1
|
Bradley NA, Roxburgh CSD, McMillan DC, Guthrie GJK. A systematic review of the neutrophil to lymphocyte and platelet to lymphocyte ratios in patients with lower extremity arterial disease. VASA 2024; 53:155-171. [PMID: 38563057 DOI: 10.1024/0301-1526/a001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Lower extremity arterial disease (LEAD) is caused by atherosclerotic plaque in the arterial supply to the lower limbs. The neutrophil to lymphocyte and platelet to lymphocyte ratios (NLR, PLR) are established markers of systemic inflammation which are related to inferior outcomes in multiple clinical conditions, though remain poorly described in patients with LEAD. This review was carried out in accordance with PRISMA guidelines. The MEDLINE database was interrogated for relevant studies. Primary outcome was the prognostic effect of NLR and PLR on clinical outcomes following treatment, and secondary outcomes were the prognostic effect of NLR and PLR on disease severity and technical success following revascularisation. There were 34 studies included in the final review reporting outcomes on a total of 19870 patients. NLR was investigated in 21 studies, PLR was investigated in two studies, and both NLR & PLR were investigated in 11 studies. Relating to increased levels of systemic inflammation, 20 studies (100%) reported inferior clinical outcomes, 13 (92.9%) studies reported increased disease severity, and seven (87.5%) studies reported inferior technical results from revascularisation. The studies included in this review support the role of elevated NLR and PLR as key components influencing the clinical outcomes, severity, and success of treatment in patients with LEAD. The use of these easily accessible, cost effective and routinely available markers is supported by the present review.
Collapse
|
2
|
Popescu AI, Rata AL, Barac S, Popescu R, Onofrei RR, Vlad C, Vlad D. Narrative Review of Biological Markers in Chronic Limb-Threatening Ischemia. Biomedicines 2024; 12:798. [PMID: 38672153 PMCID: PMC11047884 DOI: 10.3390/biomedicines12040798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Chronic limb-threatening ischemia (CLTI), the advanced stage of peripheral arterial disease, is diagnosed in the presence of ischemic rest pain, non-healing ulcers, or gangrene. Several studies have demonstrated that inflammation and endothelial dysfunction are some of the main substrates of CLTI. METHODS A narrative review was conducted and reported according to PRISMA guidelines. Three databases were searched-Web of Science, Medline, and EMBASE-for the studies assessing CLTI and the biological markers related to it. RESULTS We included 22 studies, and all the markers identified (C-reactive protein, D-dimers, fibrinogen, cytokines, IL-6, TNF-α, ICAM-1 (Intracellular Adhesion Molecule-1), VCAM-1 (Vascular Cell Adhesion Molecule-1), neutrophile-to-lymphocytes ratio (NLR), IL-8, Pentraxin-3, neutrophil gelatinase-associated lipocalin (NGAL), calprotectin, E-selectin, P-selectin, neopterin, High-Mobility Group Box-1 protein (HGMB-1), Osteoprotegerin (OPG) and Sortilin) were positively associated with advanced CLTI, with major limb or major cardiovascular events in these patients. CONCLUSIONS All the studied markers had increased values in patients with CLTI, especially when associated with diabetes mellitus, proving a very important association between diabetes and major limb or cardiovascular events in these patients. There is a need for more studies to validate these markers in terms of diagnosis or prognosis in CLTI patients and in trying to find new medical strategies that target inflammation or endothelial dysfunction in these patients.
Collapse
Affiliation(s)
- Alexandra Ioana Popescu
- Pharmacology Department, Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Andreea Luciana Rata
- Surgical Emergencies Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Sorin Barac
- Vascular Surgery Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Roxana Popescu
- Cell and Molecular Biology Department, ”Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Roxana Ramona Onofrei
- Department of Rehabilitation, Physical Medicine and Rheumatology, Research Center for Assessment of Human Motion, Functionality and Disability, ”Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Cristian Vlad
- Pharmacology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.V.); (D.V.)
| | - Daliborca Vlad
- Pharmacology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.V.); (D.V.)
| |
Collapse
|
3
|
Li Q, Wan J, Feng Z, Shi J, Wei W. Predictive Significance of the Preoperative Neutrophil-lymphocyte Ratio for Recurrence in Idiopathic Granulomatous Mastitis Patients. Am Surg 2023; 89:5577-5583. [PMID: 36880848 DOI: 10.1177/00031348231161793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND To investigate and assess the correlation between inflammatory markers, such as the preoperative neutrophil-lymphocyte ratio (NLR), and the recurrence of idiopathic granulomatous mastitis (IGM). METHODS All patients with IGM who were free of malignancy or inflammatory diseases were included in this retrospective analysis between January 2013 and December 2019. On the basis of the presence or absence of recurrence, the patients were split into two groups. After collecting retrospective data, the relationship between patient characteristics, hematological markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), NLR, platelet-lymphocyte ratio (PLR), and white blood cell count (WBC), and their connection with postoperative recurrence were assessed utilizing univariate and multivariate analyses, receiver operating characteristic curves (ROC curves), and logistic regression. RESULTS Recurrences occurred in 40.0% (32/80) of the 80 patients over a median follow-up duration of 35.5 months (22.0-47.8 months). The recurrent group showed higher NLR and CRP than the non-recurrent group (PNLR = .003, PCRP = .02). Neutrophil-lymphocyte ratio and postoperative recurrence were associated (correlation coefficient r = .436, P = .01). The ROC curve's ideal threshold, which had predictive value for IGM recurrence, was 2.18 (sensitivity: 46.9%; specificity: 14.6%). CONCLUSION The preoperative NLR is a simple and affordable way to predict IGM relapse, which is important for directing clinical work.
