Increased Preoperative Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Are Associated With Major Adverse Events and Mortality After Fenestrated/Branched Endovascular Aortic Repair

Abstract

The objective was to investigate the role of the preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic factors associated with 30-day mortality, major adverse cardiovascular events, acute kidney injury (AKI), and long-term mortality after fenestrated/branched repair (F/BEVAR) of aortic aneurysms with complex anatomy. A retrospective analysis of prospectively collected data of patients who underwent F/BEVAR was performed including cases with a diagnosis of thoracoabdominal aortic aneurysm types I, II, III, IV, and suprarenal and juxtarenal aortic aneurysms. The main inclusion criteria were: (1) complete blood cell count with differential collected within 30 days before surgery and (2) at least 30 days of follow-up. The main exclusion criteria were: (1) comorbid autoimmune/inflammatory diseases and (2) current use of corticosteroid/immunomodulatory drugs. AKI was defined according to the RIFLE (Risk of renal dysfunction, Injury to kidney, Failure or Loss of kidney function, and End-stage kidney disease) criteria. Receiver operating characteristic (ROC) curves were used to determine cutoff values of NLR and PLR associated with the study end points. From 410 patients treated with F/BEVAR between June 2012 and December 2022, 150 were included in the study (70% male; age: 72.7 ± 8.4 years). The mean follow-up time was 29.34 ± 21.79 months. An NLR ≥5 was associated with 30-day mortality with a specificity and sensitivity of 87.1% and 66.7%, respectively, by ROC analysis (Fig 1; area under the ROC curve [AUC] = 0.841, P = .043). The negative predictive value (NPV) was 99.2%. A PLR ≥189 was associated with major adverse cardiovascular events in the first 30-day period with a specificity and sensitivity of 78.8% and 75%, respectively (Fig 2, AUC = 0.830, P = .024), and an NPV of 99.1%. A PLR ≥151 was associated with AKI, with a sensitivity and specificity of 71.4% and 64.3%, respectively (AUC = 0.732, P = .038). The NPV was 97.8%. The groups above and below the cutoffs established by the ROC curves were similar in demographic composition, comorbidities, and extension of the aneurysm. The overall long-term mortality was 27.3% in 5 years. A higher PLR was observed among non-Caucasian patients who died (mean: 190.81 ± 78.4) when compared with the individuals who survived (P = .029). The same finding was not observed in Caucasian patients. Preoperative NLR and PLR are inexpensive and easily available tests that can serve as valuable prognostic tools in patients with complex anatomy aortic aneurysms submitted to F/BEVAR. They might contribute to identifying the higher-risk patients during the preoperative preparation and consequently could indicate which cases would need even more detailed workup before the surgical procedure in the attempt to reduce the odds of adverse events.Fig 2Receiver operating characteristic (ROC) curve for platelet-to-lymphocyte ratio (PLR) considering major adverse cardiovascular event (MACE) during the first 30-day period (P = .024).View Large Image Figure ViewerDownload Hi-res image Download (PPT)