Emergency Radiology

, Volume 26, Issue 5, pp 515–521 | Cite as

Neutrophil-to-lymphocyte ratio and mesenteric ischemia: can it predict the etiology of mesenteric ischemic at computed tomography?

  • M.A. Rivera Núñez
  • L. Rodríguez Gijón
  • Y. Tung ChenEmail author
  • M. Martí de Gracia
  • G. Buitrago Weiland
  • A. Díez Tascón
Original Article



To assess the usefulness of the neutrophil-to-lymphocyte ratio (NLR) as a predictive factor of acute mesenteric ischemia (AMI) in patients presenting at the emergency department (ED) with acute abdominal pain.


This is a retrospective case-control study of patients older than 16 years admitted to the ED with acute abdominal pain with CT and histologic confirmation. The study group corresponded to patients with abdominal CT with radiological signs of AMI. The control group corresponded to patients with non-AMI findings in abdominal CT. Association measurements of NLR with radiological signs were compared with a paired-sample t test, and multivariate regression performed to analyze potential correlations. To assess the diagnosis capacity of NLR, ROC curves were calculated.


A total of 61 patients were included (32 cases and 29 controls). The cases of AMI showed higher mortality (43.8% vs 6.9%, p < 0.01) and higher NLR on the limit of statistical significance (13.8 vs 8.7, p = 0.053). Patients with AMI due to occlusion of the superior mesenteric artery (SMA) showed a higher NLR (8.3 vs 22.3, p < 0.001). The area under the curve (AUC) of the NLR for AMI due to occlusion of the SMA was 0.88 (95% CI 0.7–1.0, p = 0.001). No patient with NLR < 5 presented AMI due to occlusion of the SMA. An NLR of 12.8 showed a sensitivity of 92% and a specificity of 74% for AMI due to occlusion of SMA.


The NLR is a useful parameter of AMI of arterial origin due to occlusion of the SMA; it can help the clinician to raise suspicion of this diagnosis and the interpreting radiologist in the acquisition protocol for the CT study and would alert for an early surgical treatment.


Neutrophil-to-lymphocyte ratio (NLR) Acute mesenteric ischemia (AMI) Acute abdominal pain Emergency department (ED) 



We gratefully thank the staff from the Emergency Department of Hospital La Paz for their invaluable support.

Authors’ contribution

All authors have contributed to this work. All authors read and approved the final manuscript.

Funding information

MAPAC—This study is part of a multicenter project on the adequacy of tests with ionizing radiation in the emergency department (projects P13/00896, P13/01183, P16/00296, PI16/01786, P16/01828, P16/00558) that has received funding from the Carlos III Health Institute (State Plan for R + D + i 2013–2016). It has also received partial funding from the CIBER of Epidemiology and Public Health (CIBERESP) and has been cofinanced by the European Regional Development Fund “A way of making Europe,” FEDER.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


We certify that this research was conducted in conformity with ethical principles of our institution. This work, figures and tables, have not been previously published and reproduced from another source


