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Bae MI, Shim JK, Song JW, Ko SH, Choi YS, Kwak YL. Predictive Value of the Changes in Neutrophil-Lymphocyte Ratio for Outcomes After Off-Pump Coronary Surgery. J Inflamm Res 2023; 16:2375-2385. [PMID: 37288449 PMCID: PMC10243358 DOI: 10.2147/jir.s411057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023] Open
Abstract
Purpose The neutrophil-to-lymphocyte ratio (NLR) is an extensively analyzed prognostic inflammatory index in cardiac patients. The degree of change in NLR values before and after surgery (delta-NLR) can represent the inflammatory response induced by surgery and serve as a meaningful prognostic biomarker in surgical patients; however, this has not been well investigated. We aimed to investigate the predictive value of the perioperative NLR and delta-NLR for outcomes of off-pump coronary artery bypass (OPCAB) surgery by evaluating "days alive and out of hospital (DAOH)", a novel patient-centered outcome. Patients and Methods In this single-center retrospective study, perioperative data, including NLR data, from 1322 patients were analyzed. The primary endpoint was DOAH at 90 days postoperatively (DAOH 90), and the secondary endpoint was long-term mortality. Linear regression analysis and Cox regression analysis were performed to identify independent risk factors for the endpoints. In addition, Kaplan-Meier survival curves were plotted to assess long-term mortality. Results The median NLR values significantly increased from 2.2 (1.6-3.1) at baseline to 7.4 (5.4-10.3) postoperatively, with median delta-NLR values of 5.0 (3.2-7.6). Preoperative NLR and delta-NLR were independent risk factors for short DAOH 90 in the linear regression analysis. In Cox regression analysis, delta-NLR, but not preoperative NLR, was an independent risk factor for long-term mortality. When patients were divided into two groups according to delta-NLR, the high delta-NLR group had a shorter DAOH 90 than the low delta-NLR group. Kaplan-Meier curves showed higher long-term mortality in the high delta-NLR group than in the low delta-NLR group. Conclusion In OPCAB patients, preoperative NLR and delta-NLR were significantly associated with DAOH 90, and delta-NLR was an independent risk factor for long-term mortality, indicating their role in risk assessment, which is essential for perioperative management.
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Affiliation(s)
- Myung Il Bae
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Wook Song
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seo Hee Ko
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Seo Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Lan Kwak
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Alparslan Bekir S, Sonkaya E, Ozbaki F, Aydogan Eroglu S, Sertcelik L, Duman D, Kavas M, Agca M, Erdem I, Ozmen I, Boga S, Hazar A, Sevim T, Turker H, Tuncay E, Gungor S, Karakurt Z. The utility of neutrophil-to-lymphocyte ratio determined at initial diagnosis in predicting disease stage and discriminating between active and stable disease in patients with sarcoidosis: cross-sectional study. Postgrad Med 2022; 134:603-608. [PMID: 35619233 DOI: 10.1080/00325481.2022.2082805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the utility of neutrophil-lymphocyte ratio (NLR) determined at initial diagnosis in predicting advanced disease stage and discriminating between active and stable disease in sarcoidosis. METHODS A total of 465 patients with biopsy-proven sarcoidosis (age: 47 years, 70.5% females) were included in this retrospective cross-sectional study. Data on patient demographics, sarcoidosis stage, clinical status (stable and active), anti-inflammatory treatments, complete blood count, and inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and platelet/mean platelet volume (MPV) ratio were recorded. NLR values were compared by subgrouping the patients according to the stage of sarcoidosis and clinical status, while the receiver operating characteristics (ROC) curve was plotted to determine the role of NLR in the identification of disease activity with the calculation of area under the curve (AUC) and cut-off value via ROC analysis. RESULTS Overall, active, and stable disease was evident in 36 (7.8%) and 427 (92.2%) patients, respectively. Median NLR values were significantly higher in patients with active disease compared with stable disease (3.31 (2.34-4.31) vs. 2.29 (1.67- 3.23), p=0.005). Advanced sarcoidosis stage was associated with significantly higher NLR values at stages 0, I, II, III and IV, respectively (p=0.001). ROC analysis revealed a NLR cut-off value of ≥2.39 (AUC (95% CI): 0.70(0.62 - 0.79), p<0.001) to discriminate between active and stable clinic with a sensitivity of 72.0% and specificity of 52.0%. The significantly higher percentage of patients with active vs. stable disease had NLR values ≥ 2.39 (74.0 vs. 47.0%, p=0.002). CONCLUSION Our findings indicate the potential utility of on-admission NLR values to predict the risk of advanced disease stage and to discriminate between active and stable disease in sarcoidosis. Measured via a simple, readily available, and low-cost test, NLR seems to be a valuable marker for monitoring disease activity and progression.
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Affiliation(s)
- Sumeyye Alparslan Bekir
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Esin Sonkaya
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Fatma Ozbaki
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Selma Aydogan Eroglu
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Lale Sertcelik
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Dildar Duman
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Murat Kavas
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Meltem Agca
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Ipek Erdem
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Ipek Ozmen
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Sibel Boga
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Armagan Hazar
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Tulin Sevim
- Acıbadem Hospital Chest Diseases, Department of Pulmonary Disease, Istanbul, Turkey
| | - Hatice Turker
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Eylem Tuncay
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Sinem Gungor
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Zuhal Karakurt
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
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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. BIOLOGY 2021; 11:biology11010034. [PMID: 35053032 PMCID: PMC8772913 DOI: 10.3390/biology11010034] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 12/17/2022]
Abstract
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.
