Aims and Objectives:  This study was designed to evaluate the admission neutrophil-lymphocyte ratio in predicting the risk of amputation in critical limb ischemia patients who could not get
surgical or radiological (percutaneous transluminal angioplasty) revascularization.

Methods:  A total of 150 patients who presented with CLI to our hospital between June 2017 and June 2018 and who could not have radiological or surgical revascularization are included in the study. Critical limb ischemia patients are those with is defined with ischemic rest pain and/or skin ulceration/gangrene in accordance with current guidelines reflecting patients with Fontaine class 3 and 4. This is a comparative study, 75 with CLI and rest pain and 75 without rest pain, so the NLR was significant in the rest pain group substantiated with the p-value thus proving a a vascular endpoint. An optimal cut-off value for the continuous NLR was calculated by applying a receiver operating curve analysis to discriminate between CLI and non-CLI. In our study occurrence of CLI significantly increased with an increase in NLR. A P value <0.05 was considered statistically significant and the CI was 95%. Analyses were performed using SPSS software.

Results:  Using an NLR cutoff of ≥3.2, the area under the receiver–operating characteristic curve was 0.71 (95% CI 0.54-0.78). Overall, there were a total of 9 (0.06%) deaths and 135(90%) amputations. The amputations were above the ankle in 103 (77%) and below the ankle in 32 (23%).

Conclusion:  The neutrophil-lymphocyte ratio is an independent predictive factor for amputation in critical limb ischemia patients. An increased NLR is significantly associated
with patients at high risk for CLI and other vascular endpoints. Stratification of patients with CLI according to admission NLR should be considered in the limb survival analyses of future
adjuvant and neoadjuvant trials to validate these findings.