  1. 1.
    Schoots IG, Koffeman GI, Legemate DA, Levi M, van Gulik TM (2004) Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Br J Surg 91(1):17–27CrossRefGoogle Scholar
  2. 2.
    Acosta S (2010) Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg 23(1):4–8CrossRefGoogle Scholar
  3. 3.
    White CJ (2011) Chronic mesenteric ischemia: diagnosis and management. Prog Cardiovasc Dis 54(1):36–40CrossRefGoogle Scholar
  4. 4.
    Reinus JF, Brandt LJ, Boley SJ (1990) Ischemic diseases of the bowel. Gastroenterol Clin N Am 19(2):319–343Google Scholar
  5. 5.
    Bjornsson S, Resch T, Acosta S (2013) Symptomatic mesenteric atherosclerotic disease-lessons learned from the diagnostic workup. J Gastrointest Surg 17(5):973–980CrossRefGoogle Scholar
  6. 6.
    Sanna A, Adani GL, Anania G, Donini A (2003) The role of laparoscopy in patients with suspected peritonitis: experience of a single institution. J Laparoendosc Adv Surg Tech A 13(1):17–19CrossRefGoogle Scholar
  7. 7.
    Rozycki GS, Tremblay L, Feliciano DV, Joseph R, DeDelva P, Salomone JP et al (2002) Three hundred consecutive emergent celiotomies in general surgery patients: influence of advanced diagnostic AMIging techniques and procedures on diagnosis. Ann Surg 235(5):681–688 discussion 688-689CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Khan A, Hsee L, Mathur S, Civil I (2013) Damage-control laparotomy in nontrauma patients: review of indications and outcomes. J Trauma Acute Care Surg 75(3):365–368CrossRefGoogle Scholar
  9. 9.
    Hagspiel KD, Flors L, Hanley M, Norton PT (2015) Computed tomography angiography and magnetic resonance angiography imaging of the mesenteric vasculature. Tech Vasc Interv Radiol 18(1):2–13CrossRefGoogle Scholar
  10. 10.
    Acosta S, Block T, Bjornsson S, Resch T, Bjorck M, Nilsson T (2012) Diagnostic pitfalls at admission in patients with acute superior mesenteric artery occlusion. J Emerg Med 42(6):635–641CrossRefGoogle Scholar
  11. 11.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRefGoogle Scholar
  12. 12.
    Charlson ME, Charlson RE, Peterson JC, Marinopoulos SS, Briggs WM, Hollenberg JP (2008) The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol 61(12):1234–1240CrossRefGoogle Scholar
  13. 13.
    Nunez J, Nunez E, Bodi V, Sanchis J, Minana G, Mainar L et al (2008) Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol 101(6):747–752CrossRefGoogle Scholar
  14. 14.
    Chen J, Chen M-H, Li S, Guo Y-L, Zhu C-G, Xu R-X, Zhang Y, Sun J, Qing P, Liu G, Li JJ (2014) Usefulness of the neutrophil-to-lymphocyte ratio in predicting the severity of coronary artery disease: a Gensini score assessment. J Atheroscler Thromb 21(12):1271–1282CrossRefGoogle Scholar
  15. 15.
    Arruda-Olson AM, Reeder GS, Bell MR, Weston SA, Roger VL (2009) Neutrophilia predicts death and heart failure after myocardial infarction: a community-based study. Circ Cardiovasc Qual Outcomes 2(6):656–662CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Rudiger A, Burckhardt OA, Harpes P, Muller SA, Follath F (2006) The relative lymphocyte count on hospital admission is a risk factor for long-term mortality in patients with acute heart failure. Am J Emerg Med 24(4):451–454CrossRefGoogle Scholar
  17. 17.
    Shah N, Parikh V, Patel N, Patel N, Badheka A, Deshmukh A, Rathod A, Lafferty J (2014) Neutrophil lymphocyte ratio significantly improves the Framingham risk score in prediction of coronary heart disease mortality: insights from the National Health and Nutrition Examination Survey-III. Int J Cardiol 171(3):390–397CrossRefGoogle Scholar
  18. 18.
    Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, Renlund DG, Muhlestein JB, Intermountain Heart Collaborative Study Group (2005) Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 45(10):1638–1643CrossRefGoogle Scholar
  19. 19.
    Yazici M, Ozkisacik S, Oztan MO, Gursoy H (2010) Neutrophil/lymphocyte ratio in the diagnosis of childhood appendicitis. Turk J Pediatr 52(4):400–403Google Scholar
  20. 20.
    Ishizuka M, Shimizu T, Kubota K (2012) Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int Surg 97(4):299–304CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Aktimur R, Cetinkunar S, Yildirim K, Aktimur SH, Ugurlucan M, Ozlem N (2016) Neutrophil-to-lymphocyte ratio as a diagnostic biomarker for the diagnosis of acute mesenteric ischemia. Eur J Trauma Emerg Surg 42(3):363–368. CrossRefGoogle Scholar
  22. 22.
    Boley SJ, Kaleya RN, Brandt LJ (1992) Mesenteric venous thrombosis. Surg Clin North Am 72(1):183–201CrossRefGoogle Scholar

Copyright information

© American Society of Emergency Radiology 2019

Authors and Affiliations

  1. 1.Department of emergency medicineHospital Universitario de La PazMadridSpain
  2. 2.Department of emergency radiologyHospital Universitario de La PazMadridSpain

Personalised recommendations