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. 2023 May 16;18(1):362.
doi: 10.1186/s13018-023-03840-3.

Combination of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio with plasma D-dimer level to improve the diagnosis of deep venous thrombosis (DVT) following ankle fracture

Zhida Gao #  1   2 , Kuo Zhao #  1 , Lin Jin #  1 , Xiaodong Lian  1 , Zhiang Zhang  1 , Lijie Ma  1 , Zhiyong Hou  3   4   5   6   7
Affiliations

Combination of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio with plasma D-dimer level to improve the diagnosis of deep venous thrombosis (DVT) following ankle fracture

Zhida Gao et al. J Orthop Surg Res. .

Abstract

Purpose: To investigate the relationship between neutrophil to lymphocyte ratio (NLR)/platelet to lymphocyte ratio (PLR) with deep venous thrombosis (DVT) following ankle fracture and the diagnostic ability of combination model.

Method: This retrospective study included patients with a diagnosis of ankle fracture who had undergone preoperative Duplex ultrasound (DUS) examination for detecting the possible deep venous thrombosis (DVT). The variables of interest, the calculated NLR and PLR and others (demographics, injury, lifestyles and comorbidities) were extracted from the medical records. Two independent multivariate logistics regression models were used to detect the relationship between NLR or PLR and DVT. If any, combination diagnostic model was constructed and its diagnostic ability was evaluated.

Results: There were 1103 patients included, and 92 (8.3%) were found to have preoperative DVT. The NLR and PLR, which had respective optimal cut-off point of 4 and 200, were significantly different between patients with and without DVT either in continuous or categorical variable. After adjustment for covariates, both NLR and PLR were identified as independent risk factors associated with DVT, with odd ratio of 2.16 and 2.84, respectively. The combination diagnostic model, including NLR, PLR and D-dimer, demonstrated to significantly improved the diagnostic performance than any one alone or combined (all P < 0.05), and the area under the curve was 0.729 (95% CI 0.701-0.755).

Conclusion: We concluded the relatively low incidence rate of preoperative DVT after ankle fracture, and both NLR and PLR were independently associated with DVT. The combination diagnostic model can be considered as a useful auxiliary tool for identifying high-risk patients for DUS examination.

Keywords: Ankle fracture; Combination diagnostic model; Improved diagnostic performance; Lymphocyte ratio/platelet to lymphocyte ratio.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The flowchart of this study
Fig. 2
Fig. 2
The ROC curve and analysis for NLR, PLR, and D-dimer, respectively. The optimal cut-off point for NLR, PLR, and D-dimer was 4, 200 and 0.8 mg/L, with respective AUC being 0.616 (95% CI 0.557–0.674; P < 0.001), 0.653 (95% CI 0.591–0.714; P < 0.001), and 0.660 (95% CI 0.631–0.688; P < 0.001)
Fig. 3
Fig. 3
Depicted the ROC curve and analysis for D-dimer, NLR + D-dimer, PLR + D-dimer, and NLR + PLR + D-dimer, with the latter one having the significantly higher diagnostic performance
See this image and copyright information in PMC

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