Neutrophil-to-Lymphocyte Ratio: A Comparative Study of Rupture to Nonruptured Infrarenal Abdominal Aortic Aneurysm
Neutrophil-to-Lymphocyte Ratio: A Comparative Study of Rupture to Nonruptured Infrarenal Abdominal Aortic Aneurysm
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DOI：
10.1016/j.avsg.2018.11.026
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发表时间：
2019-07-01
影响因子：
1.5
通讯作者：
Dan, Bindea
中科院分区：
文献类型：
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作者：
Aurelian, Sasarman Vasile;Adrian, Molnar;Dan, Bindea
背景：中性粒细胞与淋巴细胞比率（NLR）最近已成为心血管风险和不良结局的有用预测指标。根据先前的研究，NLR > 5对心血管疾病的术后发病率和死亡率具有最高的敏感性和特异性。本研究旨在评估肾下未破裂腹主动脉瘤（uAAA）和破裂腹主动脉瘤（rAAA）病例的NLR，并评估NLR作为uAAA和rAAA患者接受手术修复后30天死亡率的预后标志物的作用。这项回顾性队列研究检查了255例连续的肾下AAA完整或破裂患者，这些患者接受了择期或紧急开放修复术在我们的诊所里做手术。使用卡方计算评估患病率的差异，大于5的值和小于0.05的P值被认为是显著的。当Bartlett P值大于0.05时，使用ANOVA参数检验比较平均值。结果：rAAA患者组的平均NLR似乎显著较高（分别为9.3 vs. 3.39，P <0.001）。rAAA患者NLR > 5的发生率为77.6%，而uAAA患者仅为32.5%（比值比5.085; 95%可信区间[CI]：3.0025-8.6145; P < 0000.1）。就uAAA患者的术后预后而言，NLR > 5的患者术后30天的死亡率显著高于NLR < 5的患者（16.6%，6%）（RR：2.77; 95% CI：1.020-7.55; P < 0.045）。在rAAA病例中，NLR > 5的患者30天后的死亡率（61.44%）高于NLR < 5的患者（45.83%）。NLR与住院时间或NLR与AAA最大直径之间无相关性。性别或年龄组之间的NLR也没有差异。结论：本研究的主要结果是不良的结果，在30天的死亡率为患者的NLR值大于5接受开放手术修复两个类别：肾下uAAA和rAAA。我们还发现，rAAA患者的NLR显著较高，NLR > 5表示AAA破裂的可能性高5倍。我们可以使用这种容易确定、广泛可用且廉价的标记物来识别高风险患者，单独或整合到诊断为AAA的患者的风险分层系统中。这将有助于AAA的治疗管理，包括在存在禁止性风险时避免开放手术，而不是选择血管内方法。
Background: Neutrophil-to-lymphocyte ratio (NLR) has recently emerged as a useful predictor of cardiovascular risk and adverse outcomes. According to previous studies, an NLR > 5 has the highest sensitivity and specificity for postoperative morbidity and mortality in cardiovascular disease. This study aims to evaluate the NLR in cases of infrarenal unruptured abdominal aortic aneurysm (uAAA) and ruptured abdominal aortic aneurysm (rAAA) and to assess the role of NLR as a prognostic marker of 30-day mortality in patients with uAAA and rAAA who underwent surgical repair.Methods: This retrospective cohort study examined 255 consecutive patients with intact or ruptured infrarenal AAA who underwent elective or urgent open repair surgery within our clinic in a 10-year period. Differences in prevalence were assessed using chi-squared calculations and values greater than 5 and a P-value less than 0.05 were considered significant. The averages were compared using the ANOVA parameter test when the Bartlett P-value was greater than 0.05.Results: The average NLR appeared to be significantly higher in the group of patients with rAAA (9.3 vs. 3.39, respectively P < 0001). Furthermore, NLR > 5 occurred in 77.6% of patients with rAAA but only 32.5% in patients with uAAA (odds ratio 5.085; 95% confidence interval [CI]: 3.0025-8.6145; P < 0000.1). In terms of the postoperative prognosis in patients with uAAA, mortality after 30 days postoperatively was considerably higher at 16.6% in patients with NLR > 5 compared with 6% for patients with NLR < 5 (RR: 2.77; 95% CI: 1.020-7.55; P < 0.045). In the case of rAAA, mortality after 30 days was higher in patients with NLR > 5 (61.44%) than those with NLR < 5 (45.83%). There was no relationship between NLR and length of hospital stay or between NLR and the maximum diameter of the AAA. There was also no difference in the NLR between genders or age groups.Conclusions: The main findings of this study were the poor outcomes in terms of 30-day mortality for the patients presenting NLR values greater than 5 undergoing open surgical repair in both categories: infrarenal uAAA and rAAA. We also show that NLR is significantly higher among patients with rAAA and that an NLR > 5 indicates a 5 times greater possibility of AAA being ruptured. We can use this easily determinable, broadly available, and inexpensive marker to identify high-risk patients, individually, or integrated into a risk-stratification system for patients diagnosed with AAA. This would help in the therapeutic management of AAA, including the avoidance of open surgery when there are prohibitive risks, instead opting for an endovascular approach.