Predictive value of preoperative neutrophil-to-lymphocyte ratio for prognosis in aortic dissection patients without hypertension following TEVAR

Background The neutrophil-to-lymphocyte ratio (NLR) serves as a potential inflammatory biomarker for aortic dissection (AD), with elevated levels predicting adverse postoperative outcomes. Nevertheless, the prognostic significance of preoperative NLR in non-hypertensive AD patients receiving thoracic endovascular aortic repair (TEVAR) remains undefined. Objective To evaluate the predictive value of preoperative NLR for clinical prognosis in this specific cohort following TEVAR. Methods This study retrospectively analyzed 116 non-hypertensive AD patients undergoing TEVAR at our medical center (December 2014–December 2020). Receiver operating characteristic (ROC) curve analysis determined the optimal NLR cutoff, area under the curve (AUC), and 95% confidence interval (CI) for predicting the primary endpoint (all-cause mortality). Patients were stratified into low-NLR and high-NLR groups based on the cutoff. Survival differences were assessed using Kaplan-Meier analysis with log-rank testing. Associations between NLR and mortality risk were evaluated via univariate and multivariate Cox regression. Results The cohort comprised 77.6% males, with 52.6% aged >55 years, 30.2% reporting smoking history, 13.8% alcohol use, and 14.7% comorbidities. Anatomical classification included Stanford type A (5.2%) and type B (94.8%); temporal classification was acute (12.1%), subacute (30.2%), and chronic (57.8%). Branch artery reconstruction was performed in 47.4% of patients. Postoperative outcomes included all-cause mortality (1.7%), dissection recurrence (3.4%), endoleak (6.0%), and secondary intervention (9.5%). NLR demonstrated strong predictive efficacy (cutoff: 7.69; sensitivity: 96.4%; specificity: 65.9%; AUC = 0.83, 95% CI: 0.76–0.90). The high-NLR group exhibited significantly reduced survival compared to the low-NLR group ( P < 0.001). Univariate Cox regression identified high NLR (HR = 30.766, 95% CI: 4.177–226.611, P = 0.001) and branch reconstruction (HR = 2.335, 95% CI: 1.090–5.001, P = 0.029) as mortality risk factors. Multivariate analysis confirmed high NLR as an independent risk factor for all-cause death (HR = 2.033, 95% CI: 1.004–3.221). Conclusion Preoperative NLR elevation is significantly linked to decreased survival following TEVAR in AD patients with aortic dissection, and it may function as an independent predictor of all-cause mortality. This parameter may be used as a reliable prognostic marker for this specific patient group.