Impact of the neutrophil/lymphocyte ratio on the prognosis of short term outcomes in acute aortic dissection patients: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

JI Hongyu , MENG Fanhua , LI Huayin , GUO Feiyan , SUBINUER Jureti ,  FU Zhenyan , MA Yitong

1. Xinjiang Medical University, Urumqi 830011, P.R.China;
2. The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, P.R.China;

Corresponding author：

FU Zhenyan, Email: fuzhenyan316@126.com

Keywords：

Acute aortic dissection; Neutrophil to lymphocyte ratio; Prognosis; Meta-analysis

DOI：

10.7507/1672-2531.202107199

Video：

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Objective To systematically review the relationship between the neutrophil to lymphocyte ratio (NLR) and the short-term prognosis of patients with acute aortic dissection. Method Databases including PubMed, Web of Science, CNKI, CBM, and WanFang Data were electronically searched to collect studies on the prognosis associated with neutrophil/lymphocyte ratio and acute aortic dissection from inception to July 2021. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 10 case-control studies involving 1 638 patients were included. The results of meta-analysis revealed that the in-hospital mortality group of patients with acute aortic dissection had higher NLR levels than the survival group (MD=4.94, 95%CI 2.67 to 7.61, P<0.0001). In patients with acute aortic dissection, there was no statistical difference in in-hospital mortality between the low NLR group and the high NLR group (OR=3.03, 95%CI 1.00 to 9.15, P=0.05). Conclusion Patients with acute aortic dissection who died in hospital shows higher NLR levels than those who survived. However, due to the quantity and quality of included studies, the above conclusions are needed to be verified by more high-quality studies.

Citation： JI Hongyu, MENG Fanhua, LI Huayin, GUO Feiyan, SUBINUER Jureti, FU Zhenyan, MA Yitong. Impact of the neutrophil/lymphocyte ratio on the prognosis of short term outcomes in acute aortic dissection patients: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2022, 22(1): 67-72. doi: 10.7507/1672-2531.202107199 Copy