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Retrospective evaluation of ultrafiltration during cardiac surgery with cardiopulmonary bypass in adult patients with increased neutrophil to lymphocyte ratio. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.814941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Jiménez-Aguilar R, Sánchez-Zauco N, Tiburcio-Felix R, López JZ, Solano-Gutiérrez A, Riera C, Reyes-Maldonado E, Maldonado-Bernal C. Effects of cardiopulmonary bypass on the development of lymphopenia and sepsis after cardiac surgery in children with congenital cardiopathy. Exp Ther Med 2019; 19:435-442. [PMID: 31885693 PMCID: PMC6913339 DOI: 10.3892/etm.2019.8241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 05/30/2019] [Indexed: 12/20/2022] Open
Abstract
The objective of the present study was to investigate whether lymphopenia occurring after heart surgery with cardiopulmonary bypass (CPB) is related to apoptosis and or sepsis in children. The design was a prospective cohort study in a third level care hospital in Mexico City. In total, 68 children (31 girls and 37 boys) with congenital cardiopathy who needed corrective cardiac surgery with or without CPB were included. The samples were obtained from central blood before, immediately after and 24 h after surgery. Complete blood counts and lymphocyte apoptosis were analyzed. Systemic inflammatory response syndrome (SIRS), sepsis and the type of microorganism were recorded. A total of 53 patients received CPB and 15 did not. Lymphocyte count decreased after surgery in both groups (P<0.001). However, neutrophil count increased markedly in both groups. Apoptosis of B (CD19+) lymphocytes was higher in the non-CPB group (14, 2 and 21% before, immediately after and 24 h after surgery, respectively) than the CPB group (0, 2 and 3%, respectively), but apoptosis of cytotoxic T lymphocytes (CD8+) was higher in the CPB group (5, 4 and 3% before, immediately after and 24 h after surgery, respectively) than in the non-CPB group (2, 3 and 2%, respectively). However, the extent of apoptosis of T and B lymphocytes after surgery did not differ between groups. The CPB group had more complications than the non-CPB group [38 (71.7%) vs. 9 (60.0%)]. In conclusion, the decrease in lymphocyte count may be related to apoptosis of cytotoxic T lymphocytes in children receiving cardiac surgery with CPB and to apoptosis of B lymphocytes in those not receiving CPB. The decreased lymphocyte counts in both groups suggested that CPB is not the main cause of this decrease. Children who received CPB during surgery had more complications, such as sepsis and cardiogenic shock than did those who did not receive CPB.
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Affiliation(s)
- Rosalinda Jiménez-Aguilar
- Terapia Intensiva, Unidad Médica de Alta Especialidad, Hospital General Gaudencio González de la Garza, Centro Médico Nacional 'La Raza', IMSS, Mexico City C.P. 02990, México.,Departamento de Morfología, Laboratorio de Bacteriología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City C.P. 11350, México
| | - Norma Sánchez-Zauco
- División de Auxiliares de Diagnóstico y Tratamiento UMAE, Hospital de Especialidades, Centro Médico Nacional-Siglo XXI, IMSS, Mexico City C.P. 06725, México
| | - Reynaldo Tiburcio-Felix
- Departamento de Genética y Biología Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City C.P. 07240, México
| | - Jorge Zavala López
- Departamento de Circulación Extracorporea, Hospital de Pediatría del Centro Médico Nacional SXXI, Mexico City C.P. 06725, México
| | - Alejandro Solano-Gutiérrez
- Servicio de Cirugía Cardiovascular, Hospital de Cardiología del Centro Médico Nacional Siglo XXI, IMSS, Unidad Médica de Alta Especialidad, Mexico City C.P. 06725, México
| | - Carlos Riera
- Departamento de Circulación Extracorporea, Hospital de Pediatría del Centro Médico Nacional SXXI, Mexico City C.P. 06725, México
| | - Elba Reyes-Maldonado
- Departamento de Morfología, Laboratorio de Bacteriología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City C.P. 11350, México
| | - Carmen Maldonado-Bernal
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City C.P. 06171, México
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Evora PRB, Pinheiro B, Braile DM. Inflammatory Biomarkers in Cardiac Surgery and the Suggestion of an Editors' Heart Team. Braz J Cardiovasc Surg 2018; 33:I-II. [PMID: 30652739 PMCID: PMC6326444 DOI: 10.21470/1678-9741-2018-0607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Paulo Roberto B Evora
- Editor-in-Chief Interim - BJCVS Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Bruno Pinheiro
- Associate Editor - BJCVS Hospital Santa Genoveva, Goiânia, GO, Brazil
| | - Domingo M Braile
- Editor-in-Chief - BJCVS Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil and Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
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Koo CH, Eun Jung D, Park YS, Bae J, Cho YJ, Kim WH, Bahk JH. Neutrophil, Lymphocyte, and Platelet Counts and Acute Kidney Injury After Cardiovascular Surgery. J Cardiothorac Vasc Anesth 2018; 32:212-222. [DOI: 10.1053/j.jvca.2017.08.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Indexed: 12/15/2022]
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