicting Outcomes in Patients with Acute Limb Ischemia |
| title_full | Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Impact on Predicting Outcomes in Patients with Acute Limb Ischemia |
| title_fullStr | Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Impact on Predicting Outcomes in Patients with Acute Limb Ischemia |
| title_full_unstemmed | Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Impact on Predicting Outcomes in Patients with Acute Limb Ischemia |
| title_short | Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Impact on Predicting Outcomes in Patients with Acute Limb Ischemia |
| title_sort | neutrophil to lymphocyte ratio and platelet to lymphocyte ratio impact on predicting outcomes in patients with acute limb ischemia |
| topic | acute limb ischemia vascular surgery embolectomy mortality amputation |
| url | https://www.mdpi.com/2075-1729/12/6/822 |
| work_keys_str_mv | AT emilmarianarbanasi neutrophiltolymphocyteratioandplatelettolymphocyteratioimpactonpredictingoutcomesinpatientswithacutelimbischemia AT adrianvasilemuresan neutrophiltolymphocyteratioandplatelettolymphocyteratioimpactonpredictingoutcomesinpatientswithacutelimbischemia AT catalinmirceacosarca neutrophiltolymphocyteratioandplatelettolymphocyteratioimpactonpredictingoutcomesinpatientswithacutelimbischemia AT rekakaller neutrophiltolymphocyteratioandplatelettolymphocyteratioimpactonpredictingoutcomesinpatientswithacutelimbischemia AT theodorioanbud neutrophiltolymphocyteratioandplatelettolymphocyteratioimpactonpredictingoutcomesinpatientswithacutelimbischemia AT ioanhosu neutrophiltolymphocyteratioandplatelettolymphocyteratioimpactonpredictingoutcomesinpatientswithacutelimbischemia AT septimiutoadervoidazan neutrophiltolymphocyteratioandplatelettolymphocyteratioimpactonpredictingoutcomesinpatientswithacutelimbischemia AT elizamihaelaarbanasi neutrophiltolymphocyteratioandplatelettolymphocyteratioimpactonpredictingoutcomesinpatientswithacutelimbischemia AT elizarussu neutrophiltolymphocyteratioandplatelettolymphocyteratioimpactonpredictingoutcomesinpatientswithacutelimbischemia |