Neutrophil-to-lymphocyte ratio associated with an increased risk of mortality in patients with critical limb ischemia.

Min-I Su,Cheng-Wei Liu,Timir Paul

doi:10.1371/journal.pone.0252030

Abstract

Association of the neutrophil-to-lymphocyte ratio (NLR) with mortality has not been comprehensively explored in critical limb ischemia (CLI) patients. We investigated the association between the NLR and clinical outcomes in CLI. We retrospectively enrolled consecutive CLI patients between 1/1/2013 and 12/31/2018. Receiver operating characteristic curve analysis determined NLR cutoffs for 1-year in-hospital, all-cause and cardiac-related mortality; major adverse cardiovascular events (MACEs); and major adverse limb events (MALEs). Among 195 patients (age, 74.0 years, SD: 11.5; 51.8% male; body mass index, 23.4 kg/m2, SD: 4.2), 14.4% exhibited acute limb ischemia. After 1 year, patients with NLR>8 had higher in-hospital mortality (21.1% vs. 3.6%, P<0.001), all-cause mortality (54.4% vs. 13.8%, P<0.001), cardiac-related mortality (28.1% vs. 6.5%, P<0.001), MACE (29.8% vs. 13.0%, P = 0.008), and MALE (28.1% vs. 13.0%, P = 0.021) rates than those with NLR<8. In multivariate logistic regression, NLR≥8 was significantly associated with all-cause (P<0.001) and cardiac-related (adjusted HR: 5.286, 95% CI: 2.075-13.47, P<0.001) mortality, and NLR≥6 was significantly associated with MALEs (adjusted HR: 2.804, 95% CI: 1.292-6.088, P = 0.009). Each increase in the NLR was associated with increases in all-cause (adjusted HR: 1.028, 95% CI: 1.008-1.049, P = 0.007) and cardiac-related (adjusted HR:1.027, 95% CI: 0.998-1.057, P = 0.073) mortality but not in-hospital mortality or MACEs. CLI patients with high NLRs had significantly higher risks of 1-year all-cause and cardiac-related mortality and MALEs. The NLR can be used for prognostic prediction in these patients.

Highlights

The neutrophil-to-lymphocyte ratio (NLR) is widely used as a prognostic biomarker in various diseases, such as cancer and cardiovascular disease [1, 2]
NLR 8 was significantly associated with all-cause (P
Each increase in the NLR was associated with increases in all-cause and cardiac-related mortality but not in-hospital mortality or major adverse cardiovascular events (MACEs)

Summary

Introduction

The neutrophil-to-lymphocyte ratio (NLR) is widely used as a prognostic biomarker in various diseases, such as cancer and cardiovascular disease [1, 2] Both of these disorders have a common pathophysiology involving inflammatory processes that can be roughly represented as the ratio of neutrophils [3, 4]; the proportion of lymphocytes indicates the host immune response and has been associated with mortality in healthy individuals [5]. An elevated NLR has been associated with unfavorable neurological outcomes and increased mortality in patients with ischemic stroke [8], with an increased risk of mortality and major adverse cardiovascular events (MACE) in patients with acute myocardial infarction [9], and with the severity of lower extremity artery disease (LEAD) in cohort studies [10, 11].

Results

Discussion

Conclusion