Ömer Faruk ÇİÇEK, Hacı Alper UZUN, Adnan YALÇINKAYA, İrfan TAŞOĞLU, Gökhan LAFÇI, Orhan Eren GÜNERTEM, Kemal KORKMAZ, Hikmet Selçuk GEDİK, Kerim ÇAĞLI, Kumral ÇAĞLI, Osman TURAK, Adem İlkay DİKEN

Relationship of admission neutrophil-to-lymphocyte ratio with in-hospital mortality in patients with acute type I aortic dissection

Aim: Acute aortic dissection is a life-threatening cardiovascular emergency. Neutrophil-to-lymphocyte ratio is proposed as a prognostic marker and found to be related to worse clinical outcomes in various cardiovascular diseases. The aim of the present study was to evaluate the relationship between admission neutrophil-to-lymphocyte ratio and in-hospital mortality in acute type I aortic dissection. Materials and methods: We retrospectively evaluated 123 consecutive patients who had undergone emergent surgery for acute type I aortic dissection. Patients were divided into 2 groups as patients dying in the hospital (Group 1) and those discharged alive (Group 2). All parameters, including neutrophil-to-lymphocyte ratio, were compared between the 2 groups and predictors of mortality was estimated by using multivariate analysis. Results: A total of 104 patients (79 males, mean age: 55.2 ± 14 years) were included in the final analysis. In multivariate analyses, crossclamp time, cardiopulmonary bypass time, intensive care unit duration, platelet count, and neutrophil-to-lymphocyte ratio were found to be independent predictors of mortality. Patients with higher neutrophil-to-lymphocyte ratios had a significantly higher mortality rate (hazard ratio: 1.05; 95% CI: 1.01 1.10; P = 0.033). Receiver operating characteristic analysis revealed that using a cut-off point of 8, neutrophil-to-lymphocyte ratio predicts mortality with a sensitivity of 70% and specificity of 53%. Conclusion: This study suggests that admission neutrophil-to-lymphocyte ratio is a potential predictive parameter for determining the in-hospital mortality of acute type I aortic dissection.

