Frontiers in aging · 2026
Predictive value of preoperative neutrophil-to-lymphocyte ratio for prognosis in aortic dissection patients without hypertension following TEVAR.
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Yu Shun, Liu Xinghua, Guan Kunyu, Chen Liang, Zhang Hao, Sun Dengqun, Sun Yanjun, Zhu Lixue, Weng Lijun, Wu Biao
Аннотация
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.
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.