Prognostic Value of Inflammatory Biomarkers in 5‐Year Survival After Endovascular Repair of Abdominal Aortic Aneurysms in a Predominantly Male Cohort: Implications for Practice

Abstract

Background Prognostic factors of long-term survival can guide selection of patients for endovascular repair of abdominal aortic aneurysms (EVAR). The aim of this study was to evaluate the relationship between the neutrophilto-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the lymphocyte-to-monocyte ratio (LMR) and the systemic immune-inflammation index (SIII) with survival after EVAR and to assess whether the addition of these biomarkers improved the prediction of survival after surgery. Methods Retrospective analysis of 284 consecutive patients who underwent an EVAR at a single institution. The association between biomarkers and survival was explored using generalized additive models with penalized smoothing splines and multivariate Cox models. C-statistics and continuous net reclassification indexes (c-NRI) were used to assess the improvement in prediction.Results Survival rates at 2 and 5 years were 83.9% and 66.2%, respectively. The predictive score of survival included hemoglobin (HR = 0.849, p = 0.004), statin intake (HR = 0.538, p = 0.004), atrial fibrillation (HR = 2.515, p \ 0.001), heart failure (HR = 2.542, p = 0.017) and the non-revascularized coronary artery disease (HR = 2.163, p = 0.004). Spline analyses showed a linear relationship between survival and NLR, PLR, LMR and SII. After adjusting for the predictive score, there was an independent relationship between survival and NLR (HR = 1.072, p = 0.006), PLR (HR = 1.002, p = 0.014) and SII (HR = 1.000, p = 0.043). However, only the addition of NLR improved moderately the c-NRI. A NLR C 3 was independently associated with lower survival rates at 2-years (HR 1.98; 95% CI 1.07-3.66) and 5-years (HR 1.84, 95% CI 1.22-2.78) of follow-up. Conclusions Most inflammatory biomarkers are linear and independently associated with survival after EVAR, but only the NLR improved moderately the prediction of a survival score. Therefore, a NLR C 3 may be used to identify patients with a low survival rate and help in decision-making.

The Preoperative Lymphocyte-To-Monocyte Ratio Predicts Mortality Among Patients Undergoing Endovascular Aortic Repair for Abdominal Aortic Aneurysm

“…One study showed a linear relationship between survival and NLR, PLR, and LMR, but found an independent relationship between survival and NLR but not PLR or LMR. 18 Our data shows that a low preoperative LMR of <3.21 independently predicts overall mortality after EVAR for AAA (Table 2). This cut-off value is comparable to previously reported values for cancer patients (median 3.0, range 2.0-5.3).…”

“…Recent studies, including ours, showed that a high neutrophil-to-lymphocyte ratio (NLR) is associated with poor long-term survival in patients undergoing EVAR for AAA. [2][3][4][5] The NLR of >3.0 to 4.0 was associated with increased mortality after elective EVAR, regardless of other comorbidities. Neutrophilia is associated with trauma, stress, bacterial infection, and cancer, any of which ultimately might increase the risk of death from any cause.…”

Mediators of neutrophil–lymphocyte ratio in the relationship between ondansetron pre‐treatment and the mortality of ICU patients on mechanical ventilation: Causal mediation analysis from the MIMIC‐IV database

“…However, the mediation effect of the PLR between ondansetron use and 28‐day mortality was not observed. In a study of patients who had undergone endovascular repair of abdominal aortic aneurysms, the NLR and PLR were linear and associated independently with their survival, but the NLR (not the PLR) moderately improved the prediction of survival score 44 . In one study on COVID‐19, the NLR (not the PLR) could be considered an independent biomarker for indicating a poor clinical outcome 45 .…”

“…In a study of patients who had undergone endovascular repair of abdominal aortic aneurysms, the NLR and PLR were linear and associated independently with their survival, but the NLR (not the PLR) moderately improved the prediction of survival score. 44 In one study on COVID-19, the NLR (not the PLR) could be considered an independent biomarker for indicating a poor clinical outcome. 45 Hence, from the aspect of predicting survival from a critical illness, the PLR may not be as valuable as the NLR.…”

Novel Systemic Inflammatory Markers Predict All-Cause Mortality in Patients Undergoing Endovascular Abdominal Aortic Aneurysm Repair

“…NLR has been proven to be associated with the perioperative morbidity of ruptured AAA and mortality after selective EVAR [ 24 , 25 ]. However, the correlation between novel SIMs and the long-term survival rates after EVAR remains uncertain.…”