Neutrophil-lymphocyte ratio as a predictor of cognitive dysfunction in carotid endarterectomy patients

Abstract

Background Systemic inflammation has been implicated in the development of cognitive dysfunction following carotid endarterectomy (CEA). Neutrophil-lymphocyte ratio (NLR) is a reliable measure of systemic inflammation. We hypothesize that patients with elevated preoperative NLR have increased risk of cognitive dysfunction 1 day after CEA. Methods Five hundred fifty-one (551) patients scheduled for CEA were enrolled at Columbia University in New York, NY from 1995 to 2012. NLR was retrospectively reviewed; only 432 patients had preoperative NLR values available within 2 weeks of CEA. NLR was analyzed as a continuous variable and categorically with a cutoff of ≥5 and <5 and equal tertiles, as done in previous studies. Results Patients with cognitive dysfunction had significantly higher NLR than those without cognitive dysfunction (4.5±4.0 vs. 3.2±2.6, P<0.001). The incidence of cognitive dysfunction was significantly higher in patients with NLR ≥5 than NLR <5 (34.7% vs. 12.8%, P<0.001). Significantly fewer patients in the low tertile had cognitive dysfunction than in the high tertile (6.9% vs. 25.9%, P<0.001) and middle tertile (6.9% vs. 17.4%, P=0.006). In the final multivariate model, diabetes mellitus (OR: 2.03 [1.08–3.75], P=0.03) and NLR ≥5 (OR: 3.38 [1.81–6.27], P<0.001) were significantly associated with higher odds of cognitive dysfunction, while statin use was significantly associated with lower odds (OR: 0.48 [0.27–0.84], P=0.01). Conclusions Preoperative NLR is associated with cognitive dysfunction 1 day after CEA. NLR ≥5 and diabetes mellitus are significantly associated with increased odds of cognitive dysfunction while statin use is significantly associated with decreased odds.

Preoperative neutrophil–lymphocyte ratio, an independent risk factor for postoperative cognitive dysfunction in elderly patients with gastric cancer

“…The results from our multivariate logistic regression analysis indicated NLR as an independent risk factor for POCD in elderly patients with GC. Interestingly, Halazun et al have also reported the predictive role of preoperative NLR for cognitive dysfunction 1 day after carotid endarterectomy for high-grade carotid artery stenosis, 17 which is in accordance with our conclusions. However, the cut-off value of NLR for cognitive dysfunction in their results was 5, which was quite different from (cut-off value by ROC curve) our study (2.50).…”

Peripheral leukocyte populations and oxidative stress biomarkers in aged dogs showing impaired cognitive abilities

“…Blood neutrophil/lymphocyte ratio is an inexpensive and easily applicable marker of inflammation and represents a useful diagnostic tool in human and veterinary medicine. It is considered a robust predictor of deleterious outcomes in human cognitive dysfunctions (Halazun et al 2014;Kuyumcu et al 2012). In the present study, neutrophil/lymphocyte ratio was higher in aged dogs, but no differences between impaired and not impaired aged dogs were observed.…”

İlk atak psikoz hastalarında nötrofil lenfosit oranının değerlendirilmesi

“…They have also observed insignificant correlation between elevated NLR levels and psychopathology severity, these results are in line with our findings (9). Halazun et al have found that higher NLR is associated with a threefold increased risk of cognitive dysfunction 1 day after carotid endarterectomy; they have mentioned that systemic inflammation increases atherosclerosis and neuronal injury (8). In line with this result; Kuyumcu et al (2012) have evaluated NLR in 241 patients with Alzheimer's disease and found that NLR was significantly higher than normal cognitive function group (7).…”

“…Although NLR has been extensively studied in other clinical fields including; oncology, cardiovascular surgery and cardiology, there has been only a few studies published examining the relationship between NLR and neuropsychiatric diseases. Two previous studies have been investigated the relationship between NLR and cognitive functioning in carotid endarterectomy patients and Alzheimer's disease (7,8). Furthermore the other two studies about psychiatric disorders and NLR compared schizophrenic patients and major depressive disorder patients with healthy control group.…”