Preoperative systemic inflammatory markers predict overall survival in patients with peripheral artery disease after endovascular intervention

Despite advances in endovascular therapy, long-term survival outcomes in patients with peripheral artery disease (PAD) remain highly variable. Systemic inflammatory markers (SIMs) derived from routine blood tests have emerged as potential indicators for risk stratification. This study aimed to investigate the prognostic significance of preoperative SIMs in patients with PAD undergoing endovascular intervention. In this retrospective cohort study, 425 patients with PAD who underwent endovascular intervention between January 2017 and December 2024 were included. Preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and hemoglobin-to-red cell distribution width ratio (HRR) were calculated. Overall survival (OS) was assessed using Kaplan–Meier analysis and Cox proportional hazards models. Multiple-testing corrections and subgroup analyses were performed. During follow-up, 95 deaths occurred among 425 patients. Patients in the mortality group had higher NLR, PLR, SII, and SIRI, but lower LMR and HRR. Kaplan-Meier analysis showed that all six SIMs were significantly associated with OS (log-rank P < 0.001 for each). In multivariable Cox analysis, elevated NLR (HR 2.36, 95% CI 1.63–3.41, P < 0.001), PLR (HR 1.82, 95% CI 1.17–2.82, P = 0.008), SII (HR 1.80, 95% CI 1.34–2.43, P < 0.001), and SIRI (HR 1.41, 95% CI 1.16–1.72, P < 0.001) were associated with poorer OS, whereas higher LMR (HR 0.76, 95% CI 0.60–0.95, P = 0.015) and HRR (HR 0.29, 95% CI 0.16–0.51, P < 0.001) were associated with improved OS. These associations remained robust after false discovery rate correction. Subgroup analyses showed consistent effects across most clinical strata. Preoperative SIMs showed potential associations with overall survival in patients with PAD undergoing endovascular intervention. These readily available biomarkers may facilitate risk stratification and support individualized perioperative management; however, their incremental prognostic value over conventional clinical risk factors remains to be validated before they can be used to guide individualized perioperative management.