Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratio in Univentricular Patients From Birth to Follow-Up After Fontan—Predicting Lymphatic Abnormalities

Abstract

Background: Reliable laboratory parameters identifying complications after Fontan surgery including the lymphatic abnormalities and the development of protein-losing enteropathy (PLE) are rare. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocte ratio (PLR) are inflammatory markers and have been studied to predict outcome and prognosis in various diseases. The aim of this study was to investigate NLR and PLR from birth to follow-up after Fontan and evaluate their use as prognostic parameters for single ventricle patients regarding the development of lymphatic malformations during follow-up.Materials and Methods: Sixty-six univentricular patients who underwent Fontan surgery and had 6-month follow-up magnetic resonance imaging (MRI) with T2 weighted lymphatic imaging after total cavopulmonary connection (TCPC) surgery were included in the study. NLR and PLR were determined at specific time points, from neonatal age to follow-up after Fontan operation and correlated to data from the MRI 6 months after Fontan.Results: NLR and PLR increase significantly over time from the first surgery during infancy to the follow-up after Fontan (both p < 0.0001), with a significant increase after the Glenn surgery for both ratios (each p < 0.0001). Higher NLR (p = 0.002) and higher PLR (p = 0.004) correlated with higher-grade classification of lymphatic abnormalities in T2-weighted imaging 6 months after Fontan surgery and higher NLR correlated with higher transpulmonary gradient prior to Fontan surgery (p = 0.035) Both ratios showed a significant correlation to total protein at follow-up (NLR p = 0.0038; PLR<0.0001).Conclusion: Increased NLR and PLR correlate with higher degree lymphatic malformations after TCPC and therefore might contribute as valuable additional biomarker during follow-up after TCPC. NLR and PLR are simple, inexpensive and easily available parameters to complement diagnostics after TCPC.

The beneficial role of simple inflammatory blood indices in pediatric cardiology

“…Moosmann et al recommended calculating NLR and PLR for univentricular patients during the course of total cavopulmonary connection and follow-up. 56 In their study, NLR and PLR correlated with the degree of lymphatic malformations, which are associated with early complications after Fontan surgery and Fontan failure, and may also occur after Glenn surgery despite a lack of clinical manifestation. The authors suggested that patients with higher values require closer monitoring and evaluation for signs of Fontan complications, such as lymphatic malformations and protein-losing enteropathy (PLE).…”

“…Arterial hypertension is an increasing problem in children due to obesity, sedentary lifestyle and excessive [21], [27], [29], [30], [31], [32], [33], [41], [44], [45], [46], [55], [56], [57], [59], [60], [62], [63], [71] Platelet count Kawasaki disease -coronary artery aneurysms acute rheumatic carditis arterial hypertension [20], [30], [41] PLR Fontan patients neonatal sepsis ECMO use IVIG resistance in Kawasaki disease arterial hypertension [21], [41] MLR necrotizing enterocolitis in PDA children severity of valvular involvement in acute rheumatic carditis [33], [35] ECMO -extracorporeal membrane oxygenation; ICU -intensive care unit; IVIG -intravenous immunoglobulin; MLR -monocyte-to-lymphocyte ratio; NLR -neutrophil-to-lymphocyte ratio; PDA -patent ductus arteriosus; PLE -protein-losing enteropathy; PLR -platelet-to-lymphocyte ratio.…”

Association between neutrophil-lymphocyte-ratio and oxygen delivery in patients after the Norwood operation

“…In the pediatric population, the neutrophil-lymphocyte-ratio has been demonstrated to be associated with, and have prognostic implications in the setting of, several clinical occurrences such as pleural effusion after cardiac surgery, duration of mechanical ventilation after cardiac surgery, length of stay after cardiac surgery, low cardiac output after cardiac surgery, cardiac dysfunction, refractory Kawasaki disease, coronary artery lesions with Kawasaki disease, lymphatic anomalies after the Fontan procedure, carditis with Rheumatic fever, reactive airway disease, and necrotizing enterocolitis among others [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17].…”