Collapse
Affiliation(s)
- Qiang Li
- Department of Breast and Thyroid Surgery, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Nanjing, China
| | - Jiangyang Wan
- Department of Breast and Thyroid Surgery, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Nanjing, China
| | - Ziyu Feng
- Department of Breast and Thyroid Surgery, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Nanjing, China
| | - Jianhua Shi
- Department of Breast and Thyroid Surgery, Nantong First People's Hospital, the Second Affiliated Hospital of Nantong University, Nanjing, China
| | - Wan Wei
- Department of Breast and Thyroid Surgery, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
4
|
Selçuk N, Albeyoğlu Ş, Bastopcu M, Selçuk İ, Barutca H, Şahan H. Sarcopenia is a risk factor for major adverse cardiac events after surgical revascularization for critical limb ischemia. Vascular 2023; 31:64-71. [PMID: 34974778 DOI: 10.1177/17085381211059383] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We examined the effect of sarcopenia on early surgical outcomes in patients with critical limb ischemia (CLI) in terms of major adverse cardiac events (MACE) and major adverse limb events (MALE), as well as the value of inflammatory markers of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte ratios (PLR) as indicators of sarcopenia in CLI patients. METHODS This was an observational retrospective single-center study. Patients who required surgical revascularization for CLI between October 2015 and December 2020 were identified. Psoas muscle areas were calculated from computed tomography images for psoas muscle index (PMI) calculations. Sarcopenia was defined as PMI < 5.5 cm2/m2 for men and PMI < 4.0 cm2/m2 for women. Risk factors for 30-day major adverse cardiac events (MACE) and major adverse limb events (MALE) were analyzed. NLR and PLR were compared between sarcopenic and non-sarcopenic patients. RESULTS The mean age of 217 study patients was 61.5 ± 10.9, and 16 (7.4%) patients were female. 82 (37.8%) patients were sarcopenic. Patients with sarcopenia were older (65.1 ± 9.3 vs 59.4 ± 11.2, p < .001) and history of myocardial infarction was more frequent (23.2% vs 12.6%, p = 0.042) among sarcopenic patients. Sarcopenic patients more frequently encountered MACE (9.8% vs 0.7%, p = 0.002), but not MALE. Sarcopenia increased early postoperative MACE in our cohort with an odds ratio of 11.925. NLR was not different between the two groups, while PLR was higher (127.16 vs 104.06, p = 0.010) among sarcopenic patients. The platelet-to-lymphocyte ratio of 125.11 had a sensitivity of 53.7% and a specificity of 68.1% for differentiating sarcopenia. CONCLUSIONS Sarcopenia was associated with more frequent 30-day MACE and perioperative mortality after revascularization for CLI. 30-day MALE was not increased in patients with sarcopenia. The use of PLR as a simple marker of sarcopenia is limited by its low sensitivity and specificity.
Collapse
Affiliation(s)
- Nehir Selçuk
- Department of Cardiovascular Surgery, 111319Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Center, Uskudar Turkey
| | - Şebnem Albeyoğlu
- Department of Cardiovascular Surgery, 111319Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Center, Uskudar Turkey
| | - Murat Bastopcu
- Department of Cardiovascular Surgery, 111319Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Center, Uskudar Turkey
| | - İsmail Selçuk
- Department of Cardiovascular Surgery, İstanbul Sultan Abdulhamid Han Research and Training Center, Uskudar Turkey
| | - Hakan Barutca
- Department of Radiology, 111319Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Center, Uskudar, Turkey
| | - Hasan Şahan
- Department of Radiology, 111319Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Center, Uskudar, Turkey
| |
Collapse
|
5
|
The Role of Neutrophils in Lower Limb Peripheral Artery Disease: State of the Art and Future Perspectives. Int J Mol Sci 2023; 24:ijms24021169. [PMID: 36674682 PMCID: PMC9866688 DOI: 10.3390/ijms24021169] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/19/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023] Open
Abstract
In recent years, increasing attention has been paid to the role of neutrophils in cardiovascular (CV) disease (CVD) with evidence supporting their role in the initiation, progression, and rupture of atherosclerotic plaque. Although these cells have long been considered as terminally differentiated cells with a relatively limited spectrum of action, recent research has revealed intriguing novel cellular functions, including neutrophil extracellular trap (NET) generation and inflammasome activation, which have been linked to several human diseases, including CVD. While most research to date has focused on the role of neutrophils in coronary artery and cerebrovascular diseases, much less information is available on lower limb peripheral artery disease (PAD). PAD is a widespread condition associated with great morbidity and mortality, though physician and patient awareness of the disease remains low. To date, several studies have produced some evidence on the role of certain biomarkers of neutrophil activation in this clinical setting. However, the etiopathogenetic role of neutrophils, and in particular of some of the newly discovered mechanisms, has yet to be fully elucidated. In the future, complementary assessment of neutrophil activity should improve CV risk stratification and provide personalized treatments to patients with PAD. This review aims to summarize the basic principles and recent advances in the understanding of neutrophil biology, current knowledge about the role of neutrophils in atherosclerosis, as well as available evidence on their role of PAD.
