Cellular indices and outcome in patients with acute venous thromboembolism.

Abstract

<b>Background:</b> Recent studies have shown that the immune and inflammatory responses play a crucial part in the pathogenesis of the venous thromboembolism (VTE). The prognostic significance of the neutrophil to lymphocyte, the platelet to lymphocyte and the systemic immune inflammation indices is, however, quite disputed. <b>Patients and methods:</b> We used the RIETE database to collect data on patients with acute VTE. The primary end point was a clinical composite of symptomatic, objectively confirmed VTE recurrences, major bleeding, and death during the first 90 days. <b>Results:</b> We included 4,487 patients with acute VTE from January 2020 to April 2021. 2,683 of them (60%) presented with symptomatic pulmonary embolism (PE), 283 with incidental PE (6.3%), 1.997 with lower-limb deep vein thrombosis (DVT), 219 (4.9%) with upper limb DVT, and 231 (5.1%) with VTE in other locations. Mean values of the cellular indices were: NLR 5.9 ±7.1, PLR 190 ±158 and SII 1,459 ±2,028. During the 90-day study period, 38 patients (0.8%) developed recurrent DVT, 45 (1.0%) recurrent PE, 152 (3.4%) suffered major bleeding, and 484 (11%) were deceased. A multivariable analysis showed that the NLR was associated with an increased risk for death (adjusted odds ratio [aOR]: 2.501; 95%CI: 1.826-3.245) and for major bleeding (aOR: 1.733; 95%CI: 1.049-2.863), but not for an increased risk for VTE recurrences. <b>Conclusions:</b> In patients with acute VTE, cellular indices may help to predict adverse outcomes at 90 days, particularly mortality and major bleeding, thus supporting the role of the immune/inflammatory response in the pathogenesis of VTE.