THE IMPACT OF NEUTROPHIL-TOLYMPHOCYTE RATIO AND PLATELETTO- LYMPHOCYTE RATIO IN CAROTID ARTERY DISEASE

Authors

  • António Pereira-Neves Department of Biomedicine – Unit of Anatomy and Department of Surgery and Physiology
  • Mariana Fragão-Marques Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto; Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal
  • João Rocha-Neves Department of Biomedicine – Unit of Anatomy and Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto
  • Luís Gamas Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto
  • José Oliveira-Pinto Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
  • Alfredo Cerqueira Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto
  • José Andrade 1Department of Biomedicine – Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal
  • José Fernando-Teixeira Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal

DOI:

https://doi.org/10.48729/pjctvs.14

Abstract

Introduction: Inflammation is a common underlying feature of atherosclerosis. Several inflammatory biomarkers have been reported to have prognostic value, in several areas, including in vascular surgery. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) may permit to identify patients at greater risk for cerebrovascular events, tailor patient management, improve preoperative status and possibly develop target anti-atherosclerotic therapy. However, studies reporting usefulness of these hematological biomarkers in the context of carotid artery disease are still scarce. The aim of this study was to review the literature concerning the prognostic ability of NLR and PLR in the subpopulation of vascular patients with carotid artery disease.

Methods: A Medline search was performed in order to identify publications focused on the physiopathology of NLR and PLR and their impact in the management of patients with carotid artery disease.

Results: The study identified 18 articles with a total of 5339 patients. NLR is associated with carotid intima-media thickness, carotid plaques, carotid stenosis, symptomatic stenosis and intra-stent restenosis after carotid artery stenting and cognitive dysfunction after carotid endarterectomy. PLR is associated with carotid stenosis, symptomatic stenosis and predicts post-operative outcomes after carotid artery revascularization, including post-operative stroke, acute coronary syndrome and all-cause mortality.

Conclusions: The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have the ability to predict sub-clinic atherosclerosis, atherosclerosis progression in carotid artery disease and propensity for carotid stenosis to become symptomatic along with morbidity following CEA and carotid stenting. Consequently, these parameters may be considered to tailored therapy and improve patient management.

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References

Aday, A.W. and J.A. Beckman, Medical Management of Asymptomatic Carotid Artery Stenosis. Prog Cardiovasc Dis, 2017. 59(6): p. 585-590.

Bejot, Y., et al., Epidemiology of stroke in Europe and trends for the 21st century. Presse Med, 2016. 45(12 Pt 2): p. e391-e398.

Naylor, A.R., et al., Editor's Choice - Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg, 2018. 55(1): p. 3-81.

Ross, R., Atherosclerosis--an inflammatory disease. N Engl J Med, 1999. 340(2): p. 115-26.

Taleb, S., Inflammation in atherosclerosis. Arch Cardiovasc Dis, 2016. 109(12): p. 708-715.

Geovanini, G.R. and P. Libby, Atherosclerosis and inflammation: overview and updates. Clin Sci (Lond), 2018. 132(12): p. 1243-1252.

Libby, P., Inflammation in atherosclerosis. Arterioscler Thromb Vasc Biol, 2012. 32(9): p. 2045-51.

Soeki, T. and M. Sata, Inflammatory Biomarkers and Atherosclerosis. Int Heart J, 2016. 57(2): p. 134-9.

Moriya, J., Critical roles of inflammation in atherosclerosis. J Cardiol, 2019. 73(1): p. 22-27.

Lievens, D. and P. von Hundelshausen, Platelets in atherosclerosis. Thromb Haemost, 2011. 106(5): p. 827-38.

Huo, Y. and K.F. Ley, Role of platelets in the development of atherosclerosis. Trends Cardiovasc Med, 2004. 14(1): p. 18-22.

Pircher, J., et al., Platelet-Neutrophil Crosstalk in Atherothrombosis. Thromb Haemost, 2019. 119(8): p. 1274-1282.

Tavora, F.R., et al., Monocytes and neutrophils expressing myeloperoxidase occur in fibrous caps and thrombi in unstable coronary plaques. BMC Cardiovasc Disord, 2009. 9: p. 27.

Ommen, S.R., et al., Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. Am J Cardiol, 1997. 79(6): p. 812-4.

Bressi, E., et al., Impact of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio on 5-Year Clinical Outcomes of Patients with Stable Coronary Artery Disease Undergoing Elective Percutaneous Coronary Intervention. J Cardiovasc Transl Res, 2018. 11(6): p. 517-523.

