Prognostic Value of Neutrophil/Lymphocyte Ratio for Pulmonary Embolism: A Meta-Analysis and External Validation.

Ann Vasc Surg

Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China. Electronic address:

Published: August 2024

AI Article Synopsis

  • The study aimed to analyze and validate the prognostic value of the neutrophil/lymphocyte ratio (NLR) in patients with pulmonary embolism (PE) by pooling data from 15 studies involving 5,874 participants.
  • Findings indicated that a higher NLR was associated with an increased risk of PE, with a pooled risk ratio of 2.33 and moderate evidence quality.
  • Additionally, a prediction model incorporating NLR, age, D-dimer, and PE severity index showed improved predictive power, suggesting NLR's potential for clinical application in assessing PE risk.

Article Abstract

Background: Prognostic value of neutrophil/lymphocyte ratio (NLR) for pulmonary embolism (PE) has been reported in several retrospective studies. The purpose of this investigation was to perform a pooled analysis and external validation of predictive value of NLR.

Methods: PubMed, Embase, and Cochrane databases were searched from inception to November 5, 2022. A random effects model was used. Grade was used to evaluate the certainty of evidence. External validation was conducted in clinical cohorts before and after a propensity scoring matching (PSM). Covariates include basic clinical characteristics, such as age, gender, etc. The value of NLR in prediction model was also evaluated.

Results: A total of 15 studies comprising 5,874 patients were included. Pooled risk ratio of NLR was 2.33 (95% confidence interval [CI]: 1.97-2.75), with an area under the curve of 0.78 (95% CI: 0.74-0.81), a sensitivity of 0.75 (95% CI: 0.71-0.79), a specificity of 0.67 (95% CI: 0.61-0.73), and a median cut-off value of 5.7. Grade of Recommendations Assessment Development and Evaluation (GRADE) certainty analysis showed the quality of the evidence was moderate. Before (n = 336) and after (n = 152) propensity scoring matching, risk ratio of NLR was 2.69 (95% CI: 1.04-6.97) and 6.58 (95% CI: 1.99-17.75). A prediction model consisting of NLR, age, D-dimer, and simplified PE severity index had an area under the curve of 0.809 (95% CI: 0.738-0.88), a sensitivity of 0.638 (95% CI: 0.511-0.745), and a specificity of 0.851 (95% CI: 0.709-0.917). Net reclassification index (12%, P = 0.035) and integrated discrimination improvement (17%, P = 0.022) indicated an improvement caused by NLR.

Conclusions: Prognostic value of NLR for PE was confirmed by meta-analysis and validated in an independent cohort, deserving further clinical application.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.avsg.2024.01.019DOI Listing

Publication Analysis

Top Keywords

external validation
12
ratio nlr
12
95%
9
prognostic neutrophil/lymphocyte
8
neutrophil/lymphocyte ratio
8
pulmonary embolism
8
propensity scoring
8
scoring matching
8
prediction model
8
risk ratio
8

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!