Significance of Preoperative Total Lymphocyte Count as a Prognostic Criterion in Adult Cardiac Surgery

Abstract

Background:Evaluation of operational risk is a consequential goal in perioperative management of patients in cardiac surgery. Preoperative total lymphocyte count (PTLC) is a prognostic criterion of adverse major cardiovascular outcomes.Objectives:The purpose of this study was to investigate the prognostic value of PTLC as an independent predictor of postoperative morbidity and mortality in cardiac surgery.Patients and Methods:Of 1604 patients scheduled for cardiac surgery between September, 2012 and March, 2013, a total of 1171 consecutive patients underwent elective primary valvular heart surgery and coronary artery bypass grafting. The patients were divided to three groups according to their PTLCs. The baseline characteristics and postoperative mortality and morbidity of the patients as well as the intensive care unit (ICU) stay according to the PTLCs were recorded and analyzed. The only inclusion criterion was a preoperative complete blood count. Exclusion criteria included: ages under 18 or over 80 years old, emergency surgery, adult patients with congenital heart disease and previous open heart surgery, and patients with any bacterial or viral infection during two weeks before the surgery. Protocol of anesthetic medications was used in all the patients similarly and according to standard. All the patients were admitted to the ICU after the surgery.Results:A PTLC < 1500 cells/µL was associated with significantly high mortality and morbidity (P = 0.0001). In-hospital mortality and major composite morbidity were 9.65% and 28.4%, respectively. Low PTLC was associated with more frequent need for inotropic and intra-aortic balloon pump (IABP) support (P < 0.001), dialysis-dependent acute renal failure (P = 0.0001), postoperative superficial wound infections (P = 0.0001) and prolong ICU stay (P = 0.0001).Conclusions:Our study results showed that low PTLC was an independent, valuable prognostic criterion, with high sensitivity and specificity for evaluation of postoperative morbidity and mortality in cardiac surgery.

The predictive value of the prognostic nutritional index for postoperative acute kidney injury in patients undergoing on-pump coronary bypass surgery

“…Lymphopenia is a significant predictor of mortality in patients who underwent CABG surgery [35]. Aghdaii et al [12] reported that a low preoperative lymphocyte count was associated with an increased risk of postoperative renal failure in cardiac operations. In our study, we discovered the relationship of the preoperative lymphocyte count to AKI.…”

“…The immune response to surgical stress and CPB is also lymphocyte dependent along with other anti-inflammatory factors and as a result, a low count can be a predictor of poor survival in cardiac surgery. Previous studies [12] have shown that a low preoperative lymphocyte count is an independent risk factor for a worse postoperative outcome and a higher AKI after adult cardiac surgery.…”

The Neutrophil to Lymphocyte Ratio on Admission and Short-Term Outcomes in Orthogeriatric Patients

“…In this study, we have also evaluated twelve most widely recommended and used predictor markers for determining outcomes among orthogeriatric patients: age >75 years 113 - 115 , dementia, presence of CVDs, AF, high white blood cell (WBC) count 19 , low lymphocyte count 19 , 23 , 25 , 86 , 116 , 117 , 118 , low serum albumin 15 , 25 , 84 - 86 , 117 , anaemia/reduced haemoglobin levels (Hb<120g/L) 15 , 18 , 19 , 22 , 82 , 83 , 94 , 119 , vitamin D deficiency (25(OH)D<25nmol/L) and insufficiency (25(OH)D<50nmol/L), elevated PTH (6.8 pmol/L) 115 , 120 , and CKD≥3stage. The performance of these markers, which have been suggested as independent prognostic factors for unfavourable outcomes in HF patients, was variable.…”

Hematological predictors and clinical outcomes in cardiac surgery

“…For these reasons, parameters that are known and practiced by all healthcare professionals have been in use as outcome predictors. Among these parameters, along with several biochemistry and hemostasis parameters, are exist hemoglobin, red cell distribution width, mean platelet volume, platelet-to-lymphocyte ratio, and neutrophil-to-lymphocyte ratio [2,3]. Studies have been reported in the literature regarding the usability of each of these parameters in terms of outcome prediction; however, to the best of our knowledge, there is no published study investigating all these parameters together.…”