title: Relationship between neutrophil-lymphocyte ratio and severity of lower extremity peripheral artery disease.
abstract: BACKGROUND
  The aim of this study was to determine the association between neutrophil-lymphocyte ratio (NLR) and severity of lower extremity peripheral artery disease (PAD).
  
  
  METHODS
  A retrospective chart review identified 928 patients referred for peripheral angiography. NLR was assessed from routine pre-procedural hemograms with automated differentials and available in 733 patients. Outcomes of interest were extent of disease on peripheral angiography and target vessel revascularization. Median follow-up was 10.4months. Odds ratio (OR) [95% confidence intervals] was assessed using a logistic regression model.
  
  
  RESULTS
  There was a significant association between elevated NLR and presence of severe multi-level PAD versus isolated suprapopliteal or isolated infrapopliteal disease (OR 1.11 [1.03-1.19], p=0.007). This association remained significant even after adjustment for age (OR 1.09 [1.01-1.17], p=0.02); age, sex, race, and body mass index (OR 1.08 [1.00-1.16], p=0.046); and age, sex, race, body mass index, hypertension, diabetes mellitus, coronary artery disease, and creatinine (OR 1.07 [1.00-1.15], p=0.049). After additional adjustment for clinical presentation, there was a trend towards association between NLR and severe multi-level PAD (OR 1.07 [1.00-1.15], p=0.056), likely limited by sample size. In patients who underwent endovascular intervention (n=523), there was no significant difference in rate of target vessel revascularization across tertiles of NLR (1st tertile 14.8%, 2nd tertile 14.1%, 3rd tertile 20.1%; p=0.32).
  
  
  CONCLUSIONS
  In a contemporary cohort of patients undergoing peripheral angiography with possible endovascular intervention, elevated NLR was independently associated with severe multi-level PAD. Larger studies evaluating the association between this inexpensive biomarker and clinical outcomes are warranted.
authors.affiliation: Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Teperman
authors.affiliation: Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: David
authors.initials: D
authors.lastname: Carruthers
authors.affiliation: Department of Population Health, Division of Biostatistics, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: Yu
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: Mallory P
authors.initials: MP
authors.lastname: Barnett
authors.affiliation: Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: Adam A
authors.initials: AA
authors.lastname: Harris
authors.affiliation: Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA; Department of Medicine, Section of Cardiology, VA New York Harbor Health Care Center, 423 E 23rd St, New York, NY 10010, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Sedlis
authors.affiliation: Department of Medicine, Section of Rheumatology, VA New York Harbor Health Care Center, 423 E 23rd St, New York, NY 10010, USA; Department of Medicine, Division of Rheumatology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Pillinger
authors.affiliation: Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: Anvar
authors.initials: A
authors.lastname: Babaev
authors.affiliation: Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: Cezar
authors.initials: C
authors.lastname: Staniloae
authors.affiliation: Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Attubato
authors.affiliation: Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA; Department of Medicine, Section of Cardiology, VA New York Harbor Health Care Center, 423 E 23rd St, New York, NY 10010, USA. Electronic address: binita.shah@nyumc.org.
authors.forename: Binita
authors.initials: B
authors.lastname: Shah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D058729:Peripheral Arterial Disease / Q000097:blood* / Q000175:diagnosis* / Q000628:therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Lymphocyte; Neutrophil; Peripheral angiography; Peripheral artery disease