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

Abstract

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.

Current Understanding of Leukocyte Phenotypic and Functional Modulation During Extracorporeal Membrane Oxygenation: A Narrative Review

“…ECMO support is reported to increase the NLR values, and patients with high NLR have an increased risk for renal complications and mortality compared to those with a lower ratio ( 28 ). In CPB, higher NLR is associated with longer extubation time and a longer duration of ICU stay, consistent with ECMO ( 75 ). The prognostic capacity of NLR is further demonstrated across various critical illnesses ( 56 , 76 , 77 ).…”

Predictive role of perioperative neutrophil to lymphocyte ratio in pediatric congenital heart disease associated with pulmonary arterial hypertension

“…Recent studies perceived that the higher pre-operative NLR in children with CHD was not only associated with a higher risk for low cardiac output in the early post-operative period but also correlated with mortality [ 5 – 7 ]. Besides, Xu et al found that post-operative NLR in pediatric patients with CHD after CPB was significantly higher than those before operation, which was consistent with increased mechanical ventilation time and intensive care unit (ICU) stay time [ 8 ].…”

The Year in Review: Anesthesia for Congenital Heart Disease 2019

“…Their article describes the association of NLR and C-reactive protein (CRP) with clinical outcomes (length of surgery, extubation time, ICU LOS, hospital LOS), and demonstrated increased NLR to be associated with delayed extubation time and prolonged ICU LOS (P < .05). 11 Two additional studies on biomarkers focused on detection of postoperative blood stream sepsis, which continues to be a major cause of morbidity and mortality in children undergoing cardiac surgery. The first study by Abqari et al evaluated markers of inflammation and infection in 275 infants undergoing cardiac surgery and compared them with those patients with positive blood cultures in the first postoperative week.…”