Assessing the Predictive Value of the Neutrophil-to-Lymphocyte Ratio for Post-Thrombotic Syndrome following Iliofemoral Deep Venous Thrombosis

Anthony G DeMartino; Devina Chatterjee; Laura De Ravin; Olivia Babick; Anahita Shiva; Nisarg Shah; Khanjan Nagarsheth

doi:10.1016/j.avsg.2024.11.015

Assessing the Predictive Value of the Neutrophil-to-Lymphocyte Ratio for Post-Thrombotic Syndrome following Iliofemoral Deep Venous Thrombosis

Ann Vasc Surg. 2024 Nov 29:111:393-401. doi: 10.1016/j.avsg.2024.11.015. Online ahead of print.

Authors

Anthony G DeMartino¹, Devina Chatterjee², Laura De Ravin², Olivia Babick², Anahita Shiva², Nisarg Shah², Khanjan Nagarsheth³

Affiliations

¹ University of Maryland School of Medicine, Baltimore, MD. Electronic address: [email protected].
² University of Maryland School of Medicine, Baltimore, MD.
³ University of Maryland School of Medicine, Baltimore, MD; Division of Vascular Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD.

PMID: 39617298
DOI: 10.1016/j.avsg.2024.11.015

Abstract

Background: Post-thrombotic syndrome (PTS) is a common complication of deep vein thrombosis (DVT) that occurs in 20-50% of patients and results in a decreased quality of life. Even with the progressive identification of PTS risk factors, clinically useful predictors of PTS continue to be limited, unobjective, and ill-defined. The neutrophil-to-lymphocyte ratio (NLR) is an emerging prognostic biomarker used in a variety of diseases that reflects acute systemic inflammation. This pilot study aimed to evaluate the utility of the NLR at the time of iliofemoral DVT diagnosis in predicting PTS incidence in patients.

Methods: A retrospective chart review was performed on patients identified with iliofemoral DVT at the University of Maryland Medical Center between 2020 and 2022. Patients with at least one follow-up visit between 3 and 6 months after initial DVT diagnosis were included. Diagnosis of PTS was determined based on Villalta Score. The Youden index with receiver operating characteristic curve analysis was used to determine the NLR cut-off value that may be predictive of PTS. A multivariable logistic regression model was then performed to assess the utility of this NLR cut-off value and other common clinical markers in predicting the presence of PTS symptoms.

Results: Four hundred and eighteen patients with positive iliofemoral DVT venous duplex ultrasounds were screened for eligibility. One hundred and eighteen patients were eligible with a mean age of 53.18 ± 15.45 years. A total of 43 patients (36.44%) were found to have PTS. An NLR cut-off of 7.71 was determined with an area under the receiver operating characteristic curve (area under the curve) of 0.63 (P = 0.046). When the NLR was assessed jointly with other clinical markers at the time of DVT diagnosis, NLR was a statistically significant positive predictor, measured using odds ratio (1.83; 95% confidence interval, 1.20-2.78; P = 0.005).

Conclusions: Our study found that when stratified by a determined cutoff value, the NLR at the time of DVT diagnosis was significantly associated with the development of PTS in patients with iliofemoral DVT. This result is consistent with one prior research finding yet is novel in its specificity for iliofemoral DVTs and its acute lab collection for NLR calculation. The NLR should be further investigated as a potential inexpensive prognostic tool to aid in the improvement of treatment and prophylactic strategies for PTS.