O-215 - THE EFFECT OF THE PRE-OPERATIVE SYSTEMIC INFLAMMATORY RESPONSE ON OUTCOMES FOLLOWING CAROTID ENDARTERECTOMY FOR SYMPTOMATIC CAROTID STENOSIS

TOPIC:
Other
AUTHORS:
Dosanj K. (Foundation Programme Doctor, NHS Tayside ~ Dundee ~ United Kingdom) , Bradley N. (Clinical Research Fellow, University of Glasgow ~ Glasgow ~ United Kingdom) , Roxburgh C. (Senior Clinical Lecturer, University of Glasgow ~ Glasgow ~ United Kingdom) , Mcmillan D. (Professor of Surgical Sciences, University of Glasgow ~ Glasgow ~ United Kingdom) , Guthrie G. (Honorary Clinical Senior Lecturer, University of Glasgow ~ Glasgow ~ United Kingdom)
Introduction:
Stroke accounts for over 100,00 acute hospital presentations per year in the United Kingdom (UK), and approximately 4500 carotid endarterectomies are performed annually in the UK[1]. This is despite a relative paucity of cases performed for asymptomatic carotid stenosis, in comparison to other countries[1]. Periprocedural stroke and death rates have fallen in recent years[2], though remain a significant risk necessitating careful patient selection and counselling. Chronic activation of the systemic inflammatory response (SIR) is prevalent in patients with atherosclerotic disease and influences both the pathogenesis and prognosis[3], [4]. The neutrophil:lymphocyte and platelet:lymphocyte ratios (NLR, PLR) are markers of the SIR, and are reported to provide prognostic value in patients with acute stroke[5], and in patients undergoing carotid endarterectomy[6]. The Modified Glasgow Prognostic Score (mGPS) is calculated from C-reactive protein (CRP) and albumin and was originally described in patients with cancer[7]. More recently mGPS has been shown to provide prognostic value in non-cancer patient groups[8]. mGPS is representative of an alternative pathway activating the SIR and is not reported in relation to carotid endarterectomy outcomes. The present study describes our experience of the prognostic value of these pre-operative markers of SIR in patients undergoing carotid endarterectomy.
Methods:
This single centre study retrospectively identified patients undergoing carotid endarterectomy over a 5-year period. Patients undergoing carotid endarterectomy for symptomatic carotid stenosis were included. NLR, PLR, and mGPS were calculated from pre-operative blood tests. NLR values of 3.0 and 5.0 were used to subgroup patients in keeping with established cutoff values[9]. PLR was analysed as a continuous variable. mGPS values range from 0 - 2 and outcomes were compared between these groups. The primary outcome was overall mortality during the follow-up period, and the secondary outcome was 30-day post-operative stroke. Survival analyses were carried out using Kaplan-Meier curves and Cox proportional hazards models, with significant univariate covariates included in multivariate analysis. Binary logistic regression was used to assess the predictive value of covariates on 30-day stroke rate. Statistical analyses were performed using IBM SPSS v28.0. p values < 0.05 were considered statistically significant.
Results:
There were 171 eligible patients included in analysis. The median follow-up was 32.0 months, and all patients completed a minimum of 12.0 months follow-up. Mean (95% CI) survival in the entire study population was 60.2 (56.1 - 64.2) months. There was no significant difference in survival between subgroups of NLR (< 3.0 / 3.0 - 5.0 / > 5.0) (p > 0.05). Mean (95% CI) survival in the mGPS 0 / 1 / 2 subgroups was 63.2 (59.2 - 67.1) vs. 50.9 (40.6 - 61.3) vs. 30.6 (24.0 - 37.3) months (p < 0.05). Increasing mGPS score (HR 2.32, 95% CI 1.18 - 4.59, p < 0.05) and history of ischaemic heart disease (HR 3.81, 95% CI 1.66 - 8.74, p < 0.01) were associated with inferior survival on univariate analysis. NLR, PLR, and other covariates were not associated with survival (p > 0.05 for all comparisons). On multivariate analysis only mGPS (HR 2.17, 95% CI 1.06 - 4.47, p < 0.05) was associated with inferior survival. 30-day stroke rate was 2.4%. mGPS, NLR, and PLR were not associated with increased rate of 30-day stroke (p > 0.05 for all comparisons).
Conclusion:
The present study reports the prognostic value of mGPS in relation to post-operative survival following carotid endarterectomy for symptomatic carotid stenosis. In contrast to other authors[6], our results do not support NLR or PLR as prognostic factors in this patient group. The differing roles of neutrophils, platelets, and CRP in activation of the SIR may explain these findings. Our results support the growing body of evidence for the use of mGPS as a clinical prognostication tool in a range of conditions. Further characterisation of inflammatory pathways in patients with atherosclerotic disease is required to identify novel targets for therapeutic intervention.
References:
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