Mungan, I., et al., Does the preoperative platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio predict morbidity after gastrectomy for gastric cancer? Mil Med Res, 2020.

(1): p. 9.

Mady, M., et al., Neutrophil to lymphocyte ratio as a prognostic marker in metastatic gallbladder cancer. HPB (Oxford), 2020.

Vinal, D., et al., Prognostic value of neutrophil-to-lymphocyte ratio and other inflammatory markers in patients with high-risk soft tissue sarcomas. Clin Transl Oncol, 2020.

Ma, L., et al., Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in patients with systemic lupus erythematosus and their correlation with activity: A meta-analysis. Int

Immunopharmacol, 2019. 76: p. 105949.

Huang, Z., et al., Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: A meta-analysis. Am J Emerg Med, 2019.

Zhao, C., et al., Prognostic value of an inflammatory biomarker-based clinical algorithm in septic patients in the emergency department: An observational study. Int Immunopharmacol, 2020. 80: p. 106145.

Li, B., et al., Platelet-to-lymphocyte ratio in advanced Cancer: Review and meta-analysis. Clin Chim Acta, 2018. 483: p. 48-56.

Guo, W., et al., Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for breast cancer patients: An updated meta-analysis of 17079 individuals.

Cancer Med, 2019. 8(9): p. 4135-4148.

Bhutta, H., et al., Neutrophil-lymphocyte ratio predicts medium-term survival following elective major vascular surgery: a cross-sectional study. Vasc Endovascular Surg, 2011.

(3): p. 227-31.

Gary, T., et al., Platelet-to-lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS One, 2013. 8(7): p. e67688.

Gonzalez-Fajardo, J.A., et al., Prognostic significance of an elevated neutrophil-lymphocyte ratio in the amputation-free survival of patients with chronic critical limb ischemia. Ann

Vasc Surg, 2014. 28(4): p. 999-1004.

Wang, Q., et al., Neutrophil-to-lymphocyte ratio is effective prognostic indicator for post-amputation patients with critical limb ischemia. Saudi Med J, 2017. 38(1): p. 24-29.

Tasoglu, I., et al., Neutrophil-lymphocyte ratio and the platelet-lymphocyte ratio predict the limb survival in critical limb ischemia. Clin Appl Thromb Hemost, 2014. 20(6): p. 645-50.

Tasoglu, I., et al., Usefulness of neutrophil/lymphocyte ratio as a predictor of amputation after embolectomy for acute limb ischemia. Ann Vasc Surg, 2014. 28(3): p. 606-13.

Lareyre, F., et al., Association of Platelet to Lymphocyte Ratio and Risk of 30-Day Postoperative Complications in Patients Undergoing Abdominal Aortic Surgical Repair. Vasc Endovascular Surg, 2019. 53(1): p. 5-11.

Wang, S., et al., Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Are Effective Predictors of Prognosis in Patients with Acute Mesenteric Arterial Embolism and Thrombosis. Ann Vasc Surg, 2018. 49: p. 115-122.

Augene, E., et al., Platelet to lymphocyte ratio as a predictive factor of 30-day mortality in patients with acute mesenteric ischemia. PLoS One, 2019. 14(7): p. e0219763.

Deser, S.B., et al., The association between platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, and carotid artery stenosis and stroke following carotid endarterectomy. Vascular, 2019. 27(6): p. 604-611.

Massiot, N., et al., High Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio are Associated with Symptomatic Internal Carotid Artery Stenosis. J Stroke Cerebrovasc Dis, 2019. 28(1): p. 76-83.

Halazun, H.J., et al., Neutrophil-lymphocyte ratio as a predictor of cognitive dysfunction in carotid endarterectomy patients. J Vasc Surg, 2014. 59(3): p. 768-73.

Hyun, S., et al., Can the Neutrophil-to-Lymphocyte Ratio Appropriately Predict Carotid Artery Stenosis in Patients with Ischemic Stroke?-A Retrospective Study. J Stroke Cerebrovasc

Dis, 2015. 24(11): p. 2646-51.

Suarez-Cuenca, J.A., et al., Neutrophil-to-lymphocyte ratio and its relation with pro-inflammatory mediators, visceral adiposity and carotid intima-media thickness in population with obesity. Eur J Clin Invest, 2019. 49(5): p. e13085.