PDF

___

1. Mészáros I, Mórocz J, Szlávi J, Schmidt J, Tornóci L, Nagy L, Szép L. Epidemiology and clinicopathology of aortic dissection. Chest 2000; 117: 12711278.
2. Erbel R, Alfonso F, Boileau C, Dirsch O, Eber B, Haverich A, Rakowski H, Struyven J, Radegran K, Sechtem U et al. Diagnosis and management of aortic dissection. Eur Heart J 2001; 22: 16421681.
3. Rampoldi V, Trimarchi S, Eagle KA, Nienaber CA, Oh JK, Bossone E, Myrmel T, Sangiorgi GM, De Vincentiis C, Cooper JV et al. Simple risk models to predict surgical mortality in acute type A aortic dissection: the international registry of acute aortic dissection score. Ann Thorac Surg 2007; 83: 5561.
4. del Porto F, Proietta M, Tritapepe L, Miraldi F, Koverech A, Cardelli P, Tabacco F, de Santis V, Vecchione A, Mitterhofer AP et al. Inflammation and immune response in acute aortic dissection. Ann Med 2010; 42: 622629.
5. Luo F, Zhou XL, Li JJ, Hui RT. Inflammatory response is associated with aortic dissection. Ageing Res Rev 2009; 8: 31 35.
6. Schillinger M, Domanovits H, Bayegan K, Hölzenbein T, Grabenwöger M, Thoenissen J, Röggla M, Müllner M. C-reactive protein and mortality in patients with acute aortic disease. Intens Care Med 2002; 28: 740745.
7. Ranasinghe AM, Bonser RS. Biomarkers in acute aortic dissection and other aortic syndromes. J Am Coll Cardiol 2010; 56: 15351541.
8. AlMahameed ST, Novaro GM, Asher CR, Hougthaling PL, Lago RM, Bhatt DL, AlMahameed AT, Topol EJ. Predictive value of high sensitivity C-reactive protein in the diagnosis and outcomes of acute aortic syndromes. Heart Asia 2010; 2: 136139.
9. Sakakura K, Kubo N, Ako J, Wada H, Fujiwara N, Funayama H, Ikeda N, Nakamura T, Sugawara Y, Yasu T et al. Peak C-reactive protein level predicts long-term outcomes in type b acute aortic dissection. Hypertension 2010; 55: 422429.
10. Okina N, Ohuchida M, Takeuchi T, Fujiyama T, Satoh A, Sakamoto T, Adachi H, Imaizumi T. Utility of measuring C-reactive protein for prediction of in-hospital events in patients with acute aortic dissection. Heart Vessels 2013; 28: 330335.
11. Duffy BK, Gurm HS, Rajagopal V, Gupta R, Ellis SG, Bhatt DL. Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol 2006; 97: 993996.
12. Spark JI, Sarveswaran J, Blest N, Charalabidis P, Asthana S. An elevated neutrophil-lymphocyte ratio independently predicts mortality in chronic critical limb ischemia. J Vasc Surg 2010; 52: 632636.
13. Shen XH, Chen Q, ShiY, Li HW. Association of neutrophil/ lymphocyte ratio with long-term mortality after ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Chin Med J 2010; 123: 34383443.
14. Gibson PH, Croal BL, Cuthbertson BH, Small GR, Ifezulike AI, Gibson G, Jeffrey RR, Buchan KG, El-Shafei H, Hillis GS. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J 2007; 154: 995 1002.
15. Bhutta H, Agha R, Wong J, Tang TY, Wilson YG, Walsh SR. Neutrophillymphocyte ratio predicts medium-term survival following elective major vascular surgery: a cross-sectional study. Vasc Endovascular Surg 2011; 45: 227231.
16. DeBakey ME, Henly WS, Cooley DA, Morris GC Jr, Crawford ES, Beall AC Jr. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg 1965; 49: 130149.
17. Harris N, Jou JM, Devoto G, Lotz J, Pappas J, Wranovics D, Wilkinson M, Fletcher SR, Kratz A. Performance evaluation of the ADVIA 2120 hematology analyzer: an international multicenter clinical trial. Lab Hematol 2005; 11: 6270.
18. He R, Guo DC, Estrera AL, Safi HJ, Huynh TT, Yin Z, Cao SN, Lin J, Kurian T, Buja LM et al. Characterization of the inflammatory and apoptotic cells in the aortas of patients with ascending thoracic aortic aneurysms and dissections. J Thorac Cardiovasc Surg 2006; 131: 671678.
19. Kuehl H, Eggebrecht H, Boes T, Antoch G, Rosenbaum S, Ladd S, Bockisch A, Barkhausen J, Erbel R. Detection of inflammation in patients with acute aortic syndrome: comparison of FDG-PET/CT imaging and serologic markers of inflammation. Heart 2008; 94: 14721477.
20. Wen D, Wu HY, Jiang XJ, Zhang HM, Zhou XL, Li JJ, Hui RT. Role of plasma C-reactive protein and white blood cell count in predicting in-hospital clinical events of acute type A aortic dissection. Chin Med J 2011; 124: 26782682.
21. Chung J, Corriere MA, Veeraswamy RK, Kasirajan K, Milner R, Dodson TF, Salam AA, Chaikof EL. Risk factors for late mortality after endovascular repair of the thoracic aorta. J Vasc Surg 2010; 52: 549554.
22. Kalay N, Dogdu O, Koc F, Yarlioglues M, Ardic I, Akpek M, Cicek D, Oguzhan A, Ergin A, Kaya MG. Hematologic parameters and angiographic progression of coronary atherosclerosis. Angiology 2012; 63: 213217.
23. Papa A, Emdin M, Passino C, Michelassi C, Battaglia D, Cocci F. Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta 2008; 395: 2731.
24. Azab B, Zaher M, Weiserbs KF, Torbey E, Lacossiere K, Gaddam S, Gobunsuy R, Jadonath S, Baldari D, McCord D et al. Usefulness of neutrophil to lymphocyte ratio in predicting short and long term mortality after non-ST-elevation myocardial infarction. Am J Cardiol 2010; 106: 470476.
25. Turak O, Ozcan F, Isleyen A, Tok D, Sokmen E, Buyukkaya E, Aydogdu S, Akpek M, Kaya MG. Usefulness of the neutrophilto-lymphocyte ratio to predict bare-metal stent restenosis. Am J Cardiol 2012; 110: 14051410.
26. Gennari R, Dominioni L, Imperatori A, Bianchi V, Maroni P, Dionigi R. Alterations in lymphocyte subsets as prognosticators of postoperative infections. Eur J Surg 1995; 161: 493499.