title: Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) can risk stratify patients in transcatheter aortic-valve replacement (TAVR).
abstract: BACKGROUND
  Neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratios (PLR) mark systemic inflammation. Patients with high NLR and PLR have worse cardiovascular disease and outcomes. We assessed the role of these ratios in predicting outcomes after transcatheter aortic valve replacement (TAVR).
  
  
  METHODS
  The association between NLR and PLR with baseline characteristics, 30-day outcomes, and 1-year readmission/survival was determined in patients that underwent TAVR between 2007 and 2014 and had baseline complete blood count with differential. A subgroup analysis determined the association between change in NLR and PLR (discharge-baseline) and 1-year outcomes.
  
  
  RESULTS
  In 520 patients that underwent TAVR, a higher NLR (p=0.01) and PLR (p=0.02) were associated with a higher STS-PROM score, and with increased occurrence of the 30-day early-safety outcome (by VARC-2), even after adjusting for STS-PROM score, valve generation (Sapien vs. Sapien XT), and access (transfemoral vs. non-transfemoral) (NLR: OR 1.29, 95% CI 1.04-1.61; PLR: OR 1.27, 95% CI 1.01-1.60) but not with 1-year readmission or survival. In our subgroup analysis (N=294), change in PLR was not associated with the 1-year outcomes but a high change in NLR was associated with worse 1-year survival/readmission and 1-year survival, even after adjusting for STS-PROM score, valve generation and access (HR 1.22, 95% CI 1.04-1.44 and HR 1.26, 95% CI 0.99-1.6, respectively).
  
  
  CONCLUSIONS
  NLR and PLR correlate with surgical risk. An elevated NLR and PLR were associated with the occurrence of 30-day adverse outcomes, similar to the STS-PROM score. A high variation of NLR from baseline to discharge may help stratify patients that underwent TAVR in addition to traditional risk factors.
authors.affiliation: Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Jose F
authors.initials: JF
authors.lastname: Condado
authors.affiliation: Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Parichart
authors.initials: P
authors.lastname: Junpaparp
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Jose N
authors.initials: JN
authors.lastname: Binongo
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Yi
authors.initials: Y
authors.lastname: Lasanajak
authors.affiliation: Department of Cardiology, Albert Einstein Medical Center, Philadelphia, PA, United States.
authors.forename: Christian F
authors.initials: CF
authors.lastname: Witzke-Sanz
authors.affiliation: Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Chandan
authors.initials: C
authors.lastname: Devireddy
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Bradley
authors.initials: B
authors.lastname: Leshnower
authors.affiliation: Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Kreton
authors.initials: K
authors.lastname: Mavromatis
authors.affiliation: Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: James
authors.initials: J
authors.lastname: Stewart
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Guyton
authors.affiliation: Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, United States.
authors.forename: David
authors.initials: D
authors.lastname: Wheeler
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Jessica
authors.initials: J
authors.lastname: Forcillo
authors.affiliation: Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Ateet
authors.initials: A
authors.lastname: Patel
authors.affiliation: Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Block
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States.
authors.forename: Vinod
authors.initials: V
authors.lastname: Thourani
authors.affiliation: Department of Nephrology, Albert Einstein Medical Center, Philadelphia, PA, United States.
authors.forename: Janani
authors.initials: J
authors.lastname: Rangaswami
authors.affiliation: Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States. Electronic address: vbabali@emory.edu.
authors.forename: Vasilis
authors.initials: V
authors.lastname: Babaliaros
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000097:blood / Q000401:mortality / Q000601:surgery*; D001792:Blood Platelets / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D009504:Neutrophils / Q000473:pathology*; D010976:Platelet Count; D011183:Postoperative Complications / Q000097:blood* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology
keywords: Mortality; Neutrophils; Platelets; Readmissions; Transcatheter aortic valve replacement