Evolution of Hematological Parameters in Patients with Vasoplegia Following Coronary Artery Bypass Graft Surgery

Abstract

Background: The utilization of extracorporeal circulation during a coronary artery bypass graft (CABG) surgery induces the secretion of inflammatory mediators associated with the onset of vasoplegic syndrome (VS). Blood cells contribute to the amplification of enzymatic mechanisms related to the development of VS, which is responsible for high mortality rates. Objectives: To investigate possible changes in hematological ratios to evaluate the evolution of VS in patients undergoing CABG. Methods: Analytical observational study of the retrospective cohort type, utilizing data collected from medical records in a reference cardiology hospital. Results: VS was associated with decreased monocyte rates (p = 0.02) 24 hours before the CABG, as well as elevated lymphocyte/monocyte ratio (LMR) (p = 0.01) and neutrophil/monocyte ratio (NMR) (p = 0.01) on the same period. Twenty-four hours after the procedure, increased neutrophil counts (p = 0.05) and platelet/lymphocyte ratio (PLR) (p = 0.03), as well as neutrophil/lymphocyte ratio (NLR) (p = 0.04), were associated with VS. Between 24 and 48 hours after CABG, neutrophil ratios (p = 0.01), PLR (p = 0.02), MLR (p = 0.04), and systemic inflammation response index (SIRI) (p = 0.02) were lower in patients who developed vasoplegia. Conclusion: A decreased monocyte count 24 hours before CABG was associated with the development of VS, as well as an elevated neutrophil count 24 hours after the procedure. Higher LMR and NMR 24 hours before the surgery, as well as PLR and MLR after the cardiac surgery were also associated with VS. Our data show different hematological changes at different times after CABG and highlight that new studies are essential to allow the use of hematological ratios in the monitoring of patients undergoing CABG.