High Neutrophil-to-Lymphocyte Ratio as an Inflammatory Biomarker, is Associated with Neurological Symptoms in Carotid Artery Disease

Abstract

Introduction: Inflammation plays an important role in the pathogenesis of atherosclerosis. The neutrophil to lymphocyte ratio (NLR) is a marker of systemic inflammation that has been related to cardiovascular mortality in patients with lower limb ischemia. Our aim is to study the presence of differences in the inflammatory burden measured by the NLR, in patients undergoing carotid revascularization according to their clinical presentation. Methods: Retrospective analysis of 280 patients undergoing carotid revascularization during the last 5 years was performed. The study population was stratified according to the symptomatology into two groups: asymptomatic and symptomatic. Epidemiological and analytical data were registered in all patients. A preoperative blood sample were obtained up to 7 days, before surgical procedure, for the NLR assessment. We compared cardiovascular, epidemiological risk factors and NLR between both groups. Continuous variables without normal distribution were analyzed using the Mann–Whitney U-test and for categorical variables the χ2 test. Multivariate logistic regression was used to analyze the presence of independent significant factors related to carotid symptoms. Results: There were no statistically significant differences between both groups regarding cardiovascular and epidemiological risk factors. The NLR was significantly higher in the symptomatic group (2.87 vs. 2.34 p<0.001). Treatment with statins (OR: 0.461; 95% CI: 0.267-0.793) and antiplatelet drugs (OR: 0.236, 95% CI: 0.132-0.422), were inversely associated with the presence of symptoms in the univariate regression analysis, while the level of NLR was associated with the presence of symptoms (OR: 1.372; 95% CI: 1.131-1.665). In the multivariate logistic regression analysis, an inverse association was confirmed between presence of symptoms and antiplatelet therapy (OR: 0.29; 95% CI: 0.155-0.544). NLR burden were significantly associated to the presence of neurological symptoms after multivariate adjustment (OR: 1.53, 95% CI: 1.240-1.898). Conclusion: The NLR is an independent risk factor significantly associated with the presence of symptoms in the carotid stenosis and could be used as an inflammatory marker predictor of neurological symptoms in prospective studies.