Association between neutrophil-to-lymphocyte ratio and major postoperative complications after carotid endarterectomy: A retrospective cohort study

doi:10.12998/wjcc.v9.i35.10816

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World Journal of Clinical Cases

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Retrospective Cohort Study

World J Clin Cases. Dec 16, 2021; 9(35): 10816-10827
Published online Dec 16, 2021. doi: 10.12998/wjcc.v9.i35.10816

Table 1 Characteristics of the patients at baseline

	Total	WOPC group	PC group	P
No. of cases	206	166	40
Age (yr)	62.0 ± 7.2	61.6 ± 7.3	63.5 ± 6.8	0.151
Sex				0.616
Male	175 (84.95%)	140 (84.34%)	35 (87.50%)
Female	31 (15.05%)	26 (15.66%)	5 (12.50%)
BMI (kg/m²)	25.33 ± 2.89	25.25 ± 2.85	25.63 ± 3.04	0.461
Smoking history	118 (57.56%)	97 (58.79%)	21 (52.50%)	0.470
ASA grade				0.521
Grade II	157 (81.07%)	136 (81.93%)	31 (77.50%)
Grade III	39 (18.93%)	30 (18.07%)	9 (22.50%)
Preoperative combined diseases
Hypertension	146 (70.87%)	114 (68.67%)	32 (80.0%)	0.157
Diabetes mellitus	74 (35.92%)	61 (36.75%)	13 (32.50%)	0.615
Heart disease	56 (27.18%)	40 (24.10%)	16 (40.0%)	0.042^a
Respiratory disease	11 (5.34%)	10 (6.02%)	1 (2.50%)	0.374
Neurological disease	96 (46.60%)	78 (46.99%)	18 (45.0%)	0.821
Kidney disease	4 (1.94%)	4 (2.41%)	0	0.321
Degree of carotid artery stenosis on the surgical side				0.449
Mild/moderate stenosis	3 (1.46%)	2 (1.20%)	1 (2.5%)
Severe stenosis	201 (97.57%)	163 (98.19%)	38 (95.0%)
Occlusion	2 (0.97%)	1 (0.60%)	1 (2.50%)
Degree of carotid artery stenosis on the contralateral side				0.146
Mild/moderate stenosis	169 (85.35%)	132 (83.02%)	37 (94.87%)
Severe stenosis	21 (10.61%)	19 (11.95%)	2 (5.13%)
Occlusion	8 (4.04%)	8 (5.03%)	0
Operating time (min)	141.33 ± 40.96	138.39 ± 38.78	153.57 ± 47.62	0.129
Duration of carotid artery occlusion (min)	22.00 (18.0–44.0)	22.00 (17.0–43.0)	27.0 (18.50–49.50)	0.328
Anesthesia method
TIVA	163 (79.13%)	129 (77.71%)	34 (85.0%)	0.309
Combined intravenous–inhalation anesthesia	43 (20.87%)	37 (22.29%)	6 (15.0%)
Intraoperative intake and output volume (mL)	897.57 ± 333.40	911.85 ± 331.01	839.75 ± 341.01	0.221
mean_SBP	128.82 ± 12.92	128.37 ± 12.77	130.69 ± 13.54	0.309
SD_SBP	20.26 ± 4.91	20.09 ± 5.01	20.93 ± 4.48	0.333
CV_SBP	0.16 ± 0.04	0.16 ± 0.04	0.16 ± 0.03	0.550
mean_DBP	69.61 ± 7.83	69.80 ± 7.77	68.82 ± 8.14	0.480
SD_DBP	10.23 ± 2.70	10.18 ± 2.81	10.42 ± 2.26	0.612
CV_DBP	0.15 ± 0.04	0.15 ± 0.04	0.15 ± 0.04	0.372
Intraoperative use of vasopressors	84 (40.78%)	65 (39.16%)	19 (47.50%)	0.335
Intraoperative use of antihypertensive agents	73 (35.44%)	63 (37.95%)	10 (25.0%)	0.124

^aP < 0.05, statistically significant difference was observed between two groups.

