Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013;8(2):e56745.
doi: 10.1371/journal.pone.0056745. Epub 2013 Feb 15.

Neutrophil-to-lymphocyte ratio and its association with critical limb ischemia in PAOD patients

Thomas Gary  1 , Martin Pichler, Klara Belaj, Franz Hafner, Armin Gerger, Harald Froehlich, Philipp Eller, Ernst Pilger, Marianne Brodmann
Affiliations

Neutrophil-to-lymphocyte ratio and its association with critical limb ischemia in PAOD patients

Thomas Gary et al. PLoS One. 2013.

Abstract

Background: The Neutrophil-to-Lymphocyte ratio (NLR) is an easy to perform test from the white blood cell count. An increase in NLR has been associated with vascular endpoints reflecting inflammation in atherosclerotic lesions. Atherosclerosis is a global threat and vascular endpoints, like myocardial infarction or critical limb ischemia (CLI), are a leading cause of death in industrialized countries. We therefore investigated NLR and its association with CLI and other vascular endpoints in peripheral arterial occlusive disease (PAOD) patients.

Methods and findings: We evaluated 2121 PAOD patients treated at our institution from 2005 to 2010. NLR was calculated and the cohort was divided into tertiles according to the NLR. An optimal cut-off value for the continuous NLR 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 NLR. As an optimal cut-off a NLR of 3.95 was identified. Two groups were categorized, one containing 1441 patients (NLR≤3.95) and a second group with 680 patients (NLR>3.95). CLI was more frequent in NLR>3.95 patients (330(48.5%)) compared to NLR≤3.95 patients (350(24.3%)) (p<0.001), as were prior myocardial infarction (48(7.0%) vs. 47(3.3%), p<0.001) and stroke (73(10.7) vs. 98(6.8%), p<0.001). Regarding other inflammatory parameters, C-reactive protein (median 5.6 mg/l (2.3-19.1) vs. median 3 mg/l (1.5-5.5)) and fibrinogen (median 412 mg/dl (345.5-507.5) vs. 344 mg/dl (308-403.5)) also significantly differed in the two patient groups (both p<0.001). A NLR>3.95 was associated with an OR of 2.5 (95%CI 2.3-2.7) for CLI even after adjustment for other vascular risk factors.

Conclusions: An increased NLR is significantly associated with patients at high risk for CLI and other vascular endpoints. The NLR is an easy to perform test, which could be used to highlight patients at high risk for vascular endpoints.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Percentage of patients with CLI stratified by tertile of NLR.
Numbers below the figure are median NLR and the 25th and 75th percentile.
See this image and copyright information in PMC

References

    1. Bertomeu V, Morillas P, Gonzalez-Juanatey JR, Quiles J, Guindo J, et al. (2008) Prevalence and prognostic influence of peripheral arterial disease in patients >or = 40 years old admitted into hospital following an acute coronary event. Eur J Vasc Endovasc Surg 36: 189–196. - PubMed
    1. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, et al. (2007) Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 45 Suppl S: S5–67. - PubMed
    1. Novo S, Coppola G, Milio G (2004) Critical limb ischemia: definition and natural history. Curr Drug Targets Cardiovasc Haematol Disord 4: 219–225. - PubMed
    1. Bertele V, Roncaglioni MC, Pangrazzi J, Terzian E, Tognoni EG (1999) Clinical outcome and its predictors in 1560 patients with critical leg ischaemia. Chronic Critical Leg Ischaemia Group. Eur J Vasc Endovasc Surg 18: 401–410. - PubMed
    1. Gary T, Belaj K, Hafner F, Hackl G, Froehlich H, et al. (2012) A high CHA(2)DS(2)-VASc score is associated with a high risk for critical limb ischemia in peripheral arterial occlusive disease patients. Atherosclerosis 225: 517–520. - PubMed