Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2021; 9(35): 10816-10827
Published online Dec 16, 2021. doi: 10.12998/wjcc.v9.i35.10816
Association between neutrophil-to-lymphocyte ratio and major postoperative complications after carotid endarterectomy: A retrospective cohort study
Yun Yu, Wei-Hua Cui, Chan Cheng, Yu Lu, Qing Zhang, Ru-Quan Han
Yun Yu, Wei-Hua Cui, Chan Cheng, Yu Lu, Qing Zhang, Ru-Quan Han, Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Author contributions: Yu Y, Cui WH and Han RQ were major contributors to the design of the current study; Yu Y, Cui WH and Cheng C performed the analyses and interpretation the data and made substantial contributions to the draft manuscript; Lu Y, Zhang Q and Han RQ made great efforts to revise it; all authors have read and approved the final manuscript.
Supported by Clinical Medicine Development of Special Funding, No. ZYLX201708 and No. DFL20180502; Beijing Municipal Administration of Hospitals Incubating Program, No. PX2017037; Beijing Hospitals Authority Youth Programme, No. QML20190508; and Beijing Municipal Science & Technology Commission, No. Z191100006619067.
Institutional review board statement: This study was approved by the Ethics Committee of Beijing Tiantan Hospital (KY2017-024-01) and performed conforming to the 1964 Declaration of Helsinki and its later amendments.
Informed consent statement: Given the retrospective nature of the study, the ethics committee waived the need for written informed consent and no registration was required.
Conflict-of-interest statement: The authors declare no competing interests.
Data sharing statement: The original data is available on request from the corresponding author at ruquan.han@ccmu.edu.cn.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ru-Quan Han, MD, PhD, Chief Doctor, Professor, Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwest 4th Ring Road, Fengtai District, Beijing 100070, China. ruquan.han@ccmu.edu.cn
Received: January 28, 2021
Peer-review started: January 28, 2021
First decision: June 15, 2021
Revised: June 27, 2021
Accepted: September 14, 2021
Article in press: September 14, 2021
Published online: December 16, 2021
Processing time: 315 Days and 16.5 Hours
Abstract
BACKGROUND

Carotid artery cross-clamping during carotid endarterectomy (CEA) may damage local cerebral perfusion and induce cerebral ischemia–reperfusion injury to activate local inflammatory responses. Neutrophil-to-lymphocyte ratio (NLR) is an indicator that reflects systemic inflammation. However, the correlation between NLR and complications after CEA remains unclear.

AIM

To investigate the association between NLR and major complications after surgery in patients undergoing CEA.

METHODS

This retrospective cohort study included patients who received CEA between January 2016 and July 2018 at Beijing Tiantan Hospital. Neutrophil and lymphocyte counts in whole blood within 24 h after CEA were collected. The primary outcome was the composite of major postoperative complications including neurological, pulmonary, cardiovascular and acute kidney injuries. The secondary outcomes included infections, fever, deep venous thrombosis, length of hospitalization and cost of hospitalization. Statistical analyses were performed using EmpowerStats software and R software.

RESULTS

A total of 224 patients who received CEA were screened for review and 206 were included in the statistical analyses; of whom, 40 (19.42%) developed major postoperative complications. NLR within 24 h after CEA was significantly correlated with major postoperative complications (P = 0.026). After confounding factors were adjusted, the odds ratio was 1.15 (95%CI: 1.03–1.29, P = 0.014). The incidence of major postoperative complications in the high NLR group was 8.47 times that in the low NLR group (P = 0.002).

CONCLUSION

NLR is associated with major postoperative complications in patients undergoing CEA.

Keywords: Carotid artery stenosis; Carotid endarterectomy; Neutrophil to lymphocyte ratio; Inflammation; Postoperative complication; Major organ dysfunction

Core tip: We retrospectively evaluated the association between neutrophil-to-lymphocyte ratio (NLR) and major postoperative complications in patients undergoing carotid endarterectomy (CEA). Nearly 20% of patients developed major postoperative complications. NLR within 24 h after CEA was significantly correlated with major postoperative complications. The incidence of major postoperative complications in the high NLR group was 8.47 times that in the low NLR group after confounding factors were adjusted. Since early detection and early treatment help improve outcomes for CEA, inflammatory markers such as NLR may also become potential treatment targets.