Home > Journals > International Angiology > Past Issues > Articles online first > International Angiology 2021 Jan 26

CURRENT ISSUE
 

JOURNAL TOOLS

eTOC
To subscribe
Submit an article
Recommend to your librarian
 

ARTICLE TOOLS

Publication history
Reprints
Permissions
Cite this article as
Share

 

 

International Angiology 2021 Jan 26

DOI: 10.23736/S0392-9590.21.04582-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Neutrophil-lymphocyte ratio as a link between complex pedal ulcers and poor clinical results after infrainguinal surgical revascularization

Julio GONZÁLEZ-HERNANDEZ, César VARELA , Ignacio MICHEL, Ilsem V. LAIME, Jhenifer UYAGUARI, Jose R. MARCH

Angiology and Vascular-Endovascular Surgery Department, Hospital Universitario de Getafe, Getafe, Spain


PDF


BACKGROUND: Our aim is to evaluate the influence of preoperative neutrophil-lymphocyte ratio (NLR) on patency and clinical results after infrainguinal surgical revascularization for chronic limb ischemia.
METHODS: Retrospective analysis of 150 infrainguinal autologous bypasses performed to infragenicular popliteal artery or tibial vessels in 140 (93%) patients with chronic limbthreatening ischemia (CLTI) and in 10 (7%) with disabling claudication. NLR was calculated using blood samples obtained 24 hours preoperatively. The cohort was stratified into 2 groups according to interquartile ranges of NLR: “ELEVATED-NLR” (Quartile 4 n=37) and “LOW-NLR” (Quartile 1-2-3 n=113). Reperfused ulcers were described using the WIfI classification. Patency, freedom from MALE and amputationfree survival at 24 months were calculated using the Kaplan-Meier method. Univariate comparisons between NLR groups were performed using the Log-Rank test. Statistical differences on univariate analysis were adjusted in a multivariate model (Cox regression).
RESULTS: NLR values were similar between CLTI and claudication. Ischemic ulcers were more frequent, (83.4% vs. 59.3% p<0.01), more severe (W2-3: 37.8% vs. 22.1% p=0.01) and pedal infection was deeper (fI 2-3: 40.5% vs. 18.6% p=0.003) in “ELEVATED-NLR” group. Severe ischemia (I3) was similar between groups. High NLR values were independent predictors of patency loss (HR: 1.77 CI95% [1.01-3.10] p=0.04), MALE (HR: 2.04 CI95% [1.03-4.04] p=0.04) and worse amputation-free survival (HR:2.10 CI95% [1.06-4.14] p=0.03) rates at 24 months.
CONCLUSIONS: High preoperative NLR values are associated with severe and deep infected ulcers and predicts primary patency loss, higher major adverse limb events and worse amputationfree survival rates on long-term follow up after infrainguinal surgical revascularization.


KEY WORDS: Neutrophil; Lymphocyte; Lower extremity; arterial bypass; Ulcer

top of page