Demirkol, S., et al., Neutrophils/lymphocytes ratio in patients with cardiac syndrome X and its association with carotid intima-media thickness. Clin Appl Thromb Hemost, 2014.

(3): p. 250-5.

Kim, B.J., et al., The Combined Impact of Neutrophil-to-Lymphocyte Ratio and Type 2 Diabetic Mellitus on Significant Coronary Artery Disease and Carotid Artery Atherosclerosis. J

Cardiovasc Ultrasound, 2016. 24(2): p. 115-22.

Li, X., et al., High neutrophil-to-lymphocyte ratio is associated with increased carotid artery intima-media thickness in type 2 diabetes. J Diabetes Investig, 2017. 8(1): p. 101-107.

Corriere, T., et al., Neutrophil-to-Lymphocyte Ratio is a strong predictor of atherosclerotic carotid plaques in older adults. Nutr Metab Cardiovasc Dis, 2018. 28(1): p. 23-27.

Yuksel, I.O., et al., Association of Neutrophil/Lymphocyte Ratio with Plaque Morphology in Patients with Asymptomatic Intermediate Carotid Artery Stenosis. Korean Circ J, 2016.

(5): p. 699-705.

Jiang, H., et al., Neutrophil-to-Lymphocyte Ratio Correlates with Severity of Extracranial Carotid Stenosis-A Study Using Digital Subtraction Angiography. J Stroke Cerebrovasc Dis,

26(6): p. 1182-1190.

Koklu, E., et al., Is Elevated Neutrophil-to-Lymphocyte Ratio a Predictor of Stroke in Patients with Intermediate Carotid Artery Stenosis? J Stroke Cerebrovasc Dis, 2016. 25(3): p.

-84.

Dai, Z., et al., Neutrophil to Lymphocyte Ratio as a Predictor of Restenosis After Angioplasty and Stenting for Asymptomatic Carotid Stenosis. Angiology, 2019. 70(2): p. 160-165.

Bao, X., et al., Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio: novel markers for the diagnosis and prognosis in patients with restenosis following CAS. Biomark Med, 2020. 14(4): p. 271-282.

Idil Soylu, A., et al., The correlation of the platelet-to-lymphocyte ratio with the severity of stenosis and stroke in patients with carotid arterial disease. Vascular, 2017. 25(3): p. 299-306.

Varim, C., et al., Usefulness of the platelet-to-lymphocyte ratio in predicting the severity of carotid artery stenosis in patients undergoing carotid angiography. Kaohsiung J Med

Sci, 2016. 32(2): p. 86-90.

Bonaventura, A., et al., Platelet-to-lymphocyte ratio at the time of carotid endarterectomy is associated with acute coronary syndrome occurrence. J Cardiovasc Med (Hagerstown),

21(1): p. 80-82.

Tek, M., et al., Platelet to lymphocyte ratio predicts all-cause mortality in patients with carotid arterial disease. Rom J Intern Med, 2019. 57(2): p. 159-165.

Koenig, W. and N. Khuseyinova, Biomarkers of atherosclerotic plaque instability and rupture. Arterioscler Thromb Vasc Biol, 2007. 27(1): p. 15-26.

Ammirati, E., et al., Markers of inflammation associated with plaque progression and instability in patients with carotid atherosclerosis. Mediators Inflamm, 2015. 2015: p. 718329.

Tabas, I., G. Garcia-Cardena, and G.K. Owens, Recent insights into the cellular biology of atherosclerosis. J Cell Biol, 2015. 209(1): p. 13-22.

Akpek, M., et al., Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing

primary coronary intervention. Am J Cardiol, 2012. 110(5): p. 621-7.

Willeit, P., et al., Inflammatory markers and extent and progression of early atherosclerosis: Meta-analysis of individual-participant-data from 20 prospective studies of the

PROG-IMT collaboration. Eur J Prev Cardiol, 2016. 23(2): p. 194-205.

Eriksson, E.E., et al., Direct viewing of atherosclerosis in vivo: plaque invasion by leukocytes is initiated by the endothelial selectins. FASEB J, 2001. 15(7): p. 1149-57.

Silvestre-Roig, C., et al., Neutrophils as regulators of cardiovascular inflammation. Nat Rev Cardiol, 2020.

Tecchio, C., A. Micheletti, and M.A. Cassatella, Neutrophil-derived cytokines: facts beyond expression. Front Immunol, 2014. 5: p. 508.

