Work

Predictive Performance of Neutrophil-to-Lymphocyte Ratio for Mortality and Amputation Outcomes in Acute Limb Ischemia: A Meta-analysis

Year: 2025

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: BACKGROUND: Acute limb ischemia (ALI) is associated with a high risk of limb loss and mortality, even after surgical intervention. Recent findings suggest the beneficial role of the neutrophil-to-lymphocyte ratio (NLR) in predicting limb amputation and mortality in ALI patients. OBJECTIVES: This current study aims to evaluate the role of NLR in predicting all-cause mortality (ACM) and amputations due to vascular events in patients with ALI. METHODS: A systematic literature search was conducted across several databases. Meta-analysis with a random-effects model was used to quantitatively estimate the pooled odds ratio, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), while a bivariate meta-analysis was used to generate the summary receiver operating characteristic (ROC) curve. RESULTS: Five observational studies met predefined criteria. Patients with high NLR had a 7.5 times higher risk of 30-d and a 3.4 times higher risk of 2-y amputation compared to those with low NLR. The pooled sensitivity for 30-d and 2-y amputation was 81.3% and 71.0%, while the pooled specificity was 73.8% and 63.5%, respectively. For 30-d ACM, patients with high NLR had a nine times higher risk, while the risk was 1.5 times higher for 2-y ACM. The pooled sensitivity for predicting 30-d and 2-y ACM was 81.5% and 58.8%, with pooled specificity of 76.0% and 59.3%, respectively. CONCLUSIONS: NLR is a valuable predictor of short-term outcomes in patients with ALI, with higher predictive performance for 30-d amputation and ACM compared to 2-y outcomes. Its simplicity and availability make it a valuable tool in emergency settings.

Source: Journal of Surgical Research

DOI: 10.1016/j.jss.2025.09.066