Prognostic Value of Neutrophil to Lymphocyte Ratio and Risk Factors for Mortality in Patients with Stanford Type A Aortic Dissection

Authors

  • Kursad Oz Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
  • Taner Iyigun Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
  • Zeynep Karaman Department of Anaesthesiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
  • Ömer Çelik Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
  • Ertan Akbay Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
  • Okan Akınc Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
  • Okan Akınc Department of Radiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
  • Korhan Erkanli Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey

DOI:

https://doi.org/10.1532/hsf.1736

Abstract

Background: Neutrophil to lymphocyte ratio (NLR) is a prognostic predictor in a wide range of cardiovascular disease. Acute aortic dissection (AD) is an uncommon but fatal cardiovascular disease. In this study, we investigated both prognostic factors in patients with AD and whether NLR can be a predictor for mortality. 

Methods: We analyzed retrospectively the data of 57 patients with AD who had undergone emergent surgery in our hospital and included 128 consecutive patients with chest pain admitted to the emergency room as a control group. Also, patients who were operated on due to aortic dissection as another subgroup were compared to NLR values. Baseline clinical features, cardiovascular risk factors, and surgical and laboratory parameters were obtained from the hospital database. 

Results: Patients with AD had higher NLR than the control group (1.7 ± 0.5 versus 7.6 ± 3.3, P < .001). In the AD group, 15 deaths occurred and non-survivors had significantly higher NLR, compared to survivors (11.6 ± 2.4 versus 6.6 ± 2.3, P < .001). In multivariate analysis, high NLR (odds ratio [OR] 1.913, 95% CI 1.030-1.081, P = .04) and cross-clamp time (OR 1.265, 95% CI 1.003-1.596, P = .04) were determined as independent predictors of in-hospital mortality. In receiver operating characteristics curve analyses, the NLR > 9.3 predicted the mortality in AD with a specificity of 91% and a sensitivity of 86% (P < .001).

Conclusion: This study shows that high NLR can be used as a marker for prognosis in short-term mortality of patient with AD. Additionally, increased lactate level in perioperative period, prolonged cardiopulmonary bypass time, and additional cardiac procedures are strong independent predictors of short-term mortality in patients with acute AD.

References

Açar G, Fidan S, Uslu ZA et al. 2015. Relationship of neutrophil-lymphocyte ratio with the presence, severity, and extent of coronary atherosclerosis detected by coronary computed tomography angiography. Angiology 66:174-9.

Ayça B, Akın F, Celik O, et al. 2015. Neutrophil to lymphocyte ratio is related to stent thrombosis and high mortality in patients with acute myocardial infarction. Angiology 66:545-52.

Braverman AC. 2010. Acute aortic dissection: clinician update. Circulation 122:184-8.

Braverman AC, Thompson R, Sanchez L. 2012. Diseases of the aorta. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald’s Heart Disease. 9th ed. Philadelphia, PA: Elsevier.

Bhutta H, Agha R, Wong J, Tang TY, Wilson YG, Walsh SR. 2011. Neutrophil-lymphocyte ratio predicts medium-term survival following elective major vascular surgery: a cross-sectional study. Vasc Endovascular Surg 45:227-31.

Ciçek G, Açıkgoz SK, Bozbay M, et al. 2015. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio combination can predict prognosis in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Angiology 66:441-7.

Evangelista A, Salas A, Ribera A, et al. 2012. Long-term outcome of aortic dissection with patent false lumen: predictive role of entry tear size and location. Circulation 125:3133-41.

Gibson PH, Croal BL, Cuthbertson BH, et al. 2007. Perioperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J 154:995-1002.

Hagan PG, Nienaber CA, Isselbacher EM, et al. 2000. International Registry of Acute Aortic Dissection (IRAD): new insights from an old disease. JAMA 283:897-903.

Hata N, Tanaka K, Imaizumi T, et al. 2002. Clinical significance of pleural effusion in acute aortic dissection. Chest 121:825-30.

He R, Guo DC, Estrera AL, et al. 2006. Characterization of the inflammatory and apoptotic cells in the aortas of patients with ascending thoracic aortic aneurysms and dissections. J Thorac Cardiovasc Surg 131:671-8.

Kalkan M, Sahin M, Kalkan A. 2014. The relationship between the neutrophil-lymphocyte ratio and the coronary collateral circulation in patients with chronic total occlusion. Perfusion 29:360-6.

Kaya H, ErtaÅŸ F, Ä°slamoÄŸlu Y, et al. 2014. Association between neutrophil to lymphocyte ratio and severity of coronary disease. Clin Appl Thromb Hemost 20:50-4.

Kuehl H, Eggebrecht H, Boes T, et al. 2008. Detection of inflammation in patients with acute aortic syndrome: Comparison of FDG-PET/CT imaging and serological markers of inflammation. Heart 94:1472-7.

Mehta RH, O’Gara PT, Bossone E, et al. 2002. Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era. J Am Coll Cardiol 40:685-92.

Nienaber CA, Powell JT. 2012. Management of acute aortic syndromes. Eur Heart J 33.26-35b.

Núñez J, Sanchis J, Bodí V, et al. 2009. Relationship between low lymphocyte count and major cardiac events in patients with acute chest pain, a non-diagnostic electrocardiogram and normal troponin levels. Atherosclerosis 206:251-7.

Schillinger M, Domanovits H, Bayegan K, et al. 2002. C-reactive protein and mortality in patients with acute aortic disease. Intensive Care Med 28:740-5.

Wen D, Wu H-Y, Jiang X-J, et al. 2011. Role of plasma C-reactive protein and white blood cell count in predicting in-hospital clinical events of acute type A aortic dissection. Chin Med J 124:2678-82.

Wen D, Zhou XL, Li JJ, et al. 2012. Plasma concentrations of interleukin-6, C-reactive protein, tumor necrosis factor-α and matrix metalloproteinase-9 in aortic dissection. Clin Chim Acta 413:198-202.

Yalcin M, Aparci M, Uz O, et al. 2015. Neutrophil-lymphocyte ratio may predict left atrial thrombus in patients with nonvalvular atrial fibrillation. Clin Appl Thromb Hemost 21:166-71.

Yilmaz M, Tenekecioglu E, Arslan B, et al. 2015. White blood cell subtypes and neutrophil-lymphocyte ratio in prediction of coronary thrombus formation in non-ST-segment elevated acute coronary syndrome. Clin Appl Thromb Hemost 21:446-52.

Published

2017-06-30

How to Cite

Oz, K., Iyigun, T., Karaman, Z., Çelik, Ömer, Akbay, E., Akınc, O., Akınc, O., & Erkanli, K. (2017). Prognostic Value of Neutrophil to Lymphocyte Ratio and Risk Factors for Mortality in Patients with Stanford Type A Aortic Dissection. The Heart Surgery Forum, 20(3), E119-E123. https://doi.org/10.1532/hsf.1736

Issue

Section

Articles

Most read articles by the same author(s)