Usefulness of neutrophil/lymphocyte ratio as a predictor of amputation after embolectomy for acute limb ischemia

Background: The aim of this study was to examine the predictive ability of admission neutrophil/lymphocyte ratio (NLR) for predicting amputation in patients with acute limb ischemia who underwent embolectomy. Methods: We retrospectively analyzed the clinical, hematologic, and amputation data of 254 patients who had undergone embolectomy for acute limb ischemia. There were 152 (52%) men and 93 (48%) women, with a mean age of 66.04 ± 13.30 years. The admission NLR was determined by dividing the absolute neutrophil count by the absolute lymphocyte count. The primary end point was determined as amputation and death. Results: The mean duration of follow-up was 26 months. During the follow-up period, there were 18 (7%) amputations within 30 days of surgery and 36 (15%) amputations over a mean follow-up of 26 months. Based on multivariate logistic regression modeling, no arterial back bleeding and preoperative NLR were observed to be independent risk factors for amputation within 30 days of surgery, and no arterial back bleeding and preoperative NLR were observed to be independent risk factors for midterm amputation for the same time period. A NLR of ≥5.2 was taken as the cutoff based upon the receiver operating characteristic. In receiver operating characteristic curve analysis, a NLR ≥5.2 had 83% sensitivity and 63% specificity in predicting amputation within 30 days of surgery and 63% sensitivity and 63% specificity in predicting midterm amputation. Conclusions: An elevated NLR is associated with a poorer limb survival after embolectomy. This simple, inexpensive test may therefore be added to risk stratification of these high-risk patients. © 2014 Elsevier Inc. All rights reserved.