Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Impact on Predicting Outcomes in Patients with Acute Limb Ischemia
Emil Marian Arbănași, Emil Marian Arbănași, Adrian Vasile Mureșan, Cătălin Mircea Coșarcă, Réka Kaller, Theodor Ioan Bud, Ioan Hosu, Septimiu Voidăzan, Eliza Mihaela Arbănași, Eliza Mihaela Arbănași, Eliza Russu
Abstract
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; p < 0.0001; and OR:8.97; 95% CI: 4.44−18.16; p < 0.0001), mortality (OR:22.24; 95% CI: 9.61−51.47; p < 0.0001; and OR:8.32; 95% CI: 3.90−17.73; p < 0.0001), and composite endpoint (OR:21.93; 95% CI: 7.91−60.79; p < 0.0001; and OR:9.98; 95% CI: 3.89−25.55; p < 0.0001), respectively. Furthermore, for all hospitalized patients, the RC grade III (OR:7.33; 95% CI: 3.73−14.26; p < 0.0001) was an independent predictor of amputation (OR:7.33; 95% CI: 3.73−14.26; p < 0.0001), mortality (OR:8.40; 95% CI: 4.08−17.31; p < 0.0001), and composite endpoint (OR: 10.70; 95% CI: 4.48−25.56; p < 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.