Comparison of neutrophil:lymphocyte ratios following coronary artery bypass surgery with or without cardiopulmonary bypass

Abstract

ObjectiveCoronary artery bypass graft (CABG) surgery may induce postoperative systemic changes in leukocyte counts, including leukocytosis, neutrophilia or lymphopenia. This retrospective clinical study investigated whether offpump coronary artery bypass (OPCAB) surgery working on the beating heart without extracorporeal circulation could favourably affect leukocyte counts, including neutrophil-tolymphocyte (N:L) ratio, after CABG.MethodsIn this study, 30 patients who underwent isolated CABG with cardiopulmonary bypass (CPB), and another 30 patients who underwent the same operation without CPB between May 2010 and May 2013, were screened from the computerised database of our hospital. Pre-operative, and first and fifth postoperative day differential counts of leukocytes with the N:L ratio of peripheral blood were obtained.ResultsA significant increase in total leukocyte and neutrophil counts and N:L ratio, and a decrease in lymphocyte counts were observed at all time points after surgery in both groups. N:L ratio was significantly higher in the CPB group compared with the OPCAB group on the first postoperative day (20.73 ± 13.85 vs 10.19 ± 4.55, p < 0.001), but this difference disappeared on the fifth postoperative day.ConclusionCPB results in transient but significant changes in leukocyte counts in the peripheral blood stream in terms of N:L ratio compared with the off-pump technique of CABG.

Effects of cardiopulmonary bypass on the development of lymphopenia and sepsis after cardiac surgery in children with congenital cardiopathy

“…By contrast, lymphocyte count decreased significantly in both groups, which was unexpected because studies of adults have reported that lymphopenia occurs only in patients undergoing surgery with CPB. As in our study, a previous study that included pediatric patients reported reduced lymphocyte counts in both patients operated on with and without CPB, although the decrease was greater in the CPB group (2,27). In other study that included infants, it was compared the clinical effectiveness and biocompatibility of poly-2-methoxyethyl acrylate (PMEA)-coated and heparin-coated CPB circuits in elective cardiac surgery with CPB for ventricular septum defects, finding that the leukocyte counts were significantly lower 5 min after CPB in the PMEA group than the heparin group, showing that PMEA-coated circuits cause transient leukopenia during pediatric CPB (28).…”

Retrospective evaluation of ultrafiltration during cardiac surgery with cardiopulmonary bypass in adult patients with increased neutrophil to lymphocyte ratio

“…Over-activation of neutrophils, on one hand, is involved in the collateral destruction of tissues and cell together with injury from oxygen free radicals. On the other hand, activation of inflammatory cascades by the 'non-self' foreign surfaces of the CPB circuit result in cellular damage, endothelial cell and leukocyte activation, histamine release, increased vascular permeability and generalized inflammatory responses [11].…”

Neutrophil-to-lymphocyte Ratio as a Predictor of Mortality in ICU Patients: An Analysis of MIMIC-III Database

“…This may be the reason for over-representation of the MICU patients with NLR ≤ 1 (3.36%). For postoperative patients in SICU, TSICU and CSRU, surgery will normally lead to elevated levels of NLR [35,36]. On the one hand, tissue damage caused by trauma or surgery induced an acute in ammatory reaction, which leads to the accumulation of neutrophils [36,37]; on the other hand, surgery and anesthesia exposed the body to a state of stress, which induces catecholamine and adrenocorticotropic hormone release, inducing the bone marrow, liver and spleen to produce neutrophils constantly and resulting in a massive recruitment of immature neutrophils into circulation [38].…”