A Systematic Review on the Role of Neutrophil to Lymphocyte Ratio in Limb Ischemia

Background: Limb ischemia is a severe vascular condition that can lead to critical complications, endangering both limbs and lives. The goal of this research was to explore the role of neutrophil to lymphocyte ratio (NLR) in limb ischemia.

Methods: From inception to June 8, 2022, PubMed/MEDLINE, Institute for Scientific Information Web of Science, and Scopus were searched for articles comparing NLR in limb ischemia to healthy individuals.

Results: Finally, a total of 23 studies were included in the review. There was a direct link between NLR and critical limb ischemia (CLI) development in peripheral arterial disease patients. Elevated NLR levels predict a higher risk of CLI among peripheral arterial disease patients. Also, it was concluded that NLR is a dependable predictor of survival in patients with limb ischemia, and higher NLR readings are linked to decreased survival rates. Moreover, the risk of amputation is related to the level of NLR in CLI patients. However, based on the data, NLR is not a reliable indicator of sarcopenia in CLI patients. More research is needed to determine the relationship between NLR and response to treatment in CLI patients. Also, we recommend investigating the effect of each treatment on NLR level in these patients.

Conclusions: Our results provide evidence that NLR level is associated with risk of amputation and mortality in patients with limb ischemia. It is a promising biomarker that can be easily incorporated into clinical practice to assist in the prediction and prevention of CLI.