Abstract
Introduction: Acute limb ischemia (ALI), classified according to Rutherford’s classification (RC), is a vascular emergency burdened by high rates of mortality and morbidity. The need of new and different prognostic values for ALI has emerged, and, among all, the neutrophil-to-lymphocyte ratio (NLR) has been proven as a strong outcome predictor in vascular disease. The aim of this study is to investigate the role of preoperative NLR in predicting clinical outcomes in patients presenting acute limb ischemia. Material and Methods: A single-center retrospective study was conducted between January 2015 and December 2019. Demographic and clinical characteristics, procedural technical aspects, postoperative and early (up to 30-day) outcomes were recorded. All enrolled patients were categorized into low- and high-NLR at baseline, using a cut-off value of 5. Study outcomes were 30-day all-cause mortality and amputation rates. Results: A total of 177 ALI patients were included in the final analysis (6 RC I, 44 RC IIA, 108 RC IIB, and 19 RC III), 115 males (65%), mean age 78.9 ± 10.4 years. Mean NLR at hospital presentation was 6.65 ± 6.75 (range 0.5–35.4), 108 (61.1%) patients presented a low-NLR, 69 (38.9%) a high-NLR. Immediate technical success was achieved in 90.1% of cases. At 30 days, freedom from amputation and freedom from death rates were 87.1% and 83.6%, respectively. At the univariate analysis, amputation (p < 0.0001, OR: 9.65, 95%CI: 3.7–25.19), mortality (p = 0.0001, OR: 9.88, 95%CI: 3.19–30.57), and cumulative event rates (p < 0.001, OR: 14.45, 95%CI: 6.1–34.21), were significantly different between the two groups according to NLR value. Multivariate analysis showed that a high baseline NLR value was an independent predictor of unfavorable outcomes in all enrolled patients. Consistently, at ROC analysis, a preoperative NLR > 5 was strongly associated with all outcome occurrences. Conclusion: Preoperative NLR value seems to be strongly related to ALI outcomes in this unselected population. The largest series should be evaluated to confirm present results.
Highlights
Acute limb ischemia (ALI) is defined as a clinical condition characterized by a sudden decrease in arterial perfusion, mostly due to embolism or thrombosis
The aim of this study is to investigate the role of preoperative neutrophil-to-lymphocyte ratio (NLR) in predicting clinical outcomes in an unselected Rutherford’s classification (RC) II ALI patients’ population
The main result of this study is the potential role of preoperative NLR value, using a cut-off of 5 as an effective prognostic biomarker of clinical outcomes in our unselected series of RC II ALI patients
Summary
Acute limb ischemia (ALI) is defined as a clinical condition characterized by a sudden decrease in arterial perfusion, mostly due to embolism or thrombosis. Regardless of underlying causes, ALI represents a vascular emergency potentially burdened by a high rate of limb- and life-threatening complications [1]. ALI severity and its related prognosis are classically categorized on the base of physical examination and arterial and venous Doppler signals according to the Rutherford’s classification (RC). The major challenge for vascular specialists is represented by marginally (II A), and immediately threatened (II B) limb for which a prompt diagnosis and an appropriate and effective treatment could greatly determine the outcome [3,4]. ALI is still associated with a significant mortality and amputation rate up to 40%
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