The prognostic value of pre-operative systemic inflammation-based scoring in patients undergoing endovascular repair of AAA

Bradley, N.A., Walter, A., Wilson, A., Siddiqui, T., Roxburgh, C.S.D. , McMillan, D.C. and Guthrie, G.J.K. (2023) The prognostic value of pre-operative systemic inflammation-based scoring in patients undergoing endovascular repair of AAA. Journal of Vascular Surgery, 78(2), 362-369.e2. (doi: 10.1016/j.jvs.2023.04.018) (PMID:37086821)

Abstract

Objectives: Abdominal aortic aneurysm (AAA) is a common condition which is predominantly managed in the UK by endovascular aneurysm repair (EVAR). Activation of the systemic inflammatory response (SIR) appears to offer prognostic value in patients with vascular disease. The present study examines the relationship between the systemic inflammatory response and survival in patients undergoing standard and complex endovascular aneurysm repair (EVAR and F/B-EVAR). Methods: Consecutive patients undergoing elective EVAR and F/B-EVAR were retrospectively identified from three tertiary vascular centres over a 5-year period. Neutrophil:lymphocyte ratio (NLR) and modified Glasgow Prognostic Score (mGPS) were calculated from pre-operative blood results and combined into the systemic inflammatory grade (SIG). The primary outcome was all cause mortality during the follow-up period which was compared between sub-groups of SIG. Results: There were 506 patients included in the final study, with a median (IQR) follow-up of 68.0 (27.3) months, and there were 163 deaths during the follow-up period. Mean (95% CI) survival in the SIG 0 vs. SIG 1 vs. SIG 2 vs. SIG 3 vs. SIG 4 subgroups was 80.7 (76.5 – 85.0) vs. 78.7 (72.7 – 84.7) vs. 61.0 (51.1 - 70.8) vs. 65.1 (45.0 – 85.2) vs. 54.9 (34.4 – 75.3) months (p < 0.05). In the entire cohort, age (p < 0.001), BMI (p <0.05), high creatinine (p <0.05), and SIG (p < 0.05) were associated with survival on univariate analysis, with retained independent association for age (HR 1.72, 95% CI 1.29 – 2.31, p <0.001) and SIG (HR 1.20 95% CI 1.02 – 1.40, p <0.05) on multivariate analysis. Increasing SIG (AUC 0.68, 95% CI 0.58 – 0.78, p <0.01) predicted 1-year mortality. Conclusions: Markers of the systemic inflammatory response such the SIG may be used to identify patients at higher risk of adverse outcome in patients undergoing EVAR and F/B-EVAR for AAA. These findings warrant further investigation in large prospective cohort studies.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Guthrie, Mr Graeme and McMillan, Professor Donald and Bradley, Mr Nicholas and Roxburgh, Professor Campbell
• Authors: Bradley, N.A., Walter, A., Wilson, A., Siddiqui, T., Roxburgh, C.S.D., McMillan, D.C., and Guthrie, G.J.K.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Journal of Vascular Surgery
• Publisher: Elsevier
• ISSN: 0741-5214
• ISSN (Online): 1097-6809
• Published Online: 20 April 2023
• Copyright Holders: Copyright © 2023 Elsevier Inc.
• First Published: First published in Journal of Vascular Surgery 78(2):362-369.e2
• Publisher Policy: Reproduced under a Creative Commons License