Alloza, I., et al., RNAseq based transcriptomics study of SMCs from carotid atherosclerotic plaque: BMP2 and IDs proteins are crucial regulators of plaque stability. Sci Rep, 2017. 7(1): p. 3470.

Kim, H. and E.M. Conway, Platelets and Complement Cross-Talk in Early Atherogenesis. Front Cardiovasc Med, 2019. 6: p. 131.

Rosinska, J., et al., Association of platelet-derived microvesicles and their phenotypes with carotid atherosclerosis and recurrent vascular events in patients after ischemic stroke.

Thromb Res, 2019. 176: p. 18-26.

Suffee, N., et al., RANTES/CCL5-induced pro-angiogenic effects depend on CCR1, CCR5 and glycosaminoglycans. Angiogenesis, 2012. 15(4): p. 727-44.

Song, I.S., et al., Chebulinic acid inhibits smooth muscle cell migration by suppressing PDGF-Rbeta phosphorylation and inhibiting matrix metalloproteinase-2 expression. Sci Rep,

7(1): p. 11797.

Lin, B.D., et al., Causes of variation in the neutrophil-lymphocyte and platelet-lymphocyte ratios: a twin-family study. Biomark Med, 2016. 10(10): p. 1061-1072.

Li, J., et al., Neutrophil-to-Lymphocyte Ratio Positively Correlates to Age in Healthy Population. J Clin Lab Anal, 2015. 29(6): p. 437-43.

Azab, B., M. Camacho-Rivera, and E. Taioli, Average values and racial differences of neutrophil lymphocyte ratio among a nationally representative sample of United States subjects.

PLoS One, 2014. 9(11): p. e112361.

Cox, A.J., N.P. West, and A.W. Cripps, Obesity, inflammation, and the gut microbiota. Lancet Diabetes Endocrinol, 2015. 3(3): p. 207-15.

Aydin, M., et al., Neutrophil/lymphocyte ratio in obese adolescents. North Clin Istanb, 2015. 2(2): p. 87-91.

Bozkus, F., et al., Does the neutrophil-to-lymphocyte ratio have any importance between subjects with obstructive sleep apnea syndrome with obesity and without obesity? Tuberk

Toraks, 2018. 66(1): p. 8-15.

Braicu, M.D., et al., The assessment of subclinic atherosclerosis objected through IMT in normal and dyslipidemic patients with various degrees of glucose tolerance. Rom J Intern Med, 2009. 47(3): p. 257-65.

Gorelick, P.B., Carotid endarterectomy : where do we draw the line? Stroke, 1999. 30(9): p. 1745-50.

Lal, B.K., et al., Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial. Lancet Neurol, 2012. 11(9): p. 755-63.

Bolca, O., et al., The neutrophil-to-lymphocyte ratio is associated with bare-metal stent restenosis in STEMI patients treated with primary PCI. Coron Artery Dis, 2015. 26(5): p. 402-8.

Turak, O., et al., Usefulness of the neutrophil-to-lymphocyte ratio to predict bare-metal stent restenosis. Am J Cardiol, 2012. 110(10): p. 1405-10.

Ozturk, Z.A., et al., Is increased neutrophil lymphocyte ratio remarking the inflammation in sarcopenia? Exp Gerontol, 2018. 110: p. 223-229.

Akboga, M.K., et al., Increased Platelet to Lymphocyte Ratio is Related to Slow Coronary Flow. Angiology, 2016. 67(1): p. 21-6.

Soliman, W.M., et al., Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratios in Systemic Lupus Erythematosus: Relation With Disease Activity and Lupus Nephritis. Reumatol Clin, 2018.

Ridker, P.M., et al., Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial. Lancet, 2009. 373(9670): p. 1175-82.

Ridker, P.M., et al., Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. N Engl J Med, 2017. 377(12): p. 1119-1131.

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Published

08-04-2021

How to Cite

1.
Pereira-Neves A, Fragão-Marques M, Rocha-Neves J, Gamas L, Oliveira-Pinto J, Cerqueira A, Andrade J, Fernando-Teixeira J. THE IMPACT OF NEUTROPHIL-TOLYMPHOCYTE RATIO AND PLATELETTO- LYMPHOCYTE RATIO IN CAROTID ARTERY DISEASE. Rev Port Cir Cardiotorac Vasc [Internet]. 2021 Apr. 8 [cited 2024 Mar. 28];28(1):45-51. Available from: https://pjctvs.com/index.php/journal/article/view/14

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