{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T20:49:10Z","timestamp":1790023750719,"version":"4.0.1"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Aortic dissection (AD) is a highly fatal cardiovascular condition, with mortality exceeding 50% within the first 24\u2005h and postoperative mortality approaching 30%. Inflammatory mechanisms have been implicated in AD pathogenesis, but the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) remains uncertain. This study aimed to synthesize available evidence on NLR as a predictor of adverse outcomes in AD and to inform hypotheses for future research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA 2020 guidance, a systematic search was conducted in Web of Science, PubMed, Embase, and the Cochrane Library through December 2024. Study selection, data extraction, and quality assessment were performed independently by two reviewers. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random-effects model. Heterogeneity and potential bias were evaluated via subgroup analyses, sensitivity testing, and Egger's regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eleven studies (12 comparative groups) comprising 1,792 patients were included (one publication reported two independent cohorts). Eelevated NLR was associated with increased mortality risk (pooled OR\u2009=\u20091.16, 95% CI: 1.05\u20131.27,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002). This association was significant in cohort studies (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0005) but not in case-control studies (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.28). The result remained robust in leave-one-out sensitivity analyses. Substantial publication bias was detected (Egger's\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.0001). In patients with uncomplicated type B AD managed by endovascular intervention, elevated NLR predicted adverse events within two years (hazard ratio\u2009=\u20091.98,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.015).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The evidence indicates that elevated NLR may serve as a potential independent predictor of mortality in AD, supporting its incorporation into risk stratification frameworks. Notwithstanding substantial publication bias\u2014predominantly among smaller studies\u2014sensitivity analyses confirmed the overall result stability. The observed prognostic value aligns with NLR's role in other vascular diseases, consistent with its interpretation as a marker of inflammatory burden. Generalizability is limited by the predominance of small Asian cohorts; therefore, multicenter prospective studies are required to validate these findings and to establish optimal NLR thresholds for individualized management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?RecordID=648318<\/jats:ext-link>\n                      , PROSPERO CRD42025648318.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2025.1631314","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T06:35:00Z","timestamp":1767854100000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Prognostic value of neutrophil to lymphocyte ratio in patients with aortic dissection: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"12","author":[{"given":"Lilong","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linyang","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaping","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"100746","DOI":"10.1016\/j.tvir.2021.100746","article-title":"Anatomy, pathology, and classification of aortic dissection","volume":"24","author":"Sherk","year":"2021","journal-title":"Tech Vasc Interv Radiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"257","DOI":"10.3760\/cma.j.cn112434-20210319-00103","article-title":"Chinese Experts\u2019 consensus of standardized diagnosis and treatment for acute aortic syndrome(2021)","volume":"37","year":"2021","journal-title":"Chin J Thorac Cardiovasc Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1846","DOI":"10.1161\/CIRCULATIONAHA.117.031264","article-title":"Insights from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research","volume":"137","author":"Evangelista","year":"2018","journal-title":"Circulation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3760\/cma.j.cn101411-20210201-00013","article-title":"Treatment of acute type A aortic dissection: towards doing better","volume":"6","author":"Junming Zhu","year":"2021","journal-title":"Chin J Vasc Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"226","DOI":"10.3760\/cma.j.cn101411-20221128-00106","article-title":"Molecular biological mechanism of acute aortic dissection","volume":"8","author":"Zhang Han","year":"2023","journal-title":"Chin J Vasc Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"441","DOI":"10.3109\/07853890.2015.1073346","article-title":"Stanford-A acute aortic dissection, inflammation, and metalloproteinases: a review","volume":"47","author":"Cifani","year":"2015","journal-title":"Ann Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1186\/s12933-024-02191-5","article-title":"The neutrophil-to-lymphocyte ratio is associated with all-cause and cardiovascular mortality among individuals with hypertension","volume":"23","author":"Zhang","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"644","DOI":"10.14744\/tjtes.2024.78241","article-title":"Neutrophil\/lymphocyte ratio as a predictor of mortality among aortic dissection patients in the emergency department","volume":"30","author":"Ustaalioglu","year":"2024","journal-title":"Ulus Travma Acil Cerrahi Derg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e20221185","DOI":"10.1590\/1806-9282.20221185","article-title":"Evaluation of descriptive performances of platelet indices, neutrophil\/lymphocyte ratio, and platelet\/lymphocyte ratio in aortic dissections","volume":"69","author":"D\u00f6nmez","year":"2023","journal-title":"Rev Assoc Med Bras (1992)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"388","DOI":"10.4103\/tcmj.tcmj_249_20","article-title":"Can preoperative neutrophil-to-lymphocyte ratio predict in-hospital mortality in postoperative patients with Stanford type A aortic dissection? Evidence-based appraisal by meta-analysis and GRADE","volume":"33","author":"Chung","year":"2021","journal-title":"Tzu Chi Med J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.clinbiochem.2021.08.002","article-title":"The potential value of the neutrophil to lymphocyte ratio for early differential diagnosis and prognosis assessment in patients with aortic