The use of neutrophil lymphocyte ratio to predict complications post cardiac surgery

Abstract

Background: Cardiac surgery remains the gold standard treatment for select cohorts of patients with coronary artery and valvular heart diseases. It induces an acute systemic inflammatory response due to cardiopulmonary bypass (CPB), myocardial arrest, and surgical trauma. There is growing evidence that increased inflammation leads to greater complications and poorer outcomes for patients post cardiac surgery.Neutrophil/lymphocyte ratio (NLR) is a promising marker of inflammation. This study assessed if NLR could predict postoperative atrial fibrillation and acute kidney injury after cardiac surgery.Methods: A retrospective review of patients undergoing first-time on-pump cardiac surgery was performed.Postoperative atrial fibrillation and acute kidney injury within 7 days of surgery was recorded. Preoperative, day 1, and day 2 NLR were recorded. Potential confounders such as age, sex, comorbidities, and operative factors were included in univariate analysis. Backwards stepwise multivariate regression analysis was performed to identify independent predictors of these complications.Results: Nine hundred and six patients were included for analysis. Higher preoperative NLR was significantly associated with postoperative atrial fibrillation. Day 1 and day 2 NLR were associated with postoperative atrial fibrillation in analyses including all patients. Older age, male gender, preexisting atrial arrhythmias, and higher EuroSCORE II also had a significant association. Diabetes mellitus was protective for postoperative arrhythmias. Preoperative NLR was not significantly associated with acute kidney injury. Day 2 NLR, older age, higher EuroSCORE II, and longer CPB time were independently associated with acute kidney injury post cardiac surgery.Conclusions: Higher preoperative and postoperative NLRs are associated with higher rates of complications post cardiac surgery.

Preoperative Lymphocyte-to-Monocyte Ratio as a Prognostic Predictor of Long-Term Mortality in Cardiac Surgery Patients: A Propensity Score Matching Analysis

“…Recently, some markers composed of the ratios of white blood cell (WBC) subgroups have been newly introduced and demonstrated to be associated with the risks and outcomes of cardiovascular diseases and related surgeries. For example, for cardiac surgery patients, the value of the neutrophil-to-lymphocyte ratio (NLR) can serve as a predictor of early and late mortality ( 4 , 5 ), postoperative acute kidney injury ( 6 ), and postoperative atrial fibrillation ( 7 , 8 ), while the platelet-to-lymphocyte ratio (PLR) has been reported to be a predictor of prognosis in patients with aortic dissection ( 9 ).…”

Preoperative Neutrophil-Lymphocyte Ratio for Predicting Surgery-Related Acute Kidney Injury in Non-cardiac Surgery Patients under General Anaesthesia: A Retrospective Cohort Study

“…A large number of studies have shown that the NLR is closely related to the prognosis of patients with tumors [9,10], and cardiovascular disease [11][12][13]. At present, studies have been conducted on NLR and speci c high-risk populations of AKI, such as emergency surgery [14], burn surgery [15], cardiac surgery [16], and sepsis patients [17]. However, the relationship between the preoperative NLR and AKI after non-cardiac surgery under general anaesthesia has been barely studied.…”

Aqp2 may affect the occurrence of acute kidney injury after cardiopulmonary bypass

“…Although it has been found that some indicators such as cystatin C (18), neutrophils (19), urinary uromodulin (20), α 1-antitrypsin (21) and urinary IL-18(22) can predict the occurrence of AKI, creatinine is still the gold standard. As a result, we have no recognized indicators to judge AKI in the early stage.…”