ASA: American society of anesthesiologists; BMI: Body mass index; CEA: Carotid endarterectomy; CV_DBP: Coefficient of variation in diastolic blood pressure; CV_SBP: Coefficient of variation in systolic blood pressure; mean_DBP: mean diastolic blood pressure; mean_SBP: mean systolic blood pressure; PC: Post-CEA complications; SD_DBP: Standard deviation of diastolic blood pressure; SD_SBP: Standard deviation of systolic blood pressure; TIVA: Total intravenous anesthesia; WOPC: Without post-CEA complications.

Table 2 Outcome variables, stratified by major postoperative complications

	Total	WOPC group	PC group	P
No. of cases	206	166	40
Major postoperative complications	40 (19.42%)	0	40 (100%)
Neurological complications	16 (7.77%)	0	16 (40.0%)	< 0.001^a
Cardiac complications	6 (2.91%)	0	6 (15.0%)	< 0.001^a
Respiratory complications	14 (6.80%)	0	14 (35.0%)	< 0.001^a
AKI	9 (4.37%)	0	9 (22.50%)	< 0.001^a
Fever	10 (4.85%)	4 (2.41%)	6 (15.0%)	< 0.001^a
Surgical site infections	3 (1.46%)	1 (0.60%)	2 (5.0%)	0.097
Urinary infections	3 (1.46%)	1 (0.60%)	2 (5.0%)	0.097
DVT	5 (2.43%)	1 (0.60%)	4 (10.0%)	< 0.001^a
Length of stay in the ICU (d)	1.0 (0–1.0)	1.0 (0–1.0)	1.0 (1.0–1.0)	0.055
Hospitalization stay (d)	15.56 ± 4.30	15.16 ± 3.63	17.20 ± 6.17	0.105
Cost of hospitalization (CNY)	24085.15 (21694.72–28395.65)	23786.67 (21568.68–27139.36)	27127.94 (22326.75–31629.55)	< 0.001^a

^aP < 0.05, statistically significant difference was observed between two groups.

AKI: Acute kidney injury; CEA: Carotid endarterectomy; DVT: Deep venous thrombosis; ICU: Intensive care unit; PC: Post-CEA complications; WOPC: Without post-CEA complications.

Table 3 Risk factors associated with major postoperative complications

	Statistical value	Post-CEA major complications	P
Age (yr)	62.0 ± 7.2	1.04 (0.99, 1.09)	0.151
Sex			0.616
Male	175 (84.95%)	1.0
Female	31 (15.05%)	0.77 (0.28, 2.15)
BMI (kg/m²)	25.33 ± 2.89	1.05 (0.93, 1.17)	0.459
ASA grade			0.522
Grade II	167 (81.07%)	1.0
Grade III	39 (18.93%)	1.32 (0.57, 3.05)
Anesthesia methods			0.312
TIVA	163 (79.13%)	1.0
Combined intravenous–inhalation anesthesia	43 (20.87%)	0.62 (0.24, 1.58)
Degree of carotid artery stenosis on the surgical side
Mild/moderate stenosis	3 (1.46%)	1.0
Severe stenosis	201 (97.57%)	0.47 (0.04, 5.28)	0.538
Occlusion	2 (0.97%)	2.00 (0.05, 78.25)	0.711
Degree of carotid artery stenosis on the contralateral side
Mild/moderate stenosis	169 (85.35%)	1.0
Severe stenosis	21 (10.61%)	0.38 (0.08, 1.69)	0.201
Occlusion	8 (4.04%)	0 (0, Inf)	0.986
Operating time (min)	141.33 ± 40.96	1.01 (1.0, 1.02)	0.038^a
Intraoperative intake and output volume (mL)	897.57 ± 333.40	1.00 (1.0, 1.00)	0.221
Duration of carotid artery occlusion	22.0 (18.0–44.0)	1.01 (0.99, 1.03)	0.327
CV_SBP	0.16 ± 0.04	16.36 (0.00, 150500.70)	0.548
CV_DBP	0.15 ± 0.04	40.21 (0.01, 132798.95)	0.372
Preoperative NLR	2.08 ± 0.94	1.21 (0.87, 1.69)	0.264
NLR within 24 h after CEA	5.68 (3.93–8.91)	1.09 (1.01, 1.17)	0.026^a

^aP < 0.05.

