Diagnostic Value of Neutrophil Lymphocyte Ratio and D-Dimer as Biological Markers of Deep Vein Thrombosis in Patients Presenting with Unilateral Limb Edema

Abstract

Introduction: Patients with deep vein thrombosis (DVT) pose high morbidity and mortality risk thus needing fast and accurate diagnosis. Wells clinical prediction scores with D-dimer testing are traditionally used to rule out patients with low probability of DVT. However, D-dimer testing has a few limitations regarding its relatively low specificity. Neutrophillymphocyte ratio (NLR), a marker of inflammation, was found to increase in DVT. Hence, we aimed to evaluate the role of NLR for DVT diagnosis. Methods: Data were collected from medical records of patients with suspected DVT at Cipto Mangunkusumo National General Hospital during January-December 2014. Diagnosis of DVT was conducted using lower limb ultrasonography. Diagnostic values for NLR, D-dimer, and NLR + D-dimer were determined by receiver operating characteristic (ROC) analysis to obtain area under the curve (AUC), sensitivity, specificity, negative predictive value, and positive predictive values. Sensitivity and specificity analyses of NLR and D-dimer were also conducted based on Wells score and divided into groups of low and high probability of DVT. Results:The AUC values for NLR, D-dimer, and NLR + D-dimer were 72.6%, 70.4%, and 76.1%, respectively. The optimal cut-off value determined for NLR was 5.12 with sensitivity of 67.7%, specificity of 67.9%, PPV of 68.85%, and NPV of 64.91% in differentiating subjects with and without DVT. This study also found that D-dimer had sensitivity of 69.4%, specificity of 71.4%, PPV of 72.88%, and NPV of 67.8%. Meanwhile, the NLR + D-dimer combination had sensitivity of 66.1% and specificity of 72.6%. Multivariate analysis showed that NLR (OR: 2.636; 95% CI: 1.144-6.076; p: 0.023) and D-dimer (OR: 4.175; 95% CI: 1.810-9.633; p: 0.001) were associated with DVT. Conclusion: NLR value has wider AUC than D-Dimer and is relatively easier to obtain and does not require specific assay, thus enabling rapid evaluation of symptomatic patients suspected of having DVT. Adding NLR to D-dimer increased AUC to detect DVT. Therefore, NLR could serve as a complementary diagnostic tool for D-dimer to exclude DVT, especially in low clinical probability patients.

Hematological Parameters as an Early Marker of Deep Vein Thrombosis in Diabetes Mellitus: An Observational Study

“…Similar results were reported by Erden et al with an AUC of 0.739, a sensitivity of 72%, and a specificity of 67% at an NLR cut-off value of 2.12. Other studies by Farah et al [ 17 ], Mouabbi et al [ 18 ], Rinaldi et al [ 19 ], Tural et al [ 16 ], and Sujana et al [ 20 ] also reported similar results. On ROC analysis of PLR, we found out that the AUC for PLR was 0.746.…”

The Association of Neutrophil–Lymphocyte Ratio with Venous Thromboembolism: A Systematic Review and Meta-Analysis

“…Rinaldi et al have compared the diagnostic power of NLR and D-dimer for predicting DVT. 25 In this study, NLR had higher sensitivity than D-dimer (65% vs 60%) in patients with a low probability of DVT. Furthermore, for patients with a high probability of DVT, NLR had higher specificity than D-dimer (69.2% vs 53.8%).…”

“…Eventually, 10 articles with 1513 VTE participants and 2593 control participants were included for quantitative synthesis. [17][18][19][20][21][22][23][24][25][26] Table 1 and Table 2 illustrate the characteristics of included studies. All were retrospective case-control studies.…”

Hematological ratios in coronavirus disease 2019 patients with and without invasive mechanical ventilation

“…In this context, hematologic ratios such as neutrophil-to-lymphocyte ratio (NLR), derived NLR (d-NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) represent inflammatory markers that have already been described as diagnostic auxiliars for the diagnosis and prognosis of other diseases. [3][4][5][6] Novel data suggest that NLR is associated with various inflammatory conditions even with subtle or overt inflammation which includes diabetes mellitus, irritable bowel disease, and thyroiditis. [7][8][9] It is even associated with COVID-19 disease.…”

“…In this context, hematologic ratisos such as neutrophil-to-lymphocyte ratio (NLR), derived NLR (d-NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) represent inflammatory markers that have already been described as diagnostic auxiliars for the diagnosis and prognosis of other diseases. 3–6…”