3rd year internal medicine resident Tampa, Florida, United States
Background: Transcatheter aortic valve replacement (TAVR) has become an established treatment for aortic stenosis. Nevertheless, predicting post-procedural complications remains challenging. Over recent years the utilization of inflammatory biomarkers as potential predictors for risk stratification of cardiovascular patients has become a topic of growing interest. Among these, the neutrophil-to-lymphocyte ratio (NLR) has emerged as a promising candidate, although its prognostic value in TAVR patients remains unclear. This study aimed to evaluate the association between pre-procedural NLR and adverse outcomes following TAVR.
METHODS AND RESULTS: We conducted a systematic search of PubMed, Embase, Scopus, Web of Science, and Cochrane Library up to January 1, 2025. Studies evaluating pre-procedural NLR in relation to post-TAVR complications were included. Random-effect model (DerSimonian–Laird method) was used to pool the most adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). A total of 10 studies comprising 9,898 patients were included, with 8 contributing to the meta-analysis. Elevated NLR (compared to lower NLR) was associated with increased all-cause mortality (HR: 1.22, 95% CI: 1.06-1.41, I2: 60%) and a higher risk of major adverse cardiovascular events (MACE) (HR: 1.72, 95% CI: 1.20-2.47, I2: 0%). Furthermore, it was noticed that each unit increase in NLR was associated with a 22% higher risk of mortality (HR: 1.22, 95% CI: 1.11–1.33, I²: 31%) and a 16% increased risk of MACE (HR: 1.16, 95% CI: 1.01-1.33, I2: 66%). No significant association was observed between higher NLR levels and hospital readmission following TAVR (HR: 1.03, 95% CI: 0.86-1.24, P: 0.72, I2: 55%).
Conclusion: Our findings underscore the prognostic value of pre-procedural NLR in predicting adverse outcomes, particularly mortality and MACE, in TAVR patients. Given its availability and cost-effectiveness, incorporating NLR into routine pre-TAVR assessments may enhance risk stratification and facilitate the identification of high-risk patients.