Collapse
|
6
|
Salyers ZR, Mariani V, Balestrieri N, Kumar RA, Vugman NA, Thome T, Villani KR, Berceli SA, Scali ST, Vasilakos G, Ryan TE. S100A8 and S100A9 are elevated in chronically threatened ischemic limb muscle and induce ischemic mitochondrial pathology in mice. JVS Vasc Sci 2022; 3:232-245. [PMID: 35647565 PMCID: PMC9133641 DOI: 10.1016/j.jvssci.2022.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/22/2022] [Indexed: 11/19/2022] Open
Abstract
Objective The objective of the present study was to determine whether elevated levels of S100A8 and S100A9 (S100A8/A9) alarmins contribute to ischemic limb pathology. Methods Gastrocnemius muscle was collected from control patients without peripheral arterial disease (PAD; n = 14) and patients with chronic limb threatening limb ischemia (CLTI; n = 14). Mitochondrial function was assessed in permeabilized muscle fibers, and RNA and protein analyses were used to quantify the S100A8/A9 levels. Additionally, a mouse model of hindlimb ischemia with and without exogenous delivery of S100A8/A9 was used. Results Compared with the non-PAD control muscles, CLTI muscles displayed significant increases in the abundance of S100A8 and S100A9 at both mRNA and protein levels (P < .01). The CLTI muscles also displayed significant impairment in mitochondrial oxidative phosphorylation and increased mitochondrial hydrogen peroxide production compared with the non-PAD controls. The S100A8/A9 levels correlated significantly with the degree of muscle mitochondrial dysfunction (P < .05 for all). C57BL6J mice treated with recombinant S100A8/A9 displayed impaired perfusion recovery and muscle mitochondrial impairment compared with the placebo-treated mice after hindlimb ischemia surgery. These mitochondrial deficits observed after S100A8/A9 treatment were confirmed in the muscle cell culture system under normoxic conditions. Conclusions The S100A8/A9 levels were increased in CLTI limb muscle specimens compared with the non-PAD control muscle specimens, and the level of accumulation was associated with muscle mitochondrial impairment. Elevated S100A8/A9 levels in mice subjected to hindlimb ischemia impaired perfusion recovery and mitochondrial function. Together, these findings suggest that the inflammatory mediators S100A8/A9 might be directly involved in ischemic limb pathology. Despite improvements in the surgical management of chronic limb threatening limb ischemia (CLTI), the rates of major adverse limb events have remained high. Skeletal muscle has emerged as a strong predictor of outcomes in peripheral arterial disease (PAD)/CLTI; however, a complete understanding of muscle pathology in CLTI is lacking. This study identified elevated S100A8 and S100A9 alarmin proteins as a characteristic of CLTI muscle specimens and that the S100A8/A9 levels are associated with the degree of mitochondrial impairment in patient limb muscle specimens. Using a mouse model of PAD, treatment with S100A8/A9 exacerbated ischemic limb pathology, including impaired limb perfusion recovery and muscle mitochondrial impairment. Taken together, these findings connect the inflammatory milieu in the CLTI limb to exacerbated limb muscle outcomes via mitochondrial alterations.
Collapse
Affiliation(s)
- Zachary R. Salyers
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Vinicius Mariani
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Nicholas Balestrieri
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Ravi A. Kumar
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Nicholas A. Vugman
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Trace Thome
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Katelyn R. Villani
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Scott A. Berceli
- Department of Surgery, University of Florida, Gainesville, FL
- Malcom Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Salvatore T. Scali
- Department of Surgery, University of Florida, Gainesville, FL
- Malcom Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Georgios Vasilakos
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
| | - Terence E. Ryan
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL
- Center for Exercise Science, University of Florida, Gainesville, FL
- Myology Institute, University of Florida, Gainesville, FL
- Correspondence: Terence E. Ryan, PhD, Department of Applied Physiology and Kinesiology, University of Florida, 1864 Stadium Rd, Gainesville, FL 32611
| |
Collapse
|
7
|
Zhu Mm L, Jiang Mm J. Inconsistent cut-off values of inflammatory indexes in limb ischemia. Vascular 2021; 30:603-604. [PMID: 34114512 DOI: 10.1177/17085381211027436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Lihong Zhu Mm
- Intensive Care Unit, 584020Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Jianping Jiang Mm
- Internal Medicine Department, Pinghu First People's Hospital, Pinghu, Zhejiang, China
| |
Collapse
|