Key result
Elevated preoperative NLR links to ~78% greater odds of higher ASA and RCRI scores.
Why the study?
The association of neutrophil:lymphocyte ratio with systemic illness and its usefulness in preoperative risk assessment has not been fully elucidated.
Does elevated preoperative neutrophil to lymphocyte ratio (NLR) correlate with systemic illnesses and anesthesia risk indices in non-cardiac surgical patients?
Cross-Sectional (n=1,117)
No
Does elevated preoperative neutrophil to lymphocyte ratio (NLR) correlate with systemic illnesses and anesthesia risk indices in non-cardiac surgical patients?
Odds Ratio: 1.78 (95% CI 1.42–2.24)
p-value: p=<0.001
Elevated preoperative neutrophil-lymphocyte ratio is prevalent and independently associated with congestive heart failure, malignancy, and higher anesthesia risk scores in non-cardiac surgical patients.
Elevated NLR was associated with comorbidities and higher ASA/RCRI scores preoperatively; leaves open its utility for risk stratification pending prospective studies.
BACKGROUND: Neutrophil:lymphocyte ratio (NLR) is an emerging biomarker that is used to predict postoperative mortality and morbidity in cardiac and cancer surgeries. The association of this biomarker with systemic illness and its usefulness in risk assessment of preoperative patients has not been fully elucidated. OBJECTIVES: To determine the prevalence of elevated NLR in preoperative patients and to examine the relationship between elevated NLR and the presence of systemic illnesses as well as anaesthesia risk indices such as American Society of Anesthesia (ASA) and the revised cardiac risk index (RCRI) scores. DESIGN: Cross-sectional study Setting: Anaesthesia pre-admission clinic, Toronto Western Hospital, Toronto, Canada Patients: We evaluated 1117 pre-operative patients seen at an anesthesia preadmission clinic. RESULTS: NLR was elevated (>3.3) in 26.6% of target population. In multivariate analysis, congestive cardiac failure, diabetes mellitus and malignancy were independent risk factors predicting raised NLR. After regression analysis, a relationship between NLR and ASA score (Odds Ratio 1.78; 95% CI: 1.42-2.24) and revised cardiac risk index (RCRI, odds ratio 1.33; 95% CI: 1.09-1.64, p-value: 0.0063) was observed. CONCLUSIONS: NLR was elevated (> 3.3) in 26.6% of patients. Congestive cardiac failure and malignancy were two constant predictors of elevated NLR at >3.3 and > 4.5. There was a strong association between NLR and anesthesia risk scoring tools of ASA and RCRI.
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Venkatraghavan et al. (2015) conducted a cross-sectional in Preoperative elective surgical patients (n=1,117). Elevated Neutrophil Lymphocyte Ratio (NLR) vs. Normal NLR was evaluated on Association between NLR and American Society of Anesthesia (ASA) physical status score (OR 1.78, 95% CI 1.42-2.24, p=<0.001). Elevated preoperative neutrophil-lymphocyte ratio was present in 26.6% of patients and was strongly associated with higher ASA physical status scores (OR 1.78) and revised cardiac risk index scores.
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