Korean Circ J.  2016 Sep;46(5):699-705. 10.4070/kcj.2016.46.5.699.

Association of Neutrophil/Lymphocyte Ratio with Plaque Morphology in Patients with Asymptomatic Intermediate Carotid Artery Stenosis

Affiliations
  • 1Clinic of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey. drisayuksel2@hotmail.com
  • 2Clinic of Neurology, Antalya Education and Research Hospital, Antalya, Turkey.
  • 3Clinic of Radiology, Antalya Education and Research Hospital, Antalya, Turkey.
  • 4Clinic of Cardiology, Türkiye Yüksek Ä°htisas Education and Research Hospital, Ankara, Turkey.
  • 5Department of Cardiology, Medipol University Faculty of Medicine, Istanbul, Turkey.

Abstract

BACKGROUND AND OBJECTIVES
Non-calcified carotid plaques are more unstable than calcified plaques, and they are associated with a higher risk of rupture, thromboembolism, and consequently, stroke. The purpose of the present study is to compare calcified and non-calcified plaques that cause intermediate carotid artery stenosis with respect to neutrophil/lymphocyte ratio (NLR).
SUBJECTS AND METHODS
A total number of 139 asymptomatic patients with 50-70% stenosis of the carotid artery were included in this study. Carotid Doppler ultrasound imaging and computed tomography angiography were performed to divide the carotid artery plaques into two groups as calcified and non-calcified. Patients included in the calcified (n=73) and non-calcified (n=66) plaque groups were compared with respect to total neutrophil count, lymphocyte count and NLR.
RESULTS
Total lymphocyte count was statistically significantly lower in the non-calcified plaque group compared to the calcified plaque group (total lymphocyte count in non-calcified/calcified plaque groups [103/mm3]: 2.1/2.3, respectively) (p=0.002). NLR was statistically significantly higher in the non-calcified plaque group compared to the calcified plaque group (NLR in non-calcified/calcified plaque groups: 2.6/2.1, respectively) (p<0.001). The cut-off value for NLR was found to be >2.54. Multivariate regression analysis showed that NLR was independently associated with non-calcified carotid artery plaques (odds ratio 5.686, 95% CI 2.498-12.944, p<0.001).
CONCLUSIONS
NLR is increased in the presence of non-calcified carotid artery plaques that cause asymptomatic intermediate stenosis. Increased NLR can be used as a marker to assess the risk of rupture of non-calcified carotid artery plaques.

Keyword

Atherosclerosis; Carotid artery stenosis; Neutrophil, lymphocyte, ratio; Atherosclerotic plaque; Stroke

MeSH Terms

Angiography
Atherosclerosis
Carotid Arteries*
Carotid Stenosis*
Constriction, Pathologic
Humans
Lymphocyte Count
Neutrophils
Plaque, Atherosclerotic
Rupture
Stroke
Thromboembolism
Ultrasonography, Doppler

Figure

  • Fig. 1 Study participants. NSAID : nonsteroidal antiinflammatory drug.

  • Fig. 2 Comparison of NLR between the two groups demonstrated that it was statistically significantly higher in the non-calcified plaque group (p<0.001). NLR: neutrophil/lymphocyte ratio.

  • Fig. 3 In ROC curve analysis, NLR cut-off value of >2.54 was found for calcified-non calcified plaque discrimination among carotid arteries plaques which caused intermediate obstruction. NLR: neutrophil/lymphocyte ratio, AUC: area under curre.


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