title: Platelet-to-lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients.
abstract: BACKGROUND
  Platelet-to-Lymphocyte Ratio (PLR) is an easily applicable blood test. An elevated PLR has been associated with poor prognosis in patients with different oncologic disorder. As platelets play a key role in atherosclerosis and atherothrombosis, we investigated PLR and its association with critical limb ischemia (CLI) and other vascular endpoints in peripheral arterial occlusive disease (PAOD) patients.
  
  
  RESULTS
  We evaluated 2121 PAOD patients treated at our institution from 2005 to 2010. PLR was calculated and the cohort was categorized into tertiles according to the PLR. An optimal cut-off value for the continuous PLR 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 PLR. As an optimal cut-off value, a PLR of 150 was identified. Two groups were categorized, one containing 1228 patients (PLR≤150) and a second group with 893 patients (PLR>150). CLI was more frequent in PLR>150 patients (410(45.9%)) compared to PLR≤150 patients (270(22.0%)) (p<0.001), as was prior myocardial infarction (51(5.7%) vs. 42(3.5%), p = 0.02). Regarding inflammatory parameters, C-reactive protein (median 7.0 mg/l (3.0-24.25) vs. median 5.0 mg/l (2.0-10.0)) and fibrinogen (median 457 mg/dl (359.0-583.0) vs. 372 mg/dl (317.25-455.75)) also significantly differed in the two patient groups (both p<0.001). Finally, a PLR>150 was associated with an OR of 1.9 (95%CI 1.7-2.1) for CLI even after adjustment for other well-established vascular risk factors.
  
  
  CONCLUSIONS
  An increased PLR is significantly associated with patients at high risk for CLI and other cardiovascular endpoints. The PLR is a broadly available and cheap marker, which could be used to highlight patients at high risk for vascular endpoints.
authors.affiliation: Division of Vascular Medicine, Department of Internal Medicine, Medical University Graz, Graz, Austria. thomas.gary@medunigraz.at
authors.forename: Thomas
authors.initials: T
authors.lastname: Gary
authors.forename: Martin
authors.initials: M
authors.lastname: Pichler
authors.forename: Klara
authors.initials: K
authors.lastname: Belaj
authors.forename: Franz
authors.initials: F
authors.lastname: Hafner
authors.forename: Armin
authors.initials: A
authors.lastname: Gerger
authors.forename: Harald
authors.initials: H
authors.lastname: Froehlich
authors.forename: Philipp
authors.initials: P
authors.lastname: Eller
authors.forename: Peter
authors.initials: P
authors.lastname: Rief
authors.forename: Gerald
authors.initials: G
authors.lastname: Hackl
authors.forename: Ernst
authors.initials: E
authors.lastname: Pilger
authors.forename: Marianne
authors.initials: M
authors.lastname: Brodmann
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000032:analysis; D001792:Blood Platelets / Q000378:metabolism / Q000473:pathology*; D002097:C-Reactive Protein / Q000378:metabolism; D005121:Extremities / Q000098:blood supply* / Q000473:pathology; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D007511:Ischemia / Q000097:blood / Q000473:pathology*; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000097:blood / Q000473:pathology*; D010976:Platelet Count; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D005340:Fibrinogen; D002097:C-Reactive Protein