Perioperative neutrophil to lymphocyte ratio as a predictor of poor cardiac surgery patient outcomes

Giakoumidakis, Konstantinos; Fotos, Nikolaos V.; Patelarou, Athina; Theologou, Stavros; Argiriou, Mihalis; Chatziefstratiou, Anastasia A.; Katzilieri, Christina; Brokalaki, Hero

doi:10.2147/por.s130560

Cited by 21 publications

(24 citation statements)

References 25 publications

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“…To our knowledge, this is the first study to evaluate the role of the dNLR, LMR, and PLR in predicting AL. These simple blood count indexes, together with the NLR and RDW, have been demonstrated to have a prognostic potential in several chronic pathological conditions, including colorectal cancer and colorectal liver metastases [22][23][24][25][26], and a potential role in predicting outcomes in surgical procedures [15][16][17][18][19][27][28][29]. NLR is the most studied index to this purpose.…”

Section: Discussionmentioning

confidence: 99%

“…The latter has been demonstrated to be a prognostic factor in numerous diseases, including primary and metastatic colorectal cancer [11][12][13][14]. Furthermore, it has been associated with the outcomes of several types of surgical procedures, and with the onset of postoperative complications [15][16][17][18][19]. However, poor data are currently available regarding its role in predicting AL in colorectal surgery.…”

Section: Introductionmentioning

confidence: 99%

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Blood cell count indexes as predictors of anastomotic leakage in elective colorectal surgery: a multicenter study on 1432 patients

et al. 2020

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Background: The aim of this study was to evaluate a series of blood count inflammation indexes in predicting anastomotic leakage (AL) in elective colorectal surgery. Methods: Demographic, pathologic, and clinical data of 1432 consecutive patients submitted to colorectal surgery in eight surgical centers were retrospectively evaluated. The neutrophil to lymphocyte (NLR), derived neutrophil to lymphocyte (dNLR), lymphocyte to monocyte (LMR), and platelet to lymphocyte (PLR) ratios were calculated before surgery and on the 1st and 4th postoperative days, in patients with or without AL. Results: There were 106 patients with AL (65 males, mean age 67.4 years). The NLR, dNLR, and PLR were significantly higher in patients with AL in comparison to those without, on both the 1st and 4th postoperative days, but significance was greater on the 4th postoperative day. An NLR cutoff value of 7.1 on this day showed the best area under the curve (AUC 0.744; 95% CI 0.719-0.768) in predicting AL. Conclusions: Among the blood cell indexes of inflammation evaluated, NLR on the 4th postoperative day showed the best ability to predict AL. NLR is a low cost, easy to perform, and widely available index, which might be potentially used in clinical practice as a predictor of AL in patients undergoing elective colorectal surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Blood cell count indexes as predictors of anastomotic leakage in elective colorectal surgery: a multicenter study on 1432 patients

et al. 2020

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“…Moreover, the neutrophil to lymphocyte ratio (NLR) is a novel inflammatory marker which has been found to be associated with the severity and prognosis of many cardiovascular diseases (7). Importantly, increased perioperative NLR was shown to be associated with poor cardiac surgery patient outcomes in adult patients (8, 9). Despite this, NLR has not been well-studied in exclusively pediatric patients undergoing cardiac surgery requiring CPB.…”

Section: Introductionmentioning

confidence: 99%

The Relationship Between Neutrophil to Lymphocyte Ratio and Clinical Outcome in Pediatric Patients After Cardiopulmonary Bypass Surgery: A Retrospective Study

Sun

Zhang

2019

Front. Pediatr.

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Background: The aim of this study was to investigate the prognostic role of the neutrophil to lymphocyte ratio (NLR) in pediatric patients undergoing open-heart surgery with cardiopulmonary bypass (CPB). Methods: A retrospective cohort study of 61 pediatric patients who underwent CPB in the First Affiliated Hospital of Nanjing Medical University from January 2017 to October 2018 was conducted. All perioperative clinical data, including neutrophil count, lymphocyte count, and C-reactive protein (CRP), were collected retrospectively. The prognostic value of NLR and its association with extubation time, duration of intensive care unit (ICU) stay and in-hospital stay were analyzed. Results: Neutrophil count, NLR, and CRP were significantly increased post-operative compared with pre-operative ( p < 0.05). The increased post-operative levels of NLR were significantly associated with longer extubation time, as well as prolonged post-operative cardiac ICU stay ( p < 0.05). Multivariate linear regression analysis revealed that elevated NLR displayed a significant independent association with extubation time and the duration of an ICU stay. Conclusion: Increased post-operative NLR followed by cardiac surgery with CPB in pediatric patients was associated with longer extubation time and a longer duration of an ICU stay.

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“…In terms of emphasizing the results of certain biomarker tests, Sunbul et al 18 remind us that neutrophils and leukocytes are of outmost importance for the development of inflammation, and we also have to bear in mind that Giakoumidakis et al 19 and Tan et al, 20 among others, have recently investigated NL ratio as a potential biomarker for systemic inflammatory response syndrome in cardiac patients.…”

Section: Discussionmentioning

confidence: 99%

Perioperative predictors of delirium and incidence factors in adult patients post cardiac surgery

Theologou¹,

Giakoumidakis²,

Charitos³

2018

POR

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BackgroundDelirium is a quite common complication in adult patients post-cardiac surgery. The purpose of our study was to identify perioperative characteristics and also focus on incidence factors that could predict delirium in the cardiac surgery intensive care unit (CICU) postoperatively.MethodsWe conducted a prospective study of 179 consecutive patients, who underwent open-heart surgical operation and were admitted to the CICU of a general tertiary hospital in Athens, Greece. The patients were screened for delirium by using the diagnostic tools of Rich-mond Agitation Sedation Scale (RASS score) and the Confusion Assessment Method – ICU (CAM-ICU). The delirium assessment was carried out on the 1st and the 2nd postoperative day, and was conducted twice every nursing shift. A short questionnaire on sociodemographics and clinical patient characteristics was used for data collection purposes.ResultsA total of 179 patients who underwent open-heart surgical operation with cardiopulmonary bypass (CPB) were enrolled in our study. The 2-day incidence of postoperative delirium in ICU was 11.2% (n=20/179). The main independent predictors of delirium on the 2nd postoperative day were neutrophil-to-lymphocyte ratio (p=0.001) and urea levels (p=0.016). Additionally, increased perioperative creatinine (p=0.006) and sodium (p=0.039) levels were significantly associated with delirium occurrence. Furthermore, elevated EuroSCORE (p=0.001), extended length of stay (LOS) in ICU (p<0.001), and extended LOS with endotracheal tube (p=0.001) were also statistically significant indicators.ConclusionPatients with extended LOS with endotracheal tube and prolonged stay in ICU in accordance with peaked urea, neutrophil-to-lymphocyte ratio, creatinine, and sodium levels seem to have a significantly greater probability of developing delirium in the ICU. Further research is needed in the field of postoperative cardiac patients in order to determine the causality and etiology of certain risk factors for delirium.

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Perioperative neutrophil to lymphocyte ratio as a predictor of poor cardiac surgery patient outcomes

Cited by 21 publications

References 25 publications

Blood cell count indexes as predictors of anastomotic leakage in elective colorectal surgery: a multicenter study on 1432 patients

Blood cell count indexes as predictors of anastomotic leakage in elective colorectal surgery: a multicenter study on 1432 patients

The Relationship Between Neutrophil to Lymphocyte Ratio and Clinical Outcome in Pediatric Patients After Cardiopulmonary Bypass Surgery: A Retrospective Study

Perioperative predictors of delirium and incidence factors in adult patients post cardiac surgery

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