Objective:

This study aimed to investigate an association between the high preoperative NLR and unfavorable clinical outcome following combined revascularization surgery in Moyamoya disease (MMD) patients

Background:

A high preoperative neutrophil-to-lymphocyte ratio (NLR) has been associated with poor postoperative prognosis in various diseases.

Design/Methods:

This retrospective study analyzed 885 adult MMD patients who underwent combined revascularization surgery between January 2005 and February 2025. Patients were categorized into high (n = 331) and low (n = 554) preoperative NLR groups based on the optimal cut-off value derived from receiver operating characteristic analysis. The primary outcome was the incidence of unfavorable clinical outcome, defined as a modified Rankin Scale score ≥ 3 at hospital discharge. Propensity score–based inverse probability weighting (IPW) was used to adjust for potential confounders.

Results:

The high preoperative NLR (≥ 2.01) group showed a higher incidence of unfavorable clinical outcome than the low preoperative NLR (< 2.01) group, before (11.8% vs. 2.0%, P < 0.001) and after (9.4% vs. 3.5%, P < 0.001) IPW, respectively. Also, a high preoperative NLR was an independent predictor of unfavorable clinical outcome before (odds ratio [95% CI]: 1.18 [1.04–1.35], P = 0.010) and after (1.24 [1.07–1.44], P = 0.006) IPW, respectively. The area under the curve of preoperative NLR for predicting unfavorable clinical outcome was 0.71 (0.64–0.77, p < 0.001).

Conclusions:

A high preoperative NLR was associated with unfavorable clinical outcome at hospital discharge in MMD patients undergoing combined revascularization surgery