Critical limb ischemia patients clinically improving with medical treatment have lower neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios

Abstract

Objectives Inflammation is a component in the pathogenesis of critical limb ischemia. We aimed to assess how inflammation affects response to treatment in patients treated for critical limb ischemia using neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocytes ratios (PLR) as markers of inflammation. Methods Patients in a single tertiary cardiovascular center with critical limb ischemia unsuitable for surgical or interventional revascularization were retrospectively identified. Data were collected on medical history for risk factors, previous surgical or endovascular revascularization, and outcome. A standard regimen of low molecular weight heparin, aspirin, statins, iloprost infusions, and a standard pain medication protocol were applied to each patient per hospital protocol. Patients with improvement in ischemic pain and healed ulcers made up the responders group and cases with no worsening pain or ulcer size or progression to minor or major amputations made up the non-responders group. Responders and Non-responders were compared for risk factors including pretreatment NLR and PLR. Results 268 included patients who were not candidates for surgical or endovascular revascularization were identified. Responders had significantly lower pretreatment NLR (4.48 vs 8.47, p < 0.001) and PLR (162.19 vs 225.43, p = 0.001) values. After controlling for associated risk factors NLR ≥ 4.63 (p < 0.001) and PLR ≥ 151.24 (p = 0.016) were independently associated with no response to treatment. Conclusions Neutrophil-to-lymphocyte ratio and platelet-to-lymphocytes ratio are markers of inflammation that are reduced in patients improving with medical treatment suggesting a decreased state of inflammation before treatment in responding patients.

Neutrophil to Lymphocyte Ratio: a useful predictor of amputation in patients with Necrotizing fasciitis: Diagnostic accuracy study

“…The current study also demonstrated the usefulness of PLR and SII as diagnostic markers. In the study by Erdogan et al, NLR and PLR were found to reduce in patients with acute limb ischemia who improve with medical treatment [39]. Saskin et al in their study reported that increased NLR and PLR are found to be associated with extremity amputation in acute arterial occlusions [27].…”

The Role of Neutrophils in Lower Limb Peripheral Artery Disease: State of the Art and Future Perspectives

“…NLR levels ≥ 5.25 were also independently associated with 12-month death in patients with CLTI, including those undergoing infra-popliteal percutaneous intervention [ 135 , 173 ]. In a retrospective study on patients with CLTI unsuitable for revascularization and receiving standard pharmacological treatment including low molecular weight heparin, aspirin, statins, iloprost infusion, and a standard pain medication protocol, lower pre-treatment levels of NLR were associated with subsequent improvement in ischemic pain and healed ulcers [ 136 ]. Other authors showed similar findings [ 138 ].…”

Inconsistent cut-off values of inflammatory indexes in limb ischemia

“…Therefore, it is reasonable to conclude that the association between NLR/PLR and outcomes in limb ischemia was also U-shaped. If this is the case, the different cut-off values (Youden index) 1–3 may be caused by the different proportions of patients with low NLR/PLR values in these studies. For instance, the Youden index in the cohort without patients with low NLR/PLR would be much greater than that in a cohort with a high proportion of patients with low NLR/PLR.…”

“…We read with great interest Dr Erdogan et al’s study, 1 which investigated the predictive value of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios in patients with critical limb ischemia. The major finding is that after adjusting for covariates, both high NLR and PLR were independently associated with no response to treatment.…”