Department of Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina -
Department of Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
Int Angiol. 2022 Jun;41(3):188-195. doi: 10.23736/S0392-9590.22.04754-X. Epub 2022 Feb 9.
Symptomatic but unruptured abdominal aortic aneurysm (AAA) is a potentially fatal disease since its etiopathogenesis, involving acute changes in the aortic wall, including inflammation, increasing the probability of impending rupture. The objective of the present study was to assess the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) in patients undergoing urgent symptomatic AAA repair.
This was a retrospective study including 29 patients with symptomatic AAA repaired between 2011 and 2020. Both NLR and PLR were calculated on hospital admission prior to the intervention. The primary end point was in-hospital mortality, and the secondary end point included length of hospital stay and postoperative complications.
In-hospital mortality rate was 10.3%. The discriminatory performance to predict the primary end point was very good both for PLR (area under the ROC curve [AUC]: 0.92 (95% confidence interval [CI]: 0.82-1.00; P=0.02) and NLR (AUC: 0.88 [95% CI: 0.75-1.00]; P=0.04). The best cutoff point to predict in-hospital mortality was 185 for PLR (100% sensitivity and 85% specificity) and 6.4 for NLR (100% sensitivity and 77% specificity). The most frequent postoperative complication was acute kidney failure (37.9%). Both elevated PLR as NLR were significantly associated with acute kidney failure and multiorgan failure in the immediate postoperative period (P<0.01). None of the two ratios was associated with length of hospital stay (P=NS).
Both PLR and NLR are low-cost inflammatory markers widely available in every emergency department, with excellent performance to predict in-hospital mortality in patients undergoing symptomatic AAA repair. Patients with a PLR≥185 and/or an NLR≥6.4 could benefit from a "surveyed waiting conduct" improving the preoperative clinical condition prior to the intervention, or even considering endovascular repair.
有症状但未破裂的腹主动脉瘤（AAA）是一种潜在的致命疾病，因为其病因学涉及主动脉壁的急性变化，包括炎症，增加即将破裂的可能性。本研究的目的是评估中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）在接受紧急有症状 AAA 修复的患者中的预后价值。
这是一项回顾性研究，纳入了 2011 年至 2020 年间接受有症状 AAA 修复的 29 名患者。在干预前的入院时计算 NLR 和 PLR。主要终点是住院期间死亡率，次要终点包括住院时间和术后并发症。
住院死亡率为 10.3%。PLR（ROC 曲线下面积 [AUC]：0.92（95%置信区间 [CI]：0.82-1.00；P=0.02）和 NLR（AUC：0.88 [95% CI：0.75-1.00]；P=0.04）对预测主要终点的区分性能非常好。预测住院死亡率的最佳截断值为 PLR 为 185（100%敏感性和 85%特异性）和 NLR 为 6.4（100%敏感性和 77%特异性）。最常见的术后并发症是急性肾衰竭（37.9%）。PLR 和 NLR 升高均与术后即刻急性肾衰竭和多器官衰竭显著相关（P<0.01）。这两个比值均与住院时间无关（P=NS）。
PLR 和 NLR 都是成本低廉的炎症标志物，在每个急诊部门都广泛可用，对预测接受有症状 AAA 修复的患者的住院死亡率具有出色的性能。PLR≥185 和/或 NLR≥6.4 的患者可以从“调查性等待”中受益，改善术前临床状况，然后再进行干预，甚至可以考虑血管内修复。
