Diagnostic value of neutrophil-to-lymphocyte ratio for identifying severe great saphenous vein reflux in patients with chronic venous insufficiency: A retrospective cohort study

Objectives The role of inflammatory markers in chronic venous insufficiency (CVI) has been examined primarily within the CEAP clinical classification framework or at a disease-present versus disease-absent level. CEAP, however, is weighted toward symptoms and skin findings and does not directly reflect the underlying hemodynamic severity of reflux. This study evaluated the diagnostic accuracy and optimal cutoff values of five preoperative inflammatory markers in differentiating severe (Grade IV; reflux time ≥4 s) from moderate (Grade III; reflux time >1 to <4 s) great saphenous vein reflux through direct pairwise comparison. Methods This single-center retrospective cohort study enrolled 597 consecutive patients (Grade III: 412; Grade IV: 185) operated on for CVI. White blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), platelet count (PLT), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) were analyzed with group comparisons, Benjamini-Hochberg–adjusted correlation analysis, multivariable linear regression, and receiver operating characteristic (ROC) curve analysis with DeLong pairwise testing. Results All five markers were significantly elevated in the Grade IV group ( p < 0.001 for each). NLR achieved the highest discriminative performance (area under the curve [AUC]: 0.95; cutoff ≥2.20; sensitivity 83.8%; specificity 90.3%) and was significantly superior to all other markers, including CRP, on DeLong testing ( p < 0.001). Performance was preserved after excluding patients with ulceration (C5–C6; AUC: 0.96). NLR also exhibited the strongest correlations with reflux duration (ρ = 0.57) and Venous Clinical Severity Score (VCSS; ρ = 0.54). In the multivariable model, NLR was the strongest independent predictor of VCSS (B = 3.54; 95% confidence interval: 2.99–4.09; adjusted R 2 = 0.416). Conclusions NLR — calculable from a routine complete blood count at no additional cost — distinguished severe great saphenous vein reflux with high accuracy and may serve as an accessible adjunctive marker for preoperative severity assessment. Prospective multicenter validation is warranted.