1.	Nienaber CA, Clough RE, Sakalihasan N, et al. Aortic dissection. Nat Rev Dis Primers, 2016, 2: 16053.
2.	Cheng Y, Jin M, Dong X, et al. Mechanism and early intervention research on ALI during emergence surgery of Stanford type-A AAD: study protocol for a prospective, double-blind, clinical trial. Medicine (Baltimore), 2016, 95(42): e5164.
3.	Wang Y, Tan X, Gao H, et al. Magnitude of soluble ST2 as a novel biomarker for acute aortic dissection. Circulation, 2018, 137(3): 259-269.
4.	Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies. Circulation, 2003, 108(5): 628-635.
5.	Suzuki T, Eagle KA. Biomarker-assisted diagnosis of acute aortic dissection. Circulation, 2018, 137(3): 270-272.
6.	Li S, Yang J, Dong J, et al. Neutrophil to lymphocyte ratio and fibrinogen values in predicting patients with type B aortic dissection. Sci Rep, 2021, 11(1): 11366.
7.	Sakakura K, Kubo N, Ako J, et al. Peak C-reactive protein level predicts long-term outcomes in type B acute aortic dissection. Hypertension, 2010, 55(2): 422-429.
8.	Guasti L, Dentali F, Castiglioni L, et al. Neutrophils and clinical outcomes in patients with acute coronary syndromes and/or cardiac revascularisation. a systematic review on more than 34, 000 subjects. Thromb Haemost, 2011, 106(4): 591-599.
9.	Wen D, Du X, Dong JZ, et al. Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection. Heart, 2013, 99(16): 1192-1197.
10.	Di Credico G. The International Registry of Acute Aortic Dissection (IRAD): new insights on aortic dissection. Ital Heart J Suppl, 2000, 1(7): 943-944.
11.	Sbarouni E, Georgiadou P, Analitis A, et al. High neutrophil to lymphocyte ratio in type A acute aortic dissection facilitates diagnosis and predicts worse outcome. Expert Rev Mol Diagn, 2015, 15(7): 965-970.
12.	Afari ME, Bhat T. Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update. Expert Rev Cardiovasc Ther, 2016, 14(5): 573-577.
13.	Wells GA, Shea B, O’Connell D, et al. The newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses, 2000. Available at: https://www.ohri.ca/programs/clinical_ epidemiology/oxford.asp.
14.	Oz K, Iyigun T, Karaman Z, et al. Prognostic value of neutrophil to lymphocyte ratio and risk factors for mortality in patients with stanford type A aortic dissection. Heart Surg Forum, 2017, 20(3): E119-E123.
15.	Onuk T, Güngör B, Karataş B, et al. Increased neutrophil to lymphocyte ratio is associated with in-hospital mortality in patients with aortic dissection. Clin Lab, 2015, 61(9): 1275-1282.
16.	Bedel C, Selvi F. Association of platelet to lymphocyte and neutrophil to lymphocyte ratios with in-hospital mortality in patients with type A acute aortic dissection. Braz J Cardiovasc Surg, 2019, 34(6): 694-698.
17.	Karakoyun S, Gürsoy MO, Akgün T, et al. Neutrophil-lymphocyte ratio may predict in-hospital mortality in patients with acute type A aortic dissection. Herz, 2015, 40(4): 716-721.
18.	Lafçi G, Ciçek ÖF, Uzun HA, et al. Relationship of admission neutrophil-to-lymphocyte ratio with in-hospital mortality in patients with acute type I aortic dissection. Turk J Med Sci, 2014, 44(2): 186-192.
19.	Erdolu B, As AK. C-Reactive protein and neutrophil to lymphocyte ratio values in predicting inhospital death in patients with stanford type A acute aortic dissection. Heart Surg Forum, 2020, 23(4): E488-E492.
20.	严赖莎, 赵顺英, 胡晓燕. 急性主动脉夹层患者中性粒细胞/淋巴细胞比值与院内死亡的相关性研究. 浙江医学, 2019, 41(1): 71-74.
21.	Kalkan ME, Kalkan AK, Gündeş A, et al. Neutrophil to lymphocyte ratio: a novel marker for predicting hospital mortality of patients with acute type A aortic dissection. Perfusion, 2017, 32(4): 321-327.
22.	王媛, 柯兵兵, 王雪, 等. 中性粒细胞与淋巴细胞比值对主动脉夹层患者院内不良事件的预测价值. 中国医药, 2019, 14(6): 838-841.
23.	姜海军, 赵博, 霍静, 等. 中性粒细胞/淋巴细胞比值对急性Stanford B型主动脉夹层患者胸主动脉腔内修复术后疗效的预测价值. 中国医药, 2019, 14(1): 41-45.
24.	Itagaki R, Kimura N, Mieno M, et al. Characteristics and treatment outcomes of acute type A aortic dissection with elevated D-dimer concentration. J Am Heart Assoc, 2018, 7(14): e009144.
25.	Fukui T. Management of acute aortic dissection and thoracic aortic rupture. J Intensive Care, 2018, 6: 15.
26.	Baliga RR, Nienaber CA, Bossone E, et al. The role of imaging in aortic dissection and related syndromes. JACC Cardiovasc Imaging, 2014, 7(4): 406-424.
27.	Kordzadeh A, Malietzis G, Browne T, et al. Neutrophil to lymphocyte ratio (NLR) of five predicts 30-day morbidity in ruptured abdominal aortic aneurysms (rAAA): a retrospective cohort study. Int J Surg, 2015, 15: 45-48.
28.	Zhu H, Zhang L, Liang T, et al. Elevated preoperative neutrophil-to-lymphocyte ratio predicts early adverse outcomes in uncomplicated type B aortic dissection undergoing TEVAR. BMC Cardiovasc Disord, 2021, 21(1): 95.
29.	Xu Y, Fang H, Qiu Z, et al. Prognostic role of neutrophil-to-lymphocyte ratio in aortic disease: a meta-analysis of observational studies. J Cardiothorac Surg, 2020, 15(1): 215.
30.	Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst, 2014, 106(6): dju124.

