Abstract
BackgroundThe Neutrophil-to-Lymphocyte ratio (NLR) is an easy to perform test from the white blood cell count. An increase in NLR has been associated with vascular endpoints reflecting inflammation in atherosclerotic lesions. Atherosclerosis is a global threat and vascular endpoints, like myocardial infarction or critical limb ischemia (CLI), are a leading cause of death in industrialized countries. We therefore investigated NLR and its association with CLI and other vascular endpoints in peripheral arterial occlusive disease (PAOD) patients.Methods and FindingsWe evaluated 2121 PAOD patients treated at our institution from 2005 to 2010. NLR was calculated and the cohort was divided into tertiles according to the NLR. An optimal cut-off value for the continuous NLR was calculated by applying a receiver operating curve analysis to discriminate between CLI and non-CLI. In our cohort occurrence of CLI significantly increased with an increase in NLR. As an optimal cut-off a NLR of 3.95 was identified. Two groups were categorized, one containing 1441 patients (NLR≤3.95) and a second group with 680 patients (NLR>3.95). CLI was more frequent in NLR>3.95 patients (330(48.5%)) compared to NLR≤3.95 patients (350(24.3%)) (p<0.001), as were prior myocardial infarction (48(7.0%) vs. 47(3.3%), p<0.001) and stroke (73(10.7) vs. 98(6.8%), p<0.001). Regarding other inflammatory parameters, C-reactive protein (median 5.6 mg/l (2.3–19.1) vs. median 3 mg/l (1.5–5.5)) and fibrinogen (median 412 mg/dl (345.5–507.5) vs. 344 mg/dl (308–403.5)) also significantly differed in the two patient groups (both p<0.001). A NLR>3.95 was associated with an OR of 2.5 (95%CI 2.3–2.7) for CLI even after adjustment for other vascular risk factors.ConclusionsAn increased NLR is significantly associated with patients at high risk for CLI and other vascular endpoints. The NLR is an easy to perform test, which could be used to highlight patients at high risk for vascular endpoints.
Highlights
Peripheral arterial occlusive disease (PAOD) is frequent and underdiagnosed [1]
An increased Neutrophil-to-Lymphocyte ratio (NLR) is significantly associated with patients at high risk for critical limb ischemia (CLI) and other vascular endpoints
In one recently published study we showed that a high CHA2DS2-VASc (congestive heart failure, hypertension, age$75 years, type 2 diabetes, previous stroke, transient ischemic attack, or thromboembolism, vascular disease, age 65 to 75 years, and sex category) score was associated with a high risk for CLI in peripheral arterial occlusive disease (PAOD) patients [5]
Summary
If PAOD is not diagnosed in time and treatment is not initiated immediately, the probability of disease progression and development of critical limb ischemia (CLI) is high [2]. CLI is an entity with a high mortality and high risk of limb amputation. In one recently published study we showed that a high CHA2DS2-VASc (congestive heart failure, hypertension, age$75 years (doubled), type 2 diabetes, previous stroke, transient ischemic attack, or thromboembolism (doubled), vascular disease, age 65 to 75 years, and sex category) score was associated with a high risk for CLI in PAOD patients [5]. Atherosclerosis is a global threat and vascular endpoints, like myocardial infarction or critical limb ischemia (CLI), are a leading cause of death in industrialized countries. We investigated NLR and its association with CLI and other vascular endpoints in peripheral arterial occlusive disease (PAOD) patients
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