Jackson Sarah M, Perry Luke A, Borg Carla, Ramson Dhruvesh M, Campbell Ryan, Liu Zhengyang, Nguyen Jacqueline, Douglas Ned, Kok Juliana, Penny-Dimri Jahan
Department of Anaesthesia, 90134Royal Melbourne Hospital, Parkville, Victoria, Australia.
Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia.
Vasc Endovascular Surg. 2020 Nov;54(8):697-706. doi: 10.1177/1538574420951315. Epub 2020 Aug 25.
The global burden of surgical vascular disease is increasing and with it, the need for cost-effective, accessible prognostic biomarkers to aid optimization of peri-operative outcomes. The neutrophil-lymphocyte ratio (NLR) is emerging as a potential candidate biomarker for perioperative risk stratification. We therefore performed this systematic review and meta-analysis on the prognostic value of elevated preoperative NLR in vascular surgery.
We searched Embase (Ovid), Medline (Ovid), and the Cochrane Library database from inception to June 2019. Screening was performed, and included all peer-reviewed original research studies reporting preoperative NLR in adult emergent and elective vascular surgical patients. Studies were assessed for bias and quality of evidence using a standardized tool. Meta-analysis was performed by general linear (mixed-effects) modelling where possible, and otherwise a narrative review was conducted. Between-study heterogeneity was estimated using the Chi-squared statistic and explored qualitatively.
Fourteen studies involving 5,652 patients were included. The overall methodological quality was good. Elevated preoperative NLR was associated with increased risk of long-term mortality (HR 1.40 [95%CI: 1.13-1.74], Chi-squared 60.3%, 7 studies, 3,637 people) and short-term mortality (OR: 3.08; 95%CI: 1.91-4.95), Chi-squared 66.59%, 4 studies, 945 people). Outcome measures used by fewer studies such as graft patency and amputation free survival were assessed via narrative review.
NLR is a promising, readily obtainable, prognostic biomarker for mortality outcomes following vascular surgery. Heterogeneity in patient factors, severity of vascular disease, and type of vascular surgery performed renders direct comparison of outcomes from the current literature challenging. This systematic review supports further investigation for NLR measurement in pre-vascular surgical risk stratification. In particular, the establishment of a universally accepted NLR cut-off value is of importance in real-world implementation of this biomarker.
外科血管疾病的全球负担正在增加，因此需要具有成本效益且易于获取的预后生物标志物，以帮助优化围手术期结果。中性粒细胞与淋巴细胞比值（NLR）正在成为围手术期风险分层的潜在候选生物标志物。因此，我们对术前NLR升高在血管手术中的预后价值进行了这项系统评价和荟萃分析。
我们检索了从建库至2019年6月的Embase（Ovid）、Medline（Ovid）和Cochrane图书馆数据库。进行了筛选，纳入了所有报道成年急诊和择期血管手术患者术前NLR的同行评审原始研究。使用标准化工具评估研究的偏倚和证据质量。尽可能通过一般线性（混合效应）模型进行荟萃分析，否则进行叙述性综述。使用卡方统计量估计研究间异质性并进行定性探讨。
纳入了14项涉及5652例患者的研究。总体方法学质量良好。术前NLR升高与长期死亡率增加（HR 1.40 [95%CI：1.13 - 1.74]，卡方60.3%，7项研究，3637人）和短期死亡率增加（OR：3.08；95%CI：1.91 - 4.95）相关，卡方66.59%，4项研究，945人。通过叙述性综述评估了较少研究使用的结局指标，如移植物通畅率和无截肢生存率。
NLR是血管手术后死亡率结局的一个有前景、易于获得的预后生物标志物。患者因素、血管疾病严重程度和血管手术类型的异质性使得直接比较当前文献中的结果具有挑战性。这项系统评价支持在血管手术前风险分层中进一步研究NLR测量。特别是在该生物标志物的实际应用中，建立普遍接受的NLR临界值很重要。
