title: Neutrophil-to-lymphocyte ratio may be a marker of peripheral artery disease complexity.
abstract: OBJECTIVE
  The aim of this study was to evaluate the relationship between peripheral artery disease (PAD) severity and complexity, as evaluated by TransAtlantic Inter-Society Consensus-II (TASC-II) classification, and neutrophil-to-lymphocyte (N/L) ratio.
  
  
  METHODS
  A total of 407 patients underwent peripheral angiography due to signs and symptoms of PAD; of these, 64 patients were excluded and the remaining 343 patients were WARFARIN in this cross-sectional study. Patients with previous peripheral revascularizations, acute coronary syndrome, vasculitis, non-atherosclerotic stenosis, and malignancy were excluded. Patients were divided into 4 groups according to TASC-II classification, and clinical and laboratory data were compared. The chi-square test, Student's t-test, Mann-Whitney U test, analysis of variance, Kruskal-Wallis test, Spearman's correlation analysis, multiple logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were used for statistical analysis.
  
  
  RESULTS
  Lymphocyte count was weakly correlated (r=-0.169, p=0.002) whereas neutrophil count and N/L ratio were moderately correlated with the TASC score (r=0.432, p<0.001 and r=0.470, p<0.001, respectively). Low-density lipoprotein cholesterol [odds ratio (OR)=1.010, 95% confidence interval (CI) 95%=1.003-1.017, p=0.004], high-density lipoprotein cholesterol (OR=0.940, 95% CI=0.894-0.987, p=0.013), and N/L ratio (OR=1.914, 95% CI=1.515-2.418, p<0.001) were the independent factors for predicting a higher TASC class in multiple logistic regression analysis. The cut-off value of the N/L ratio for predicting TASC C&D class was >3.05 (sensitivity=75.0%, specificity=62.9%, area under the curve=0.678, 95% CI=0.688-0.784, p<0.001) in ROC curve analysis.
  
  
  CONCLUSIONS
  The N/L ratio, a marker of inflammation, may be an important predictor of PAD complexity. Therefore, a simple blood count test may provide an important clue about the severity of PAD and risk stratification in patients presenting with intermittent claudication. Additional studies are required to confirm our findings.
authors.affiliation: Department of Cardiology, Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon-Turkey. ahmetaykan@yahoo.com.
authors.forename: Ahmet Çağrı
authors.initials: AÇ
authors.lastname: Aykan
authors.affiliation: Department of Cardiology, Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon-Turkey.
authors.forename: Engin
authors.initials: E
authors.lastname: Hatem
authors.affiliation: Department of Cardiology, Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon-Turkey.
authors.forename: Ezgi
authors.initials: E
authors.lastname: Kalaycıoğlu
authors.affiliation: Department of Cardiology, Kartal Koşuyolu Heart Education and Research Hospital, İstanbul-Turkey.
authors.forename: Can Yücel
authors.initials: CY
authors.lastname: Karabay
authors.affiliation: Department of Cardiology, Siyami Ersek Education and Research Hospital, İstanbul-Turkey.
authors.forename: Regayip
authors.initials: R
authors.lastname: Zehir
authors.affiliation: Department of Cardiology, Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon-Turkey.
authors.forename: Tayyar
authors.initials: T
authors.lastname: Gökdeniz
authors.affiliation: Department of Pharmacology, Karadeniz Technical University Faculty of Medicine, Trabzon-Turkey.
authors.forename: Duygun
authors.initials: D
authors.lastname: Altıntaş Aykan
authors.affiliation: Department of Cardiology, Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon-Turkey.
authors.forename: Şükrü
authors.initials: Ş
authors.lastname: Çelik