Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predict in-hospital mortality in symptomatic but unruptured abdominal aortic aneurysm patients

Background: Symptomatic but unruptured abdominal aortic aneurysm (AAA) is a potentially fatal disease since its etiopathogenesis, involving acute changes in the aortic wall, including inflammation, increasing the probability of impending rupture. The objective of the present study was to assess the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) in patients undergoing urgent symptomatic AAA repair. Methods: This was a retrospective study including 29 patients with symptomatic AAA repaired between 2011 and 2020. Both NLR and PLR were calculated on hospital admission prior to the intervention. The primary end point was in-hospital mortality, and the secondary end point included length of hospital stay and postoperative complications. Results: In-hospital mortality rate was 10.3%. The discriminatory performance to predict the primary end point was very good both for PLR (area under the ROC curve [AUC]: 0.92 (95% confidence interval [CI]: 0.82-1.00; P=0.02) and NLR (AUC: 0.88 [95% CI: 0.75-1.00]; P=0.04). The best cutoff point to predict in-hospital mortality was 185 for PLR (100% sensitivity and 85% specificity) and 6.4 for NLR (100% sensitivity and 77% specificity). The most frequent postoperative complication was acute kidney failure (37.9%). Both elevated PLR as NLR were significantly associated with acute kidney failure and multiorgan failure in the immediate postoperative period (P 0.01). None of the two ratios was associated with length of hospital stay (P=NS). Conclusions: Both PLR and NLR are low-cost inflammatory markers widely available in every emergency department, with excellent performance to predict in-hospital mortality in patients undergoing symptomatic AAA repair. Patients with a PLR 185 and/or an NLR>6.4 could benefit from a "surveyed waiting conduct" improving the preoperative clinical condition prior to the intervention, or even considering endovascular repair.