{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T06:16:31Z","timestamp":1783577791229,"version":"3.55.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"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. Aging"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The neutrophil-to-lymphocyte ratio (NLR) serves as a potential inflammatory biomarker for aortic dissection (AD), with elevated levels predicting adverse postoperative outcomes. Nevertheless, the prognostic significance of preoperative NLR in non-hypertensive AD patients receiving thoracic endovascular aortic repair (TEVAR) remains undefined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the predictive value of preoperative NLR for clinical prognosis in this specific cohort following TEVAR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study retrospectively analyzed 116 non-hypertensive AD patients undergoing TEVAR at our medical center (December 2014\u2013December 2020). Receiver operating characteristic (ROC) curve analysis determined the optimal NLR cutoff, area under the curve (AUC), and 95% confidence interval (CI) for predicting the primary endpoint (all-cause mortality). Patients were stratified into low-NLR and high-NLR groups based on the cutoff. Survival differences were assessed using\n                      <jats:italic>Kaplan-Meier<\/jats:italic>\n                      analysis with\n                      <jats:italic>log-rank<\/jats:italic>\n                      testing. Associations between NLR and mortality risk were evaluated via univariate and multivariate Cox regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort comprised 77.6% males, with 52.6% aged &amp;gt;55 years, 30.2% reporting smoking history, 13.8% alcohol use, and 14.7% comorbidities. Anatomical classification included Stanford type A (5.2%) and type B (94.8%); temporal classification was acute (12.1%), subacute (30.2%), and chronic (57.8%). Branch artery reconstruction was performed in 47.4% of patients. Postoperative outcomes included all-cause mortality (1.7%), dissection recurrence (3.4%), endoleak (6.0%), and secondary intervention (9.5%). NLR demonstrated strong predictive efficacy (cutoff: 7.69; sensitivity: 96.4%; specificity: 65.9%; AUC = 0.83, 95% CI: 0.76\u20130.90). The high-NLR group exhibited significantly reduced survival compared to the low-NLR group (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). Univariate Cox regression identified high NLR (HR = 30.766, 95% CI: 4.177\u2013226.611,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.001) and branch reconstruction (HR = 2.335, 95% CI: 1.090\u20135.001,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.029) as mortality risk factors. Multivariate analysis confirmed high NLR as an independent risk factor for all-cause death (HR = 2.033, 95% CI: 1.004\u20133.221).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preoperative NLR elevation is significantly linked to decreased survival following TEVAR in AD patients with aortic dissection, and it may function as an independent predictor of all-cause mortality. This parameter may be used as a reliable prognostic marker for this specific patient group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fragi.2026.1875447","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T05:36:49Z","timestamp":1783575409000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictive value of preoperative neutrophil-to-lymphocyte ratio for prognosis in aortic dissection patients without hypertension following TEVAR"],"prefix":"10.3389","volume":"7","author":[{"given":"Shun","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Vascular Surgery, Changhai Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinghua","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, 920th Hospital of Joint Logistics Support Force, PLA","place":["Kunming, Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunyu","family":"Guan","sequence":"additional","affiliation":[{"name":"Pediatric, Changhai Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Changhai Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Changhai Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dengqun","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The Chinese People\u2019s Armed Police Forces Anhui Provincial Corps Hospital","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanjun","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The Chinese People\u2019s Armed Police Forces Anhui Provincial Corps Hospital","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixue","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Changhai Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijun","family":"Weng","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, The Chinese People\u2019s Armed Police Forces Anhui Provincial Corps Hospital","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biao","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Changhai Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3637","DOI":"10.2147\/IJGM.S414567","article-title":"Preoperative immature neutrophils predict clinical outcomes in patients with uncomplicated Type-B aortic dissection after thoracic endovascular aortic repair","volume":"16","author":"Abu","year":"2023","journal-title":"Int. J. Gen. Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1007\/s11748-019-01066-x","article-title":"Etiology of aortic dissection","volume":"67","author":"Akutsu","year":"2019","journal-title":"Gen. Thorac. Cardiovasc Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"104598","DOI":"10.1016\/j.mvr.2023.104598","article-title":"Neutrophil-to-lymphocyte ratio an inflammatory biomarker, and prognostic marker in heart failure, cardiovascular disease and chronic inflammatory diseases: new insights for a potential predictor of anti-cytokine therapy responsiveness","volume":"150","author":"Artemio","year":"2023","journal-title":"Microvasc. Research"},{"key":"B4","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":"B26","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1024\/0301-1526\/a001117","article-title":"A systematic review of the neutrophil to lymphocyte and platelet to lymphocyte ratios in patients with lower extremity arterial disease","volume":"53","author":"Bradley","year":"2024","journal-title":"Vasa"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.surge.2024.08.014","article-title":"A systematic review of the role of systemic inflammation-based prognostic scores in patients with abdominal aortic aneurysm","volume":"23","author":"Bradley","year":"2025","journal-title":"Surgeon"},{"key":"B6","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1016\/j.ejvs.2024.12.003","article-title":"Aortic dissection incidence and risk factor analysis: findings from the China Kadoorie Biobank","volume":"69","author":"Chen","year":"2025","journal-title":"Eur. J. Vasc. Endovasc. Surg. Off. J. Eur. Soc. Vasc. Surg."},{"key":"B7","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":"B8","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":"B9","doi-asserted-by":"publisher","first-page":"622","DOI":"10.3109\/07853890.2010.518156","article-title":"Inflammation and immune response in acute aortic dissection","volume":"42","author":"del Porto","year":"2010","journal-title":"Ann. Med."},{"key":"B10","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1111\/jch.13556","article-title":"Poor management of hypertension is an important precipitating factor for the development of acute aortic dissection","volume":"21","author":"Dong","year":"2019","journal-title":"J. Clin. Hypertens. (greenwich Conn,)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC)","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur. Heart J."},{"key":"B12","doi-asserted-by":"publisher","first-page":"985","DOI":"10.3390\/life14080985","article-title":"The prognostic role of the neutrophil-to-lymphocytes ratio in the most frequent cardiovascular diseases: an update","volume":"14","author":"Evelina","year":"2024","journal-title":"Life Basel Switz."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1095646","DOI":"10.3389\/fcvm.2023.1095646","article-title":"Prognostic significance of neutrophil count on in-hospital mortality in patients with acute type A aortic dissection","volume":"10","author":"Feng","year":"2023","journal-title":"Front. Cardiovasc Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"e579","DOI":"10.1016\/j.wneu.2023.11.151","article-title":"Association of early longitudinal changes in the neutrophil-to-lymphocyte ratio with adverse clinical outcomes in acute ischemic stroke patients after endovascular treatment","volume":"182","author":"Fengli","year":"2024","journal-title":"World Neurosurg."},{"key":"B15","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1001\/jama.2023.0265","article-title":"Management of thoracic aortic dissection","volume":"329","author":"Hameed","year":"2023","journal-title":"JAMA"},{"key":"B16","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":"B17","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1016\/j.jtcvs.2005.09.018","article-title":"Characterization of the inflammatory and apoptotic cells in the aortas of patients with ascending thoracic aortic aneurysms and dissections","volume":"131","author":"He","year":"2006","journal-title":"J. Thorac. Cardiovasc Surg."},{"key":"B18","doi-asserted-by":"publisher","first-page":"R12","DOI":"10.1186\/cc11157","article-title":"Failure to normalize lymphopenia following trauma is associated with increased mortality, independent of the leukocytosis pattern","volume":"16","author":"Heffernan","year":"2012","journal-title":"Crit. Care"},{"key":"B19","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1016\/j.tcm.2021.08.008","article-title":"Update in aortic dissection","volume":"32","author":"Juraszek","year":"2022","journal-title":"Trends Cardiovasc Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"674","DOI":"10.2967\/jnumed.109.065227","article-title":"Uptake of 18F-FDG in acute aortic dissection: a determinant of unfavorable outcome","volume":"51","author":"Kato","year":"2010","journal-title":"J. Nucl. Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1631314","DOI":"10.3389\/fcvm.2025.1631314","article-title":"Prognostic value of neutrophil to lymphocyte ratio in patients with aortic dissection: a systematic review and meta-analysis","volume":"12","author":"Li","year":"2025","journal-title":"Front. Cardiovasc Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1016\/j.jtcvs.2021.11.091","article-title":"The society of thoracic Surgeons\/American association for thoracic surgery clinical practice guidelines on the management of type B aortic dissection","volume":"163","author":"MacGillivray","year":"2022","journal-title":"J. Thorac. Cardiovasc Surg."