Can Peroperative Neutrophil To Lymphocyte Ratio Change (Deltanlr) Be Used as a Parameter in Predicting Acute Renal Failure Following Coronary Bypass Operations With Cardiopulmonary Bypass?

Abstract

Background: Inflammation plays a significant role in the pathogenesis of many diseases as well as postoperative acute renal failure (ARF). Preoperative neutrophil to lymphocyte ratio (NLR) values have a prognostic value for postoperative ARF after cardiovascular surgeries. Methods: Patients who underwent elective coronary artery bypass graft (CABG) with cardiopulmonary bypass in our clinic between December 15, 2015 and December 15, 2019, retrospectively were included in this study. Patients who did not develop ARF after the operation were categorized as Group 1, and patients who did were included in Group 2. NLR was calculated from the hemograms during three periods (Preoperative (Pre), Postcardiotomy (Pc), Postoperative Day 1 (Po1). DeltaNLR1 (PcNLR- PreNLR) and DeltaNLR2 (Po1NLR-PreNLR) values were obtained from these calculated values. Results: The mean ages of patients in Group 1 (N = 274) and Group 2 (N = 61) were 60 ± 9.1 years and 67.7 ± 9.8 years, respectively (P < .001). In the multivariate analysis, being over 65 years of age (Odds ratio [OR]: 1.074, 95% confidence interval [CI]: 1.012-1.194, P = .030), postoperative inotropic need (OR: 0.678, CI 95%: 0.395-0.819, P = .021), increased blood product use (OR: 0.916, CI 95%: 0.779-0.986, P = .034), preoperative creatinine increase (OR: 1.974, CI 95%: 1.389-4.224, P = .007), PcNLR (OR : 1.988, CI 95%: 1.765-3.774, P <.001), Po1NLR (OR: 1.090, CI 95%: 1.007-2.116, P = .028), DeltaNLR1 (OR: 3.090, CI 95%: 1.698-6.430, P < .001) and DeltaNLR2 (OR: 1.676, CI 95%: 1.322-2.764, P = .003) were identified as independent predictors for predicting postoperative ARF. Conclusion: In this study, we have shown that peroperative NLR changes can be used as an effective parameter to predict ARF developing following CABG operations.

Predictive value of neutrophil to lymphocyte ratio on acute kidney injury after on-pump coronary artery bypass: a retrospective, single-center study

“…Our results showed that preoperative serum creatinine was significantly higher in patients in the AKI group compared with those in non-AKI group and was positively correlated with the highest blood creatinine value, suggesting that the earlier the onset and the greater the elevation of blood creatinine, the greater the likelihood of AKI. After adjusting other risk factors, high preoperative serum creatinine levels also significantly increased the risk of postoperative AKI, which was consistent with previous studies [8,19,20]. Previous studies showed that preoperative serum creatinine ≥ 1.3 mg/dl was an independent risk factor for AKI associated with cardiac surgery, which was largely similar to our results [21].…”

“…Studies showed that NLR had the positive correlation and synchronous changes with various classical inflammatory indices, indicating the state of renal function during the inflammation and disease processes [ 7 ]. However, existing studies have shown the conflicting predictive value of preoperative NLR for postoperative AKI in patients undergoing CABG alone [ 6 , 8 ]. In this study, we aimed to investigate the correlation between preoperative NLR and postoperative AKI after ONCAB, and the combined predictive value of preoperative NLR with other indicators.…”

The Importance of Prognostic Nutritional Index in Predicting Acute Renal Failure After On-Pump Coronary Artery Bypass Operations in Patients with Insulin-Dependent Diabetes Mellitus

“…Today, coronary artery bypass graft (CABG) operations are widely performed, and the success of the procedure is influenced by complications that develop after the operation besides surgical technique [Erdolu 2020]. One of the most important complications is acute kidney injury (AKI) clinic, which can occur after the operations [Usta 2021]. In addition, 20-30% of diabetes mellitus (DM) is detected in patients with CABG planned.…”

The prognostic value of elevated neutrophil–lymphocyte ratio for cardiac surgery‐associated acute kidney injury: A systematic review and meta‐analysis

“…From 10 studies 41–50 involving 7660 patients, we found a statistically significant association between elevated preoperative NLR and postoperative AKI (OR 1.45, 95% CI 1.18–1.77) (Figure 2).…”

“…From six studies [42][43][44][45]47,48 with 3637 patients, we found no association between elevated NLR at postoperative day 1 (POD1) and postoperative AKI (OR 1.43, 95% CI 0.94-2.16) (Figure 4). Similarly, meta-regression could not be performed to assess the substantial heterogeneity (I 2 statistic 99.9%) due to insufficient study numbers.…”