Zhao Wen-Xin, Wu Zhi-Yuan, Zhao Ning, Diao Yong-Peng, Lan Yong, Li Yong-Jun
Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100010 Beijing, China.
Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, 100010 Beijing, China.
Rev Cardiovasc Med. 2024 May 31;25(6):202. doi: 10.31083/j.rcm2506202. eCollection 2024 Jun.
Clinically useful predictors for risk stratification of long-term survival may assist in selecting patients for endovascular abdominal aortic aneurysm (EVAR) procedures. This study aimed to analyze the prognostic significance of peroperative novel systemic inflammatory markers (SIMs), including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), hemoglobin-to-red cell distribution width ratio (HRR), systemic immune-inflammatory index (SIII), and systemic inflammatory response index (SIRI), for long-term mortality in EVAR.
A retrospective analysis was performed on 147 consecutive patients who underwent their first EVAR procedure at the Department of Vascular Surgery, Beijing Hospital. The patients were divided into the mortality group (n = 37) and the survival group (n = 110). The receiver operating characteristic curves were used to ascertain the threshold value demonstrating the most robust connection with mortality. The Kaplan-Meier survival analysis was performed between each SIM and mortality. The relationship between SIMs and survival was investigated using restricted cubic splines and multivariate Cox regression analysis.
The study included 147 patients, with an average follow-up duration of 34.28 22.95 months. Deceased patients showed significantly higher NLR ( 0.001) and reduced HRR ( 0.001). The Kaplan-Meier estimates of mortality were considerably greater in the higher-NLR group (NLR 2.77) and lower-HRR group (HRR 10.64). The hazard ratio (HR) of 0.833 (95% confidence interval (95% CI): 0.71-0.97, 0.021) was determined to be statistically significant in predicting death in the multivariable analysis.
Preoperative higher-NLR and lower-HRR have been associated with a lower long-term survival rate in abdominal aortic aneurysm (AAA) patients undergoing elective EVAR. Multivariate Cox regression showed that decreased preoperative HRR is an independent risk factor that increases mortality risk following EVAR. SIMs, such as the NLR and HRR, could be used in future clinical risk prediction methodologies for AAA patients undergoing EVAR. However, additional prospective cohort studies are needed to identify these findings.
用于长期生存风险分层的临床有用预测指标可能有助于选择适合血管内腹主动脉瘤（EVAR）手术的患者。本研究旨在分析围手术期新型全身炎症标志物（SIMs），包括中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、血红蛋白与红细胞分布宽度比值（HRR）、全身免疫炎症指数（SIII）和全身炎症反应指数（SIRI）对EVAR患者长期死亡率的预后意义。
对在北京医院血管外科接受首次EVAR手术的147例连续患者进行回顾性分析。将患者分为死亡组（n = 37）和生存组（n = 110）。使用受试者工作特征曲线确定与死亡率关联最密切的阈值。对每个SIM与死亡率进行Kaplan-Meier生存分析。使用受限立方样条和多变量Cox回归分析研究SIMs与生存之间的关系。
该研究纳入147例患者，平均随访时间为34.28±22.95个月。死亡患者的NLR显著更高（P<0.001），HRR更低（P<0.001）。在高NLR组（NLR>2.77）和低HRR组（HRR<10.64）中，Kaplan-Meier估计的死亡率明显更高。在多变量分析中，确定风险比（HR）为0.833（95%置信区间（95%CI）：0.71-0.97，P = 0.021）在预测死亡方面具有统计学意义。
术前较高的NLR和较低的HRR与接受择期EVAR的腹主动脉瘤（AAA）患者较低的长期生存率相关。多变量Cox回归显示，术前HRR降低是增加EVAR后死亡风险的独立危险因素。NLR和HRR等SIMs可用于未来接受EVAR的AAA患者的临床风险预测方法。然而，需要更多的前瞻性队列研究来验证这些发现。
