Relationship Between Neutrophil/Albumin Ratio and Early Mortality After Major Lower Extremity Amputation

Abstract

IntroductionDiabetic foot infection is a condition that affects the patient's life, may cause limb loss, and has a high mortality. Too many parameters were used for predicting early mortality but the gold standard method wasn't described. Neutrophil lymphocyte ratio (NLR) is universally accepted as a predictive value for amputation-free survival and mortality. NLR increases due to inflammation-induced neutrophilia and lymphopenia related to cortisol-induced stress. Increasing in the neutrophil albumin ratio is expected due to decreasing albumin levels because albumin is a negative acute-phase reactant. The aim of this study is to investigate the sensitivity and value of the neutrophil albumin ratio (NAR) for early mortality after major lower extremity amputation (LEA). MethodsFollowing the approval of the ethics committee, 87 patients who underwent major LEA between May 2018 and May 2020 were analyzed for the study. White blood cell (WBC), neutrophil, lymphocyte, C-reactive protein (CRP), creatinine, albumin, platelet, and hemoglobin values on the day prior to surgery were recorded. NLR was calculated as the ratio of neutrophil count to lymphocyte count, NAR as the ratio of neutrophil count to albumin value, CRP/albumin ratio (CAR) as the ratio of CRP value to albumin value, and platelet lymphocyte ratio (PLR) as the ratio of platelet count to lymphocyte count. Each parameter was also recorded in the postoperative second week. ResultsOf the patients included in the study, 52 were men (59.8%) and 35 were women (40.2%). It was determined that 29 of 87 patients (33.3%) died within the first year. The relationship between post-operative NAR value and early mortality is examined. The area under the curve was calculated as 0.873. When the cut-off value was applied as 0.265, the sensitivity was found as 88% and specificity as 76%. ConclusionsHigher neutrophil/albumin ratio after lower extremity amputation was associated with early mortality after extremity amputation. This parameter can help predict mortality. The cut-off value was determined as 0.265, the sensitivity was found as 88%, and specificity as 76%.

A High Immediate Postoperative Neutrophil-to-Albumin Ratio is Associated With Unfavorable Clinical Outcomes at Hospital Discharge in Patients With Aneurysmal Subarachnoid Hemorrhage

“…Lastly, unfavorable clinical outcomes occurred more frequently in group HH than in groups HL and LL; however, there was no significant difference in the incidence of unfavorable clinical outcomes between Groups HH and LH. Similar to our results, a previous study investigating the relationship between NAR and early mortality after major lower extremity amputation found that the preoperative NAR had lower sensitivity and specificity than postoperative NAR for mortality prediction 22 . Although both pre- and postoperative NARs were associated with unfavorable clinical outcomes in our study, postoperative NAR was a better predictor of unfavorable outcome than preoperative NAR.…”

“…Similar to our results, a previous study investigating the relationship between NAR and early mortality after major lower extremity amputation found that the preoperative NAR had lower sensitivity and specificity than postoperative NAR for mortality prediction. 22 Although both pre-and postoperative NARs were associated with unfavorable clinical outcomes in our study, postoperative NAR was a better predictor of unfavorable outcome than preoperative NAR.…”

Inflammatory and nutritional markers predict the risk of post-operative delirium in elderly patients following total hip arthroplasty

“…NAR, consisting of neutrophil and Alb, is a promising biomarker for predicting the prognosis of cancer (44-47). Günay et al showed that higher NAR after lower extremity amputation was significantly associated with early mortality after extremity amputation (48). Chen et al found that NAR was related to allcause mortality in patients with stroke (49).…”