Table 4 Correlation between neutrophil to lymphocyte ratio within 24 h after carotid endarterectomy and major postoperative complications

Exposure factors	Unadjusted	P value	Model I	P value	Model II	P
NLR	1.09 (1.01, 1.17)	0.026^a	1.08 (1.00, 1.16)	0.041^a	1.15 (1.03, 1.29)	0.014^a
NLR tertile groups
Low NLR group	1.0		1.0		1.0
Middle NLR group	1.60 (0.63, 4.09)	0.322	1.52 (0.59, 3.92)	0.386	3.99 (1.03, 15.49)	0.046^a
High NLR group	2.92 (1.21, 7.02)	0.017^a	2.88 (1.17, 7.09)	0.022^a	8.47 (2.20, 32.63)	0.002^a

^aP < 0.05.

Model I-adjusted variables: Sex and age; Model II-adjusted variables: Sex, age, BMI, ASA grade, preoperative combined heart disease, anesthesia method, degree of stenosis on the surgical side, degree of stenosis on the contralateral side, operating time, intraoperative intake and output volume, duration of carotid artery occlusion, CV_SBP, and CV_DBP. ASA: American society of anesthesiologists; BMI: Body mass index; CEA: Carotid endarterectomy; CV_DBP: Coefficient of variation in diastolic blood pressure; CV_SBP: Coefficient of variation in systolic blood pressure; NLR: Neutrophil to lymphocyte ratio.

Table 5 Outcome variables, stratified by NLR ratio tertile groups

	Total	Low NLR group	Middle NLR group	High NLR group	P
No. of cases	206	68	69	69
Major postoperative complications	40 (19.42%)	8 (11.76%)	11 (15.94%)	21 (30.43%)	0.015^a
Neurological complications	16 (7.77%)	4 (5.88%)	4 (5.80%)	8 (11.59%)	0.346
Cardiac complications	6 (2.91%)	0 (0.00%)	3 (4.35%)	3 (4.35%)	0.218
Respiratory complications	14 (6.80%)	2 (2.94%)	5 (7.25%)	7 (10.14%)	0.242
AKI	9 (4.37%)	2 (2.94%)	1 (1.45%)	6 (8.70%)	0.089
Fever	10 (4.85%)	1 (1.47%)	2 (2.90%)	7 (10.14%)	0.040^a
Surgical site infections	3 (1.46%)	1 (1.47%)	1 (1.45%)	1 (1.45%)	1.000
Urinary infections	3 (1.46%)	0 (0.00%)	1 (1.45%)	2 (2.90%)	0.367
DVT	5 (2.43%)	2 (2.94%)	1 (1.45%)	1 (1.45%)	0.766
Length of stay in the ICU (d)	1.0 (0–1.0)	1.0 (0–1.0)	1.0 (0–1.0)	1.0 (1.0–1.0)	0.079
Hospitalization stay (d)	15.56 ± 4.30	15.44 ± 4.40	15.28 ± 4.27	15.96 ± 4.26	0.627
Cost of hospitalization (CNY)	26886.26 ± 11277.49	24371.70 ± 5233.73	26837.07 ± 12681.34	29413.56 ± 13520.49	0.032^a

^aStatistically significant difference was observed between the groups.

AKI: Acute kidney injury; CEA: Carotid endarterectomy; CNY: Chinese Yuan; DVT: Deep venous thrombosis; ICU: Intensive care unit; NLR: Neutrophil-to-lymphocyte ratio.

Citation: Yu Y, Cui WH, Cheng C, Lu Y, Zhang Q, Han RQ. Association between neutrophil-to-lymphocyte ratio and major postoperative complications after carotid endarterectomy: A retrospective cohort study. World J Clin Cases 2021; 9(35): 10816-10827
URL: https://www.wjgnet.com/2307-8960/full/v9/i35/10816.htm
DOI: https://dx.doi.org/10.12998/wjcc.v9.i35.10816