Prognostic Significance of an Elevated Neutrophil–Lymphocyte Ratio in the Amputation-free Survival of Patients with Chronic Critical Limb Ischemia
Background The aim of this study was to investigate the utility of admission neutrophil–lymphocyte ratio (NLR) in predicting the amputation-free survival (AFS) of patients with critical limb ischemia (CLI) who underwent an elective infrainguinal therapeutic intervention. Methods All patients with CL...
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| Veröffentlicht in: | Annals of vascular surgery 2014-05, Vol.28 (4), p.999-1004 |
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| creator | González-Fajardo, José A Brizuela-Sanz, José A Aguirre-Gervás, Beatriz Merino-Díaz, Borja Del Río-Solá, Lourdes Martín-Pedrosa, Miguel Vaquero-Puerta, Carlos |
| description | Background The aim of this study was to investigate the utility of admission neutrophil–lymphocyte ratio (NLR) in predicting the amputation-free survival (AFS) of patients with critical limb ischemia (CLI) who underwent an elective infrainguinal therapeutic intervention. Methods All patients with CLI undergoing elective infrainguinal vascular surgery (open or endovascular) at a single university teaching hospital between January 2005 and December 2009 were retrospectively identified from a prospectively maintained database. The primary end point was AFS. The cut-off of NLR >5 was used to categorize patients into low- and high-NLR groups. Kaplan–Meier analysis and long-rank test were used to compare survival between both groups. Cox regression analysis was conducted to determine independent factors affecting the AFS. Results During a median follow-up of 31 months, 561 patients with chronic CLI underwent infrainguinal revascularization. Five-year mortality was lower in the NLR 5 group (49%) ( P ≤ 0.001), and the AFS was significantly higher in the NLR 5 group (26%) ( P ≤ 0.001). In a multivariate analysis, preoperative NLR >5 was independently associated with 5-year AFS (hazard ratio 2.325, 95% CI 1.732–3.121). Conclusions Elevated NLR predicts a worse AFS in patients undergoing infrainguinal vascular revascularization with chronic CLI, suggesting that the NLR conveys powerful prognostic information that is independent of other conventional clinical risk factors. |
| doi_str_mv | 10.1016/j.avsg.2013.06.037 |
| format | Article |
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Methods All patients with CLI undergoing elective infrainguinal vascular surgery (open or endovascular) at a single university teaching hospital between January 2005 and December 2009 were retrospectively identified from a prospectively maintained database. The primary end point was AFS. The cut-off of NLR >5 was used to categorize patients into low- and high-NLR groups. Kaplan–Meier analysis and long-rank test were used to compare survival between both groups. Cox regression analysis was conducted to determine independent factors affecting the AFS. Results During a median follow-up of 31 months, 561 patients with chronic CLI underwent infrainguinal revascularization. Five-year mortality was lower in the NLR <5 group (33%) than in the NLR >5 group (49%) ( P ≤ 0.001), and the AFS was significantly higher in the NLR <5 group (50%) than in the NLR >5 group (26%) ( P ≤ 0.001). In a multivariate analysis, preoperative NLR >5 was independently associated with 5-year AFS (hazard ratio 2.325, 95% CI 1.732–3.121). Conclusions Elevated NLR predicts a worse AFS in patients undergoing infrainguinal vascular revascularization with chronic CLI, suggesting that the NLR conveys powerful prognostic information that is independent of other conventional clinical risk factors.</description><identifier>ISSN: 0890-5096</identifier><identifier>EISSN: 1615-5947</identifier><identifier>DOI: 10.1016/j.avsg.2013.06.037</identifier><identifier>PMID: 24559786</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Amputation ; Chi-Square Distribution ; Chronic Disease ; Critical Illness ; Disease-Free Survival ; Endovascular Procedures - adverse effects ; Endovascular Procedures - mortality ; Female ; Hospitals, University ; Humans ; Ischemia - blood ; Ischemia - diagnosis ; Ischemia - mortality ; Ischemia - therapy ; Kaplan-Meier Estimate ; Limb Salvage ; Lymphocyte Count ; Lymphocytes ; Male ; Middle Aged ; Multivariate Analysis ; Neutrophils ; Peripheral Arterial Disease - blood ; Peripheral Arterial Disease - diagnosis ; Peripheral Arterial Disease - mortality ; Peripheral Arterial Disease - therapy ; Predictive Value of Tests ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Spain ; Surgery ; Time Factors ; Treatment Outcome ; Vascular Surgical Procedures - adverse effects ; Vascular Surgical Procedures - mortality</subject><ispartof>Annals of vascular surgery, 2014-05, Vol.28 (4), p.999-1004</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-3184237f20ecc1d6ff946c3a4165e7574f00eb3162148c91e5623ce90c7973183</citedby><cites>FETCH-LOGICAL-c411t-3184237f20ecc1d6ff946c3a4165e7574f00eb3162148c91e5623ce90c7973183</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.avsg.2013.06.037$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24559786$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>González-Fajardo, José A</creatorcontrib><creatorcontrib>Brizuela-Sanz, José A</creatorcontrib><creatorcontrib>Aguirre-Gervás, Beatriz</creatorcontrib><creatorcontrib>Merino-Díaz, Borja</creatorcontrib><creatorcontrib>Del Río-Solá, Lourdes</creatorcontrib><creatorcontrib>Martín-Pedrosa, Miguel</creatorcontrib><creatorcontrib>Vaquero-Puerta, Carlos</creatorcontrib><title>Prognostic Significance of an Elevated Neutrophil–Lymphocyte Ratio in the Amputation-free Survival of Patients with Chronic Critical Limb Ischemia</title><title>Annals of vascular surgery</title><addtitle>Ann Vasc Surg</addtitle><description>Background The aim of this study was to investigate the utility of admission neutrophil–lymphocyte ratio (NLR) in predicting the amputation-free survival (AFS) of patients with critical limb ischemia (CLI) who underwent an elective infrainguinal therapeutic intervention. Methods All patients with CLI undergoing elective infrainguinal vascular surgery (open or endovascular) at a single university teaching hospital between January 2005 and December 2009 were retrospectively identified from a prospectively maintained database. The primary end point was AFS. The cut-off of NLR >5 was used to categorize patients into low- and high-NLR groups. Kaplan–Meier analysis and long-rank test were used to compare survival between both groups. Cox regression analysis was conducted to determine independent factors affecting the AFS. Results During a median follow-up of 31 months, 561 patients with chronic CLI underwent infrainguinal revascularization. Five-year mortality was lower in the NLR <5 group (33%) than in the NLR >5 group (49%) ( P ≤ 0.001), and the AFS was significantly higher in the NLR <5 group (50%) than in the NLR >5 group (26%) ( P ≤ 0.001). In a multivariate analysis, preoperative NLR >5 was independently associated with 5-year AFS (hazard ratio 2.325, 95% CI 1.732–3.121). Conclusions Elevated NLR predicts a worse AFS in patients undergoing infrainguinal vascular revascularization with chronic CLI, suggesting that the NLR conveys powerful prognostic information that is independent of other conventional clinical risk factors.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Amputation</subject><subject>Chi-Square Distribution</subject><subject>Chronic Disease</subject><subject>Critical Illness</subject><subject>Disease-Free Survival</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - mortality</subject><subject>Female</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Ischemia - blood</subject><subject>Ischemia - diagnosis</subject><subject>Ischemia - mortality</subject><subject>Ischemia - therapy</subject><subject>Kaplan-Meier Estimate</subject><subject>Limb Salvage</subject><subject>Lymphocyte Count</subject><subject>Lymphocytes</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neutrophils</subject><subject>Peripheral Arterial Disease - blood</subject><subject>Peripheral Arterial Disease - diagnosis</subject><subject>Peripheral Arterial Disease - mortality</subject><subject>Peripheral Arterial Disease - therapy</subject><subject>Predictive Value of Tests</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Spain</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vascular Surgical Procedures - adverse effects</subject><subject>Vascular Surgical Procedures - mortality</subject><issn>0890-5096</issn><issn>1615-5947</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ks2O0zAUhSMEYsrAC7BAXrJJ8E_sJBJCGlUDjFTBiMLacp2bxiWxi-1k1B3vAE_Ik-CoAwsWrCxdfedc-ZybZc8JLggm4tWhUHPYFxQTVmBRYFY9yFZEEJ7zpqweZitcNzjnuBEX2ZMQDhgTWpf14-yClpw3VS1W2c9b7_bWhWg02pq9NZ3RympArkPKousBZhWhRR9git4dezP8-v5jcxqPvdOnCOiTisYhY1HsAV2NxykuA5t3HgBtJz-bWQ2L2W2ag40B3ZnYo3XvnU0r196kzYnYmHGHboLuYTTqafaoU0OAZ_fvZfbl7fXn9ft88_Hdzfpqk-uSkJgzUpeUVR3FoDVpRdc1pdBMlURwqHhVdhjDjhFBSVnrhgAXlGlosK6aKonZZfby7Hv07tsEIcrRBA3DoCy4KUjCKWGUC76g9Ixq70Lw0MmjN6PyJ0mwXNqQB7m0IZc2JBYytZFEL-79p90I7V_Jn_gT8PoMQPrlbMDLoFNKGlrjQUfZOvN__zf_yPVg7JLnVzhBOLjJ25SfJDJQieV2uYflHAjDmIuSs98ITrLE</recordid><startdate>20140501</startdate><enddate>20140501</enddate><creator>González-Fajardo, José A</creator><creator>Brizuela-Sanz, José A</creator><creator>Aguirre-Gervás, Beatriz</creator><creator>Merino-Díaz, Borja</creator><creator>Del Río-Solá, Lourdes</creator><creator>Martín-Pedrosa, Miguel</creator><creator>Vaquero-Puerta, Carlos</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140501</creationdate><title>Prognostic Significance of an Elevated Neutrophil–Lymphocyte Ratio in the Amputation-free Survival of Patients with Chronic Critical Limb Ischemia</title><author>González-Fajardo, José A ; Brizuela-Sanz, José A ; Aguirre-Gervás, Beatriz ; Merino-Díaz, Borja ; Del Río-Solá, Lourdes ; Martín-Pedrosa, Miguel ; Vaquero-Puerta, Carlos</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-3184237f20ecc1d6ff946c3a4165e7574f00eb3162148c91e5623ce90c7973183</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Amputation</topic><topic>Chi-Square Distribution</topic><topic>Chronic Disease</topic><topic>Critical Illness</topic><topic>Disease-Free Survival</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - mortality</topic><topic>Female</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Ischemia - blood</topic><topic>Ischemia - diagnosis</topic><topic>Ischemia - mortality</topic><topic>Ischemia - therapy</topic><topic>Kaplan-Meier Estimate</topic><topic>Limb Salvage</topic><topic>Lymphocyte Count</topic><topic>Lymphocytes</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neutrophils</topic><topic>Peripheral Arterial Disease - blood</topic><topic>Peripheral Arterial Disease - diagnosis</topic><topic>Peripheral Arterial Disease - mortality</topic><topic>Peripheral Arterial Disease - therapy</topic><topic>Predictive Value of Tests</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Spain</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vascular Surgical Procedures - adverse effects</topic><topic>Vascular Surgical Procedures - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>González-Fajardo, José A</creatorcontrib><creatorcontrib>Brizuela-Sanz, José A</creatorcontrib><creatorcontrib>Aguirre-Gervás, Beatriz</creatorcontrib><creatorcontrib>Merino-Díaz, Borja</creatorcontrib><creatorcontrib>Del Río-Solá, Lourdes</creatorcontrib><creatorcontrib>Martín-Pedrosa, Miguel</creatorcontrib><creatorcontrib>Vaquero-Puerta, Carlos</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>González-Fajardo, José A</au><au>Brizuela-Sanz, José A</au><au>Aguirre-Gervás, Beatriz</au><au>Merino-Díaz, Borja</au><au>Del Río-Solá, Lourdes</au><au>Martín-Pedrosa, Miguel</au><au>Vaquero-Puerta, Carlos</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic Significance of an Elevated Neutrophil–Lymphocyte Ratio in the Amputation-free Survival of Patients with Chronic Critical Limb Ischemia</atitle><jtitle>Annals of vascular surgery</jtitle><addtitle>Ann Vasc Surg</addtitle><date>2014-05-01</date><risdate>2014</risdate><volume>28</volume><issue>4</issue><spage>999</spage><epage>1004</epage><pages>999-1004</pages><issn>0890-5096</issn><eissn>1615-5947</eissn><abstract>Background The aim of this study was to investigate the utility of admission neutrophil–lymphocyte ratio (NLR) in predicting the amputation-free survival (AFS) of patients with critical limb ischemia (CLI) who underwent an elective infrainguinal therapeutic intervention. Methods All patients with CLI undergoing elective infrainguinal vascular surgery (open or endovascular) at a single university teaching hospital between January 2005 and December 2009 were retrospectively identified from a prospectively maintained database. The primary end point was AFS. The cut-off of NLR >5 was used to categorize patients into low- and high-NLR groups. Kaplan–Meier analysis and long-rank test were used to compare survival between both groups. Cox regression analysis was conducted to determine independent factors affecting the AFS. Results During a median follow-up of 31 months, 561 patients with chronic CLI underwent infrainguinal revascularization. Five-year mortality was lower in the NLR <5 group (33%) than in the NLR >5 group (49%) ( P ≤ 0.001), and the AFS was significantly higher in the NLR <5 group (50%) than in the NLR >5 group (26%) ( P ≤ 0.001). In a multivariate analysis, preoperative NLR >5 was independently associated with 5-year AFS (hazard ratio 2.325, 95% CI 1.732–3.121). Conclusions Elevated NLR predicts a worse AFS in patients undergoing infrainguinal vascular revascularization with chronic CLI, suggesting that the NLR conveys powerful prognostic information that is independent of other conventional clinical risk factors.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>24559786</pmid><doi>10.1016/j.avsg.2013.06.037</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Amputation Chi-Square Distribution Chronic Disease Critical Illness Disease-Free Survival Endovascular Procedures - adverse effects Endovascular Procedures - mortality Female Hospitals, University Humans Ischemia - blood Ischemia - diagnosis Ischemia - mortality Ischemia - therapy Kaplan-Meier Estimate Limb Salvage Lymphocyte Count Lymphocytes Male Middle Aged Multivariate Analysis Neutrophils Peripheral Arterial Disease - blood Peripheral Arterial Disease - diagnosis Peripheral Arterial Disease - mortality Peripheral Arterial Disease - therapy Predictive Value of Tests Proportional Hazards Models Retrospective Studies Risk Assessment Risk Factors Spain Surgery Time Factors Treatment Outcome Vascular Surgical Procedures - adverse effects Vascular Surgical Procedures - mortality |
| title | Prognostic Significance of an Elevated Neutrophil–Lymphocyte Ratio in the Amputation-free Survival of Patients with Chronic Critical Limb Ischemia |
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