dissection","volume":"97","author":"Zhang","year":"2021","journal-title":"Clin Biochem"},{"key":"B12","first-page":"7","article-title":"The Newcastle-Ottawa scale (NOS) for assessing the quality of non-randomised studies in meta-analyses","author":"Wells","year":"2014","journal-title":"Ottawa Health Res Instit Web Site"},{"key":"B13","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"Br Med J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1442","DOI":"10.21037\/atm-21-4063","article-title":"Development and evaluation of an early death risk prediction model after acute type A aortic dissection","volume":"9","author":"Zhang","year":"2021","journal-title":"Ann Transl Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1177\/00033197211012514","article-title":"Impact of lymphocyte-related blood parameters on short- and long-term outcomes of patients undergoing thoracic endovascular aortic repair","volume":"72","author":"Yang","year":"2021","journal-title":"Angiology"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1383","DOI":"10.1007\/s12265-023-10436-z","article-title":"Inflammatory profiles define phenotypes with clinical relevance in acute type A aortic dissection","volume":"16","author":"Zhao","year":"2023","journal-title":"J Cardiovasc Transl Res"},{"key":"B17","doi-asserted-by":"publisher","first-page":"694","DOI":"10.21470\/1678-9741-2018-0343","article-title":"Association of platelet to lymphocyte and neutrophil to lymphocyte ratios with in-hospital mortality in patients with type A acute aortic dissection","volume":"34","author":"Bedel","year":"2019","journal-title":"Braz J Cardiovasc Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"E488","DOI":"10.1532\/hsf.3055","article-title":"C-Reactive protein and neutrophil to lymphocyte ratio values in predicting inhospital death in patients with Stanford type A acute aortic dissection","volume":"23","author":"Erdolu","year":"2020","journal-title":"Heart Surg Forum"},{"key":"B19","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1177\/0267659115590625","article-title":"Neutrophil to lymphocyte ratio: a novel marker for predicting hospital mortality of patients with acute type A aortic dissection","volume":"32","author":"Kalkan","year":"2017","journal-title":"Perfusion"},{"key":"B20","doi-asserted-by":"publisher","first-page":"186","DOI":"10.3906\/sag-1301-136","article-title":"Relationship of admission neutrophil-to-lymphocyte ratio with in-hospital mortality in patients with acute type I aortic dissection","volume":"44","author":"Laf\u00e7i","year":"2014","journal-title":"Turk J Med Sci"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1275","DOI":"10.7754\/Clin.Lab.2015.150216","article-title":"Increased neutrophil to lymphocyte ratio is associated with in-hospital mortality in patients with aortic dissection","volume":"61","author":"Onuk","year":"2015","journal-title":"Clin Lab"},{"key":"B22","doi-asserted-by":"publisher","first-page":"E119","DOI":"10.1532\/hsf.1736","article-title":"Prognostic value of neutrophil to lymphocyte ratio and risk factors for mortality in patients with Stanford type A aortic dissection","volume":"20","author":"Oz","year":"2017","journal-title":"Heart Surg Forum"},{"key":"B23","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1186\/s12872-021-01904-y","article-title":"Elevated preoperative neutrophil-to-lymphocyte ratio predicts early adverse outcomes in uncomplicated type B aortic dissection undergoing TEVAR","volume":"21","author":"Zhu","year":"2021","journal-title":"BMC Cardiovasc Disord"},{"key":"B24","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1186\/s13019-024-03226-4","article-title":"Biomarkers to predict the outcomes of surgical intervention for aortic dissection","volume":"20","author":"Hanna","year":"2025","journal-title":"J Cardiothorac Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1018","DOI":"10.12677\/acm.2024.1492561","article-title":"Research Status of inflammation-related markers and anti-inflammatory treatment in aortic dissection","volume":"14","author":"Asiyiguli Tuersun","year":"2024","journal-title":"ACM"},{"key":"B26","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.arr.2008.08.001","article-title":"Inflammatory response is associated with aortic dissection","volume":"8","author":"Luo","year":"2009","journal-title":"Ageing Res Rev"},{"key":"B27","doi-asserted-by":"publisher","first-page":"5","DOI":"10.3390\/jcm10194343","article-title":"Neutrophil-to-Lymphocyte ratio could predict outcome in patients presenting with acute limb ischemia","volume":"10","author":"Taurino","year":"2021","journal-title":"J Clin Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3390\/biomedicines13030651","article-title":"Neutrophil-to-Lymphocyte ratio as potential marker of outcome in popliteal artery aneurysm repair","volume":"13","author":"Sirignano","year":"2025","journal-title":"Biomedicines"},{"key":"B29","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1590\/1516-3180.2021.0298.r1.27052021","article-title":"Usefulness of the neutrophil-to-lymphocyte ratio in predicting the severity of COVID-19 patients: a retrospective cohort study","volume":"140","author":"Y\u0131lmaz","year":"2022","journal-title":"Sao Paulo Med J"},{"key":"B30","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1186\/s13019-020-01263-3","article-title":"Prognostic role of neutrophil-to-lymphocyte ratio in aortic disease: a meta-analysis of observational studies","volume":"15","author":"Xu","year":"2020","journal-title":"J Cardiothorac Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"143","DOI":"10.22514\/sv.2022.080","article-title":"The utility of hemoglobin, albumin, lymphocyte and platelet (HALP) score in predicting mortality among COVID-19 patients: a preliminary study","volume":"19","author":"K\u0131l\u0131\u00e7","year":"2023","journal-title":"Signa Vitae"},{"key":"B32","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1177\/0267659116657865","article-title":"The relationship between neutrophil-lymphocyte ratio and acute aortic dissection","volume":"32","author":"Balta","year":"2017","journal-title":"Perfusion"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1631314\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T06:35:02Z","timestamp":1767854102000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1631314\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,8]]},"references-count":32,"alternative-id":["10.3389\/fcvm.2025.1631314"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1631314","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,8]]},"article-number":"1631314"}}