Prognostic Role of Neutrophil / Lymphocyte Ratio after Transfemoral Aortic Valve Implantation

Introduction: There is a growing need for better risk stratification in patients undergoing TAVI before and after the procedure. Neutrophil-to-lymphocyte ratio (NLR) is an easily available and reliable marker for general immune responses to various stress stimuli. The aim of our study was to assess the value of NLR as a predictor of short and long term adverse events in patients undergoing TAVI.

Methods and Results: A total of 324 patients undergoing TAVI were stratified according to NLR status, and the relationships between the NLR and clinical parameters were analyzed. NLR was found to be superior to other inflammatory biomarkers (hs-CRP, WBC). Therefore, we focused on NLR in our analysis. NLR value of 5.0 was determined best to dichotomies survival data by a modified receiver–operating characteristics curves. Mean follow up time was 862 ± 483 days (range 143-1912 days). In multivariable Cox regression analysis, NLR level >5 on day 3 was the independently correlated and the most predictive marker for all-cause mortality compared with NLR of 5 had higher incidence of complications including in hospital sepsis, cardiogenic shock, respiratory failure, acute kidney injury and stroke.

Conclusions: NLR >5 on day 3 was independently associated with all-cause mortality, complication rate and length of stay compared with NLR of >5 was superior to other inflammatory biomarkers as a predictor of complications and mortality. Hence, it may have a role for risk stratification following TAVI in order to shorten length of stay, reduce complications, and plan for early discharge.