Preoperative Neutrophil and Lymphocyte Ratio as a Predictor of Mortality and Morbidity After Cardiac Surgery

Haran, Cheyaanthan; Gimpel, Damian; Clark, Helen; McCormack, David

doi:10.1016/j.hlc.2020.05.115

Cited by 21 publications

(15 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The prognostic performance of these indices has been also evaluated by others on cardiac surgery patients [30][31][32][33]. In a recent retrospective study of 1,694 patients divided into two groups according to their preoperative NLR optimal cut-off point of 3.23, authors conclude that patients having an NLR value greater than 3.23 experienced greater mortality (OR:3.36, 95% CI: 1.63-6.91); other parameters, as the ICU stay were also affected [34]. The predictive value of preoperative NLR and PLR values for major adverse cardiovascular and cerebrovascular events has also been con rmed by Larmann et al [35], who reported a cut-off point of > 204.4 for PLR and > 3.1 for NLR.…”

Section: Discussionmentioning

confidence: 99%

Statistical games to predict mortality and length of hospital stay after cardiac surgery

Tzikos

Alexiou

Tsagkaropoulos

et al. 2023

Preprint

View full text Add to dashboard Cite

Purpose Neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are widely accepted indices positively correlated with the disease severity, progression, and mortality. Since in a previous study we had correlated nutritional parameters with morbidity and mortality in cardiac surgery patients, we decided to perform a post-hoc analysis to test whether these parameters are also correlated with the NLR and PLR indices. Methods NLR and PLR were calculated on days 0, 3, 5, and 7 postoperatively. ROC curve was generated to assess their prognostic value and multivariate logistic analysis to identify independent risk factors for 90day mortality. Results Analysis was performed on 179 patients-data, 11 of which (6.15%) died within 90 days. The discriminatory performance for predicting 90day mortality was better for NLR7 (AUC = 0.925, 95%CI: 0.865–0.984) than for NLR5 (AUC = 0.810, 95%CI: 0.678–0.942), the respective cut-off points being 7.10 and 6.60. PLR3 exhibited a significantly strong discriminatory performance (AUC = 0.714, 95%CI: 0.581–0.847), with a cut-off point of 126.34. Similarly, a significant discriminative performance was prominent for PLR3, NLR5, and NLR7 with respect to the length of hospital stay. Moreover, NLR7 (OR: 2.143, 95% CI: 1.076–4.267, p = 0.030) and ICU length of stay (OR:1.361, 95% CI: 1.045–1.774, p = 0.022) were significant independent risk factors. Conclusion NLR and PLR are efficient predictive factors for 90day mortality and hospital length of stay in cardiac surgery patients. Owing to the simplicity of determining NLR and PLR, their postoperative monitoring may offer a reliable predictor of patients’ outcomes in terms of length of stay and mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Statistical games to predict mortality and length of hospital stay after cardiac surgery

Tzikos

Alexiou

Tsagkaropoulos

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…NLR, a promising marker of inflammation, has been identified as a novel predictor of AKI [ 34 ]. Moreover, it has emerged as a potential biomarker for lethal outcomes and adverse events in patients undergoing cardiac surgery [ 35 , 36 ]. Interestingly, lower baseline HDL levels were independently associated with an increased risk of AKI after cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Prediction of acute kidney injury after cardiac surgery: model development using a Chinese electronic health record dataset

