Relationship between neutrophil-lymphocyte ratio and severity of lower extremity peripheral artery disease

Int J Cardiol. 2017 Feb 1:228:201-204. doi: 10.1016/j.ijcard.2016.11.097. Epub 2016 Nov 14.

Abstract

Background: The aim of this study was to determine the association between neutrophil-lymphocyte ratio (NLR) and severity of lower extremity peripheral artery disease (PAD).

Methods: A retrospective chart review identified 928 patients referred for peripheral angiography. NLR was assessed from routine pre-procedural hemograms with automated differentials and available in 733 patients. Outcomes of interest were extent of disease on peripheral angiography and target vessel revascularization. Median follow-up was 10.4months. Odds ratio (OR) [95% confidence intervals] was assessed using a logistic regression model.

Results: There was a significant association between elevated NLR and presence of severe multi-level PAD versus isolated suprapopliteal or isolated infrapopliteal disease (OR 1.11 [1.03-1.19], p=0.007). This association remained significant even after adjustment for age (OR 1.09 [1.01-1.17], p=0.02); age, sex, race, and body mass index (OR 1.08 [1.00-1.16], p=0.046); and age, sex, race, body mass index, hypertension, diabetes mellitus, coronary artery disease, and creatinine (OR 1.07 [1.00-1.15], p=0.049). After additional adjustment for clinical presentation, there was a trend towards association between NLR and severe multi-level PAD (OR 1.07 [1.00-1.15], p=0.056), likely limited by sample size. In patients who underwent endovascular intervention (n=523), there was no significant difference in rate of target vessel revascularization across tertiles of NLR (1st tertile 14.8%, 2nd tertile 14.1%, 3rd tertile 20.1%; p=0.32).

Conclusion: In a contemporary cohort of patients undergoing peripheral angiography with possible endovascular intervention, elevated NLR was independently associated with severe multi-level PAD. Larger studies evaluating the association between this inexpensive biomarker and clinical outcomes are warranted.

Keywords: Lymphocyte; Neutrophil; Peripheral angiography; Peripheral artery disease.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiography
  • Endovascular Procedures
  • Female
  • Humans
  • Lower Extremity / blood supply*
  • Lymphocyte Count
  • Lymphocytes*
  • Male
  • Middle Aged
  • Neutrophils*
  • Peripheral Arterial Disease / blood*
  • Peripheral Arterial Disease / diagnosis*
  • Peripheral Arterial Disease / therapy
  • Predictive Value of Tests
  • Retrospective Studies
  • Severity of Illness Index