title: Neutrophil-lymphocyte ratio predicts medium-term survival following elective major vascular surgery: a cross-sectional study.
abstract: BACKGROUND
  The systemic nature of atherosclerosis compromises medium-term survival following major vascular surgery. Neutrophil-lymphocyte ratio (NLR) is a simple index of systemic inflammatory burden which correlates with survival following percutaneous coronary intervention.
  
  
  METHODS
  Patients undergoing elective major vascular surgery in 2 tertiary vascular units were identified from prospectively maintained databases. Factors associated with 2-year mortality were assessed by univariate and multivariate analyses.
  
  
  RESULTS
  Over a 4-year period, 1021 patients underwent elective major vascular surgery (carotid endarterectomy, abdominal aortic aneurysm repair, lower limb revascularization). Two-year mortality was 11.2%. In multivariate analysis, preoperative NLR > 5 was independently associated with 2-year mortality (multivariate odds ratio [OR] 2.21; 95% confidence interval [CI] 1.22-4.01).
  
  
  CONCLUSIONS
  Preoperative NLR identifies patients at increased risk of death within 2 years of major vascular surgery. This simple index may facilitate targeted preventive measures for high-risk patients.
authors.affiliation: Norfolk & Norwich Vascular Unit, Norfolk & Norwich University Hospital, Colney Lane, Norwich, United Kingdom.
authors.forename: Hina
authors.initials: H
authors.lastname: Bhutta
authors.forename: Riaz
authors.initials: R
authors.lastname: Agha
authors.forename: Joy
authors.initials: J
authors.lastname: Wong
authors.forename: Tjun Y
authors.initials: TY
authors.lastname: Tang
authors.forename: Yvonne G
authors.initials: YG
authors.lastname: Wilson
authors.forename: Stewart R
authors.initials: SR
authors.lastname: Walsh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures / Q000401:mortality; D016894:Endarterectomy, Carotid / Q000401:mortality; D057510:Endovascular Procedures / Q000401:mortality; D004739:England; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology*; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000401:mortality*