Platelet-to-Lymphocyte Ratio: A Novel Marker for Critical Limb Ischemia in Peripheral Arterial Occlusive Disease Patients

Abstract

BackgroundPlatelet-to-Lymphocyte Ratio (PLR) is an easily applicable blood test. An elevated PLR has been associated with poor prognosis in patients with different oncologic disorder. As platelets play a key role in atherosclerosis and atherothrombosis, we investigated PLR and its association with critical limb ischemia (CLI) and other vascular endpoints in peripheral arterial occlusive disease (PAOD) patients.Methods and FindingsWe evaluated 2121 PAOD patients treated at our institution from 2005 to 2010. PLR was calculated and the cohort was categorized into tertiles according to the PLR. An optimal cut-off value for the continuous PLR was calculated by applying a receiver operating curve analysis to discriminate between CLI and non-CLI. In our cohort occurrence of CLI significantly increased with an increase in PLR. As an optimal cut-off value, a PLR of 150 was identified. Two groups were categorized, one containing 1228 patients (PLR≤150) and a second group with 893 patients (PLR>150). CLI was more frequent in PLR>150 patients (410(45.9%)) compared to PLR≤150 patients (270(22.0%)) (p<0.001), as was prior myocardial infarction (51(5.7%) vs. 42(3.5%), p = 0.02). Regarding inflammatory parameters, C-reactive protein (median 7.0 mg/l (3.0–24.25) vs. median 5.0 mg/l (2.0–10.0)) and fibrinogen (median 457 mg/dl (359.0–583.0) vs. 372 mg/dl (317.25–455.75)) also significantly differed in the two patient groups (both p<0.001). Finally, a PLR>150 was associated with an OR of 1.9 (95%CI 1.7–2.1) for CLI even after adjustment for other well-established vascular risk factors.ConclusionsAn increased PLR is significantly associated with patients at high risk for CLI and other cardiovascular endpoints. The PLR is a broadly available and cheap marker, which could be used to highlight patients at high risk for vascular endpoints.

Association between neutrophil to lymphocyte ratio and severity of coronary artery disease

“…In a recent study, Kocaman et al showed that NLR was independently related with increased age, glucose, and serum uric acid levels. [23][24][25] As shown in previous studies, we found that glucose, HDL, and NLR are independently related with severity of atherosclerosis.…”

The Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Markers for Prognosis in Idiopathic Sudden Sensorineural Hearing Loss

“…On the other hand, NLR and PLR values are more reliable risk factors because both values were increased in the patients group despite of increased lymphocyte counts. Some studies suggested the optimal cut-off value for NLR and PLR; NLR > 3.95 and PLR > 150 [8]. Our values of NLR and PLR between the patients group and the control group satisfied these cut-off criteria.…”

“…An elevated platelet count leading to an elevated PLR might therefore lead to an increase in vascular endpoints. Gary et al proved that an increased PLR is significantly associated with patients at high risk for critical limb ischemia (CLI) and other cardiovascular endpoints [8]. By means of NLR and PLR CLI patients with a high risk for limb amputation during a five-year follow-up period were discriminated from patients with a lower risk for limb amputation during the same follow-up period [25].…”

“…The recent remarkable observation has been that neutrophilto-lymphocyte ratio (NLR) has predictability as a marker in cardiovascular diseases and is emerging as an independent useful prognostic parameter in cardiovascular diseases [7]. And platelet-to-lymphocyte ratio (PLR) is associated with poor prognosis in patients with a key role in atherosclerosis and atherothrombosis in peripheral arterial occlusive disease patients [8,9]. Both increasing NLR and PLR values may be risk factors for atherosclerosis as well as inflammation in microvascular structures.…”

New Prognostic Parameters of Sudden Hearing Loss: Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio

“…Plateletler ateroskleroz gelişiminde önemli rol oynarlar. Yapı-lan çalışmalarda, yüksek platelet sayısı ve yükselmiş PLO değerinin iskemik hastalıklarla birlikte olduğu gösterilmiştir (25) . Çeşitli periferik vasküler hastalık-lar, koroner arter hastalıkları, bazı jinekolojik ve hepatobiliyer malignitelerde PLO değeri yüksek bulunmuş ve bu durum kötü prognoz ile ilişkilendirilmiştir.…”