1. Nienaber CA, Clough RE, Sakalihasan N, et al. Aortic dissection. Nat Rev Dis Primers, 2016, 2: 16053.
2. Cheng Y, Jin M, Dong X, et al. Mechanism and early intervention research on ALI during emergence surgery of Stanford type-A AAD: study protocol for a prospective, double-blind, clinical trial. Medicine (Baltimore), 2016, 95(42): e5164.
3. Wang Y, Tan X, Gao H, et al. Magnitude of soluble ST2 as a novel biomarker for acute aortic dissection. Circulation, 2018, 137(3): 259-269.
4. Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies. Circulation, 2003, 108(5): 628-635.
5. Suzuki T, Eagle KA. Biomarker-assisted diagnosis of acute aortic dissection. Circulation, 2018, 137(3): 270-272.
6. Li S, Yang J, Dong J, et al. Neutrophil to lymphocyte ratio and fibrinogen values in predicting patients with type B aortic dissection. Sci Rep, 2021, 11(1): 11366.
7. Sakakura K, Kubo N, Ako J, et al. Peak C-reactive protein level predicts long-term outcomes in type B acute aortic dissection. Hypertension, 2010, 55(2): 422-429.
8. Guasti L, Dentali F, Castiglioni L, et al. Neutrophils and clinical outcomes in patients with acute coronary syndromes and/or cardiac revascularisation. a systematic review on more than 34, 000 subjects. Thromb Haemost, 2011, 106(4): 591-599.
9. Wen D, Du X, Dong JZ, et al. Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection. Heart, 2013, 99(16): 1192-1197.
10. Di Credico G. The International Registry of Acute Aortic Dissection (IRAD): new insights on aortic dissection. Ital Heart J Suppl, 2000, 1(7): 943-944.
11. Sbarouni E, Georgiadou P, Analitis A, et al. High neutrophil to lymphocyte ratio in type A acute aortic dissection facilitates diagnosis and predicts worse outcome. Expert Rev Mol Diagn, 2015, 15(7): 965-970.
12. Afari ME, Bhat T. Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update. Expert Rev Cardiovasc Ther, 2016, 14(5): 573-577.
13. Wells GA, Shea B, O’Connell D, et al. The newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses, 2000. Available at: https://www.ohri.ca/programs/clinical_ epidemiology/oxford.asp.
14. Oz K, Iyigun T, Karaman Z, et al. Prognostic value of neutrophil to lymphocyte ratio and risk factors for mortality in patients with stanford type A aortic dissection. Heart Surg Forum, 2017, 20(3): E119-E123.
15. Onuk T, Güngör B, Karataş B, et al. Increased neutrophil to lymphocyte ratio is associated with in-hospital mortality in patients with aortic dissection. Clin Lab, 2015, 61(9): 1275-1282.
16. Bedel C, Selvi F. Association of platelet to lymphocyte and neutrophil to lymphocyte ratios with in-hospital mortality in patients with type A acute aortic dissection. Braz J Cardiovasc Surg, 2019, 34(6): 694-698.
17. Karakoyun S, Gürsoy MO, Akgün T, et al. Neutrophil-lymphocyte ratio may predict in-hospital mortality in patients with acute type A aortic dissection. Herz, 2015, 40(4): 716-721.
18. Lafçi G, Ciçek ÖF, Uzun HA, et al. Relationship of admission neutrophil-to-lymphocyte ratio with in-hospital mortality in patients with acute type I aortic dissection. Turk J Med Sci, 2014, 44(2): 186-192.
19. Erdolu B, As AK. C-Reactive protein and neutrophil to lymphocyte ratio values in predicting inhospital death in patients with stanford type A acute aortic dissection. Heart Surg Forum, 2020, 23(4): E488-E492.
20. 严赖莎, 赵顺英, 胡晓燕. 急性主动脉夹层患者中性粒细胞/淋巴细胞比值与院内死亡的相关性研究. 浙江医学, 2019, 41(1): 71-74.
21. Kalkan ME, Kalkan AK, Gündeş A, et al. Neutrophil to lymphocyte ratio: a novel marker for predicting hospital mortality of patients with acute type A aortic dissection. Perfusion, 2017, 32(4): 321-327.
22. 王媛, 柯兵兵, 王雪, 等. 中性粒细胞与淋巴细胞比值对主动脉夹层患者院内不良事件的预测价值. 中国医药, 2019, 14(6): 838-841.
23. 姜海军, 赵博, 霍静, 等. 中性粒细胞/淋巴细胞比值对急性Stanford B型主动脉夹层患者胸主动脉腔内修复术后疗效的预测价值. 中国医药, 2019, 14(1): 41-45.
24. Itagaki R, Kimura N, Mieno M, et al. Characteristics and treatment outcomes of acute type A aortic dissection with elevated D-dimer concentration. J Am Heart Assoc, 2018, 7(14): e009144.
25. Fukui T. Management of acute aortic dissection and thoracic aortic rupture. J Intensive Care, 2018, 6: 15.
26. Baliga RR, Nienaber CA, Bossone E, et al. The role of imaging in aortic dissection and related syndromes. JACC Cardiovasc Imaging, 2014, 7(4): 406-424.
27. Kordzadeh A, Malietzis G, Browne T, et al. Neutrophil to lymphocyte ratio (NLR) of five predicts 30-day morbidity in ruptured abdominal aortic aneurysms (rAAA): a retrospective cohort study. Int J Surg, 2015, 15: 45-48.
28. Zhu H, Zhang L, Liang T, et al. Elevated preoperative neutrophil-to-lymphocyte ratio predicts early adverse outcomes in uncomplicated type B aortic dissection undergoing TEVAR. BMC Cardiovasc Disord, 2021, 21(1): 95.
29. Xu Y, Fang H, Qiu Z, et al. Prognostic role of neutrophil-to-lymphocyte ratio in aortic disease: a meta-analysis of observational studies. J Cardiothorac Surg, 2020, 15(1): 215.
30. Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst, 2014, 106(6): dju124.

Chinese Journal of Evidence-Based Medicine

Impact of the neutrophil/lymphocyte ratio on the prognosis of short term outcomes in acute aortic dissection patients: a meta-analysis

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