Prediction of Critical Limb Ischemia in Peripheral Arterial Disease by Comparing White Blood Cell to Mean Platelet Volume Ratio, Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio

Background: Peripheral arterial occlusive disease, commonly referred to as peripheral arterial disease or peripheral vascular disease refer to the obstruction or deterioration of arteries other than those supplying the heart and within the brain. Peripheral arterial disease(PAD) is common and includes arterial part of vascular system except intra cranial and coronary arteries. Atherosclerosis is the main cause of PAD. Incidence of symptomatic PAD increases with age from approximately 0.3% per year for men aged 40 to 55 years to approximately 1% per year for men older than 75 years. Method: The study was carried out in the department of general surgery, Swaroop Rani Nehru hospital, Prayagraj. Study setting All consecutive patients visiting the CTVS, plastic surgery and general surgery OPDs were selected who were fulfilling the criteria. Results: The Sensitivity of PLR, WMR and NLR was 95.65%, 93.48% and 89.13% respectively and the Specificity of PLR, WMR and NLR was 78.57%, 57.14% and 92.86% respectively for diagnosing PAOD. NLR, PLR, WMR had significant discriminatory power to predict critical limb ischemia. WMR (AUC 0.829; 95% CI: 0.690 to 0.924) was excellent and discriminatory power of NLR (AUC 0.788; 95% CI: 0.642 to 0.894) and PLR (AUC 0.793; 95% CI: 0.648 to 0.898) was acceptable. Conclusion: NLR, PLR, and WMR have significant discriminatory power to predict peripheral arterial disease and critical limb ischemia. Among all the parameters, platelet lymphocyte ratio is the best predictor of peripheral arterial disease. The sensitivity and specificity of all markers were comparable in terms of assessing CLI.