Pre-operative neutrophil-lymphocyte ratio predicts survival following major vascular surgery

Background: The systemic nature of atherosclerosis compromises medium-term survival following major vascular surgery. Neutrophil lymphocyte ratio (NLR) is a simple index of systemic inflammatory burden which correlates with survival following percutaneous coronary intervention. Methods: Patients undergoing elective major vascular surgery in two tertiary vascular units were identified from prospectively maintained databases. Factors associated with two-year mortality were assessed by univariate and multivariate analyses. Results: Over a four-year period, 1,021 patients underwent elective major vascular surgery (carotid endarterectomy, abdominal aortic aneurysm repair, lower limb revascularisation). Two-year mortality was 11.2%. In multivariate analysis, preoperative NLR[5 was independently associated with 2-year mortality (multivariate odds ratio 2.21; 95% CI: 1.224.01). Conclusion: Pre-operative NLR identifies patients at increased risk of death within 2 years of major vascular surgery. This simple index may facilitate targeted preventative measures for high-risk patients. Conflict of interest