et al. 2022

View full text Add to dashboard Cite

Background Acute kidney injury (AKI) is a major complication following cardiac surgery that substantially increases morbidity and mortality. Current diagnostic guidelines based on elevated serum creatinine and/or the presence of oliguria potentially delay its diagnosis. We presented a series of models for predicting AKI after cardiac surgery based on electronic health record data. Methods We enrolled 1457 adult patients who underwent cardiac surgery at Nanjing First Hospital from January 2017 to June 2019. 193 clinical features, including demographic characteristics, comorbidities and hospital evaluation, laboratory test, medication, and surgical information, were available for each patient. The number of important variables was determined using the sliding windows sequential forward feature selection technique (SWSFS). The following model development methods were introduced: extreme gradient boosting (XGBoost), random forest (RF), deep forest (DF), and logistic regression. Model performance was accessed using the area under the receiver operating characteristic curve (AUROC). We additionally applied SHapley Additive exPlanation (SHAP) values to explain the RF model. AKI was defined according to Kidney Disease Improving Global Outcomes guidelines. Results In the discovery set, SWSFS identified 16 important variables. The top 5 variables in the RF importance matrix plot were central venous pressure, intraoperative urine output, hemoglobin, serum potassium, and lactic dehydrogenase. In the validation set, the DF model exhibited the highest AUROC (0.881, 95% confidence interval [CI] 0.831–0.930), followed by RF (0.872, 95% CI 0.820–0.923) and XGBoost (0.857, 95% CI 0.802–0.912). A nomogram model was constructed based on intraoperative longitudinal features, achieving an AUROC of 0.824 (95% CI 0.763–0.885) in the validation set. The SHAP values successfully illustrated the positive or negative contribution of the 16 variables attributed to the output of the RF model and the individual variable’s effect on model prediction. Conclusions Our study identified 16 important predictors and provided a series of prediction models to enhance risk stratification of AKI after cardiac surgery. These novel predictors might aid in choosing proper preventive and therapeutic strategies in the perioperative management of AKI patients.

show abstract

“…NLR increase in early inflammatory phase after cardiac surgery procedures with concomitant activation of CD16 mean fluorescence index (MFI) (non-classical monocytes) was postulated in a previous report supporting the use of NLR as an inflammatory marker for outcomes prediction [ 53 ]. Preoperative NLR values above 3.36 were found significant for mortality prediction in a 30-day analysis by Haran et al [ 54 ]. The relationship between preoperative values of NLR above 2.6 and long-term survival after heart surgery was presented by Silberman et al [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Significance of Neutrophil to Lymphocyte Ratio (NLR), Monocyte to Lymphocyte Ratio (MLR) and Platelet to Lymphocyte Ratio (PLR) on Long-Term Survival in Off-Pump Coronary Artery Bypass Grafting (OPCAB) Procedures

Urbanowicz

Olasińska-Wiśniewska

Michalak

et al. 2021

Biology

View full text Add to dashboard Cite

Background: Cardiovascular diseases, apart from commonly known risk factors, are related to inflammation. There are several simple novel markers proposed to present the relation between inflammatory reactions activation and atherosclerotic changes. They are easily available from whole blood count and include neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), and platelets to lymphocyte ratio (PLR). The RDW results were excluded from the analysis. Method and results: The study based on retrospective single-centre analysis of 682 consecutive patients (131 (19%) females and 551 (81%) males) with median age of 66 years (60–71) who underwent off-pump coronary artery bypass grafting (OPCAB) procedure. During the median 5.3 +/− 1.9 years follow-up, there was a 87% cumulative survival rate. The laboratory parameters including preoperative MLR > 0.2 (HR 2.46, 95% CI 1.33–4.55, p = 0.004) and postoperative NLR > 3.5 (HR 1.75, 95% CI 1.09–2.79, p = 0.019) were found significant for long-term mortality prediction in multivariable analysis. Conclusion: Hematological indices NLR and MLR can be regarded as significant predictors of all-cause long-term mortality after OPCAB revascularization. Multivariable analysis revealed preoperative values of MLR > 0.2 and postoperative values of NLR > 3.5 as simple, reliable factors which may be applied into clinical practice for meticulous postoperative monitoring of patients in higher risk of worse prognosis.

show abstract

Preoperative Neutrophil and Lymphocyte Ratio as a Predictor of Mortality and Morbidity After Cardiac Surgery

Cited by 21 publications

References 13 publications

Statistical games to predict mortality and length of hospital stay after cardiac surgery

Statistical games to predict mortality and length of hospital stay after cardiac surgery

Prediction of acute kidney injury after cardiac surgery: model development using a Chinese electronic health record dataset

The Prognostic Significance of Neutrophil to Lymphocyte Ratio (NLR), Monocyte to Lymphocyte Ratio (MLR) and Platelet to Lymphocyte Ratio (PLR) on Long-Term Survival in Off-Pump Coronary Artery Bypass Grafting (OPCAB) Procedures

Contact Info

Product

Resources

About