Vascular Surgery Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
Universitat Autònoma de Barcelona / Universitat Pompeu Fabra, Barcelona, Spain.
World J Surg. 2021 Jun;45(6):1949-1955. doi: 10.1007/s00268-021-06051-1. Epub 2021 Mar 15.
Prognostic factors of long-term survival can guide selection of patients for endovascular repair of abdominal aortic aneurysms (EVAR). The aim of this study was to evaluate the relationship between the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the lymphocyte-to-monocyte ratio (LMR) and the systemic immune-inflammation index (SIII) with survival after EVAR and to assess whether the addition of these biomarkers improved the prediction of survival after surgery.
Retrospective analysis of 284 consecutive patients who underwent an EVAR at a single institution. The association between biomarkers and survival was explored using generalized additive models with penalized smoothing splines and multivariate Cox models. C-statistics and continuous net reclassification indexes (c-NRI) were used to assess the improvement in prediction.
Survival rates at 2 and 5 years were 83.9% and 66.2%, respectively. The predictive score of survival included hemoglobin (HR = 0.849, p = 0.004), statin intake (HR = 0.538, p = 0.004), atrial fibrillation (HR = 2.515, p < 0.001), heart failure (HR = 2.542, p = 0.017) and the non-revascularized coronary artery disease (HR = 2.163, p = 0.004). Spline analyses showed a linear relationship between survival and NLR, PLR, LMR and SII. After adjusting for the predictive score, there was an independent relationship between survival and NLR (HR = 1.072, p = 0.006), PLR (HR = 1.002, p = 0.014) and SII (HR = 1.000, p = 0.043). However, only the addition of NLR improved moderately the c-NRI. A NLR ≥ 3 was independently associated with lower survival rates at 2-years (HR 1.98; 95% CI 1.07-3.66) and 5-years (HR 1.84, 95% CI 1.22-2.78) of follow-up.
Most inflammatory biomarkers are linear and independently associated with survival after EVAR, but only the NLR improved moderately the prediction of a survival score. Therefore, a NLR ≥ 3 may be used to identify patients with a low survival rate and help in decision-making.
长期生存的预后因素可以指导腹主动脉瘤血管内修复术（EVAR）患者的选择。本研究旨在评估中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与单核细胞比值（LMR）和全身免疫炎症指数（SIII）与 EVAR 后生存的关系，并评估这些生物标志物的加入是否改善了手术预后的预测。
对在一家单机构接受 EVAR 的 284 例连续患者进行回顾性分析。使用带惩罚平滑样条的广义加性模型和多变量 Cox 模型探讨生物标志物与生存的关系。C 统计量和连续净重新分类指数（c-NRI）用于评估预测的改善。
2 年和 5 年的生存率分别为 83.9%和 66.2%。生存预测评分包括血红蛋白（HR=0.849，p=0.004）、他汀类药物摄入（HR=0.538，p=0.004）、心房颤动（HR=2.515，p<0.001）、心力衰竭（HR=2.542，p=0.017）和未血管化的冠心病（HR=2.163，p=0.004）。样条分析显示，生存与 NLR、PLR、LMR 和 SII 之间存在线性关系。在调整预测评分后，NLR（HR=1.072，p=0.006）、PLR（HR=1.002，p=0.014）和 SII（HR=1.000，p=0.043）与生存之间存在独立关系。然而，只有 NLR 的增加适度地改善了 c-NRI。NLR≥3 与 2 年（HR 1.98；95%CI 1.07-3.66）和 5 年（HR 1.84，95%CI 1.22-2.78）随访时的生存率较低独立相关。
大多数炎症生物标志物与 EVAR 后生存呈线性相关且独立相关，但只有 NLR 适度改善了生存评分的预测。因此，NLR≥3 可用于识别生存率较低的患者，并有助于决策。