},{"key":"B23","doi-asserted-by":"publisher","first-page":"3538","DOI":"10.1093\/eurheartj\/ehae179","article-title":"2024 ESC guidelines for the management of peripheral arterial and aortic diseases","volume":"45","author":"Mazzolai","year":"2024","journal-title":"Eur. Heart J."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.avsg.2024.09.065","article-title":"A systematic review on the role of neutrophil to lymphocyte ratio in limb ischemia","volume":"111","author":"Monireh","year":"2025","journal-title":"Ann. Vasc. Surg."},{"key":"B25","doi-asserted-by":"publisher","first-page":"3000605241291742","DOI":"10.1177\/03000605241291742","article-title":"Association between admission hyperglycaemia with in-hospital mortality rate in patients with hypertension and acute aortic dissection","volume":"52","author":"Mutailifu","year":"2024","journal-title":"J. Int. Med. Res."},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.2174\/1574887115999201027145406","article-title":"Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as biomarkers for cardiovascular surgery procedures: a literature review","volume":"16","author":"Raffaela","year":"2021","journal-title":"Rev. Recent Clin. Trials"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e230421186875","DOI":"10.2174\/1573403X16666201014142930","article-title":"Aortic dissection: a review of the pathophysiology, management and prospective advances","volume":"17","author":"Sayed","year":"2021","journal-title":"Curr. Cardiol. Rev."},{"key":"B29","doi-asserted-by":"publisher","first-page":"2338","DOI":"10.1093\/eurjpc\/zwac205","article-title":"Dose-dependent relationship of blood pressure and glycaemic status with risk of aortic dissection and aneurysm","volume":"29","author":"Suzuki","year":"2022","journal-title":"Eur. J. Prev. Cardiol."},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.23736\/S0392-9590.22.04795-2","article-title":"Association of neutrophils, lymphocytes, and neutrophil-lymphocyte ratio to overall mortality after endovascular abdominal aortic aneurysm repair","volume":"41","author":"Toshiya","year":"2022","journal-title":"Int. Angiol. J. Int. Union Angiol."},{"key":"B31","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":"B32","doi-asserted-by":"publisher","first-page":"259","DOI":"10.12945\/j.aorta.2013.13-044","article-title":"Inflammatory cell infiltrates in acute and chronic thoracic aortic dissection","volume":"1","author":"Wu","year":"2013","journal-title":"Aorta (stamford Conn,)"},{"key":"B33","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1186\/s13019-024-03165-0","article-title":"Prognostic significance of preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with ruptured abdominal aortic aneurysm undergoing endovascular aneurysm repair","volume":"19","author":"Wu","year":"2024","journal-title":"J. Cardiothorac. Surg."},{"key":"B34","doi-asserted-by":"publisher","first-page":"5431545","DOI":"10.1155\/ijog\/5431545","article-title":"The relationship between preoperative neutrophil-lymphocyte ratio and postoperative length of stay in carotid body tumor resection","volume":"2025","author":"Wu","year":"2025","journal-title":"Int. J. Genomics"},{"key":"B35","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1186\/s12872-025-04775-9","article-title":"Predictive value of inflammatory indexes in in-hospital mortality for patients with acute aortic dissection","volume":"25","author":"Xin","year":"2025","journal-title":"BMC Cardiovasc Disord."},{"key":"B36","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":"B37","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":"B38","doi-asserted-by":"publisher","first-page":"2203","DOI":"10.1038\/s41440-023-01351-6","article-title":"Causal effect of hypertension and blood pressure on aortic diseases: evidence from mendelian randomization","volume":"46","author":"Yang","year":"2023","journal-title":"Hypertens. Res. Off. J. Jpn. Soc. Hypertens."},{"key":"B39","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":"B40","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":"B41","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24087397","article-title":"Neutrophil-to-lymphocyte ratio is an independent risk factor for coronary artery disease in central obesity","volume":"24","author":"Zsolt","year":"2023","journal-title":"Int. J. Mol. Sci."}],"container-title":["Frontiers in Aging"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fragi.2026.1875447\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T05:36:49Z","timestamp":1783575409000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fragi.2026.1875447\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":41,"alternative-id":["10.3389\/fragi.2026.1875447"],"URL":"https:\/\/doi.org\/10.3389\/fragi.2026.1875447","relation":{},"ISSN":["2673-6217"],"issn-type":[{"value":"2673-6217","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]},"article-number":"1875447"}}