Neutrophil–Lymphocyte Ratio as a Predictor of Venous Thromboembolism after Total Knee Replacement

Won-Woo Seo; Myung-Soo Park; Sung Eun Kim; Jun-Hee Lee; Dae-Gyun Park; Kyoo-Rok Han; Dong-Jin Oh; Min-Su Hyon

doi:10.1055/s-0039-1694043

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2021; 34(02): 171-177
DOI: 10.1055/s-0039-1694043

Original Article

Neutrophil–Lymphocyte Ratio as a Predictor of Venous Thromboembolism after Total Knee Replacement

Won-Woo Seo

¹Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea

²Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea

³Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, South Korea

,

Myung-Soo Park

²Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea

⁴Division of Cardiology, Dongtan Sacred Heart Hospital, Dongtan, South Korea

,

Sung Eun Kim

¹Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea

²Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea

,

Jun-Hee Lee

¹Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea

²Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea

,

Dae-Gyun Park

¹Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea

²Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea

,

Kyoo-Rok Han

¹Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea

²Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea

,

Dong-Jin Oh

¹Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea

²Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea

,

Min-Su Hyon

³Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, South Korea

⁵Division of Cardiology, Soonchunhyang University Hospital, Seoul, South Korea

› Author Affiliations

Abstract

Venous thromboembolism (VTE) is a potentially serious complication after total knee replacement (TKR), and recent guideline recommends thromboprophylaxis for VTE after TKR. The neutrophil–lymphocyte ratio (NLR) has emerged as a simple and new prognostic biomarker for several cardiovascular diseases. This study was performed to investigate the precise incidence of postoperative VTE and the role of NLR for predicting VTE in patients receiving thromboprophylaxis after TKR. We retrospectively enrolled 264 patients undergoing TKR who underwent routine screening enhanced pulmonary artery and lower extremity venography computed tomography (CT) scan within 7 postoperative days. Biochemical tests were performed within 2 weeks prior to surgery, and the NLR was defined as the absolute neutrophil count in peripheral blood divided by lymphocyte count. All patients received thromboprophylaxis with enoxaparin postoperatively. Of 264 patients, 102 (38.6%) were diagnosed with deep vein thrombosis (DVT) or pulmonary embolism on CT scan. Preoperative NLR was significantly higher in patients with postoperative VTE compared with that in patients without VTE (2.57 ± 1.59 vs. 2.11 ± 1.10, p = 0.011). Receiver operating characteristic curve analysis showed that a preoperative NLR of 1.90 was the best cutoff value for the prediction of postoperative VTE (sensitivity 57.8%, specificity 55.6%, and area under curve 0.589). In the multivariate analysis, a preoperative NLR ≥1.90 was a sole independent predictor of postoperative VTE (odds ratio: 1.95, 95% computed tomography: 1.16–3.31, p = 0.013). The present study shows a higher incidence of VTE (38.6%) after TKR in patients receiving thromboprophylaxis than that reported in previous studies. Furthermore, preoperative NLR was significantly higher in patients with postoperative VTE, and a high preoperative NLR (≥1.90) was an independent predictor of VTE after TKR. NLR measurement may be a simple and useful method for the prediction of VTE in patients undergoing TKR.

Keywords

neutrophil–lymphocyte ratio - venous thromboembolism - total knee replacement

Full Text

References

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