# Neutrophil-to-Lymphocyte Ratio as Potential Marker of Outcome After Standard EVAR

## TL;DR

The study shows that a high neutrophil-to-lymphocyte ratio (NLR) is linked to worse long-term outcomes after endovascular aneurysm repair (EVAR) surgery.

## Contribution

This study is the first to demonstrate that preoperative NLR is a marker for long-term mortality after EVAR.

## Key findings

- Patients with NLR > 5 had higher aneurysm diameters and longer ICU and hospital stays.
- Higher NLR was significantly associated with lower long-term survival rates.
- NLR did not affect immediate surgical outcomes like endograft occlusion or endoleaks.

## Abstract

Introduction: The neutrophil–lymphocyte ratio (NLR) has proven to be an inexpensive and easily available inflammatory marker for cardiovascular disease. The aim of the present study is to evaluate a possible association between preoperative NLR value and endovascular aneurysm repair (EVAR) outcomes. Methods: A multicentric retrospective study of patients undergoing EVAR in elective setting between 2015 and 2023 was performed. Preoperative NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count, and a cut-off of 5 was used as threshold for the analysis. Primary outcomes (technical success, endograft occlusion, AAA-related reintervention, endoleaks, and mortality rates) were compared between the NLR < 5 and the NLR > 5 group. Kaplan–Meier survival analysis was employed to assess overall survival and the incidence of long-term complications. Results: The study initially considered 1360 patients. Eventually, 823 patients were included in the study, of whom 129 (15.7%) with NLR > 5. The latter group presented a higher AAA diameter (59.1 mm vs. 55, mm; p = 0.004). Technical success was obtained in 98,9% of all enrolled patients. NLR values were significantly associated with ASA class (p = 0.014), involvement of the iliac arteries (p = 0.023), duration of ICU stays (p < 0.001), and overall length of hospitalization (<0.001). At Kaplan–Meier analysis, patient with NLR > 5 showed a significant lower survival rates (p = 0.006), while no significant differences were found in terms of endograft occlusion (p = 0.45), AAA-related reintervention (p = 0.63), and endoleaks (p = 0.49). Conclusions: This study highlights the association between the NLR value and an elevated risk of long-term mortality, highlighting its role as an indicator of the patient’s overall clinical condition rather than immediate surgical outcomes. Focusing on this selected group of patients can improve postoperative care and reduce long-term complications.