Neutrophil-lymphocyte ratio predicts all-cause and cardiovascular mortality in a pan- vascular disease population: a nationally representative study

Background A novel medical specialty, pan-vascular medicine, has recently emerged for atherosclerosis treatment. Its objective is the integrated management of pan-vascular diseases, including coronary artery cerebrovascular, and peripheral artery diseases. This study aimed to examine the correlation between neutrophil-lymphocyte ratio (NLR) and mortality in a population with pan-vascular disease, to assess its predictive value. Methods This retrospective cohort study comprised 1,767 individuals with pan-vascular disease sourced from the NHANES database (2001–2016). Study endpoints were all-cause and cardiovascular mortality. The relationship among NLR, all-cause mortality, and cardiovascular mortality was examined in a population with a broad range of vascular diseases. Weighted Cox regression analyses and restricted cubic spline (RCS) analyses were conducted. Discrepancies in survival rates between the three groups classified according to NLR were investigated using Kaplan-Meier survival analysis. Prognostic accuracy of the NLR model for mortality in the pan-vascular disease population was evaluated using time-dependent receiver operating characteristic curves and calibration curves. Results The median follow-up period for this study was 90 months, during which a total of 832 patients died, including 269 who died of cardiovascular causes. Neutrophil-to-lymphocyte ratio (NLR) was an independent predictor of all-cause mortality [hazard ratio (HR) = 1.13, 95% confidence interval (CI) (1.07–1.20), p < 0.001] and cardiovascular mortality [HR = 1.14, 95% CI (1.05–1.24), p = 0.001] in individuals with pan-vascular disease. RCS analysis indicated a linear association between NLR and all-cause mortality (p-value for nonlinearity = 0.108) and cardiovascular mortality (p-value for nonlinearity = 0.149) in the population with pan-vascular disease. Risk of all-cause mortality and cardiovascular mortality was elevated among individuals with higher levels of NLR. NLR model exhibited favorable predictive efficacy for all-cause mortality and cardiovascular mortality in the pan-vascular disease population. Furthermore, the calibration curve illustrated the high predictive accuracy of the NLR model for all-cause mortality in the pan-vascular disease population at 3 and 5 years. Conclusions NLR is an independent risk factor for cardiovascular mortality and all-cause mortality in pan-vascular disease populations, and is linearly associated with all-cause mortality and cardiovascular mortality in pan-vascular disease populations and has some predictive value.