Elevated neutrophil-lymphocyte ratio predicts vascular remodelling outcome in spontaneous isolated superior mesenteric dissection.

Abstract

The neutrophil-lymphocyte ratio (NLR) is a prognostic marker predicting in-hospital mortality and stent patency in vascular disorders. This study aimed to investigate whether the NLR obtained at admission can be used to predict vascular remodelling outcomes in spontaneous isolated superior mesenteric dissection (SISMAD) patients. A total of 109 consecutive SISMAD patients, admitted to a single centre between November 2017 and June 2019, were retrospectively enrolled. Demographics, comorbidities, imaging data, and follow-up results were recorded. NLR at admission was calculated from a routine hemogram. The study endpoint was complete vascular remodelling or follow-up deadline. Patients were divided into two groups: complete vascular remodelling (Group 1) and partial vascular remodelling (Group 2). All parameters, including NLR, were compared between the groups. Multivariate logistic regression analysis determined whether NLR is independent of vascular remodelling in SISMAD patients after conservative treatment. Complete vascular remodelling of SISMAD occurred in 26 patients (23.9%) and partial remodelling in 83 patients (76.1%). Baseline NLR was significantly higher in the partial remodelling group than in the complete remodelling group [(6.32±2.10) vs. (4.90±2.12), p=0.003]. Complete remodelling was higher in the low NLR group than in the high NLR group [(15, 34.1%) vs. (11, 16.9%), p=0.039]. NLR (odd ratio [OR], 1.631; 95% confidence interval [CI], 1.027-2.592; p=0.038) and superior mesenteric artery-distal aorta angle (OR, 9.246; 95% CI, 2.217-38.560; p=0.002) were independent predictors of complete remodelling in multivariate logistic regression analysis. From the receiver operating characteristic curve, the best NLR cut-off value to predict complete vascular remodelling was 5.37, with 72.3% sensitivity and 69.2% specificity. The inflammation marker NLR may predict worse vascular remodelling in SISMAD patients.