title: Neutrophil to lymphocyte ratio (NLR) of five predicts 30-day morbidity in ruptured abdominal aortic aneurysms (rAAA): a retrospective cohort study.
abstract: BACKGROUND
  In recent years the role of neutrophil to lymphocyte ratio (NLR) as an independent predictor of mortality and morbidity has gained significant attention in colorectal, upper gastrointestinal and cancer surgery. To date, no study has examined this in ruptured abdominal aortic aneurysms (rAAAs). This study aims to assess the role of NLR as a prognostic marker of 30-day (30d) morbidity and mortality in patients undergoing repair of rAAAs.
  
  
  METHODS
  Data from 80 consecutive patients with a diagnosis of rAAAs from November 2007 to June 2014 were included. Receiver operating characteristic curve analysis was used to identify the optimal value for NLR in relation to 30d mortality and morbidity. Univariate and multivariate logistic regression analysis were used to determine the role of NLR after stratification by several clinical factors.
  
  
  RESULTS
  25 patients (31.2%) had a low NLR (LNLR) and 55 patients (68.8%) had a high NLR (HNLR). Elevated NLR was significantly associated with low Hemoglobin and it was not associated with gender, age, AAA Size, history of HTN, COPD, smoking and renal failure. Patients with HNLR had higher 30d morbidity compared with the LNLR group (35 vs. 6 p = 0.001) but no difference in intraoperative blood loss, length of hospital, ITU stay and 30d mortality. High NLR through multivariate analysis was an independent prognostic factor for 30d morbidity [OR = 4.28, 95% (1.27-14.42), p = 0.02].
  
  
  CONCLUSIONS
  A preoperative NLR >5 is an independent predictive marker of 30d morbidity in rAAAs. This appears to be in line with earlier literature demonstrating similar outcome in the elective group of abdominal aortic aneurysm.
authors: Department of Vascular and Endovascular Surgery, Broomfield Hospital, Chelmsford CM1 7ET, United Kingdom; Faculty of Medical Sciences, Anglia Ruskin University, Bishop Hall Lane, Chelmsford CM1 1SQ, United Kingdom. Electronic address: Alikordzadeh@gmail.com.
authors: Ali
authors: A
authors: Kordzadeh
authors: Department of Surgery and Cancer, Imperial College, Paddington, London W2 1NY, United Kingdom.
authors: George
authors: G
authors: Malietzis
authors: Department of Vascular and Endovascular Surgery, Broomfield Hospital, Chelmsford CM1 7ET, United Kingdom.
authors: Tom
authors: T
authors: Browne
authors: Department of Vascular and Endovascular Surgery, Broomfield Hospital, Chelmsford CM1 7ET, United Kingdom.
authors: Ioannis
authors: I
authors: Prionidis
authors: Department of Vascular and Endovascular Surgery, Broomfield Hospital, Chelmsford CM1 7ET, United Kingdom.
authors: Yiannis P
authors: YP
authors: Panayiotopoulos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Morbidity; Mortality; Neutrophil lymphocyte ratio (NLR); Outcome; Ruptured abdominal aortic aneurysm (rAAA)