Bu çalışmada yeni geliştirilen bir enflamatuvar parametre olan nötrofil/lenfosit oranının koroner arter baypas greft (KABG) cerrahisi sonrası erken dönem mortalite prediktörü olarak etkisi araştırıldı. Ça lış mapla nı:Aralık 2011-Nisan 2012 tarihleri arasında kliniğimizde izole KABG cerrahisi yapılan ardışık 210 hasta prospektif olarak incelendi. Hastaların başlangıç özellikleri ve ameliyat öncesi nötrofil/lenfosit oranları belirlendi. Ameliyat sonrası takip süresi 86.1±38.9 gün idi. Primer sonlanım noktası, tüm-nedenlere bağlı mortalite olarak belirlendi. Bul gu lar: Dört hastada ameliyat sonrası ilk 30 günde olmak üzere, toplam sekiz hastada (%3.8) mortalite görüldü. Tek değişkenli analizlerde ameliyat öncesi nötrofil/lenfosit oranı, mortalite gelişen ve gelişmeyen gruplar arasında anlamlı derecede farklı olarak saptandı (p= 0.037). Alıcı işlem karakteristikleri (ROC) eğrisinde nötrofil/lenfosit oranı için eşik değeri 2.81 olarak belirlendi (AUC= 0.72, duyarlılık: %75, özgüllük: %67). İki grup arasında anlamlı farka sahip olan değişkenler ile yapılan lojistik regresyon analizinde ise, nötrofil/lenfosit oranı için eşik değerinin üzerinde olması mortalite için bağımsız bir prediktör olarak saptandı (OR 6.47, %95 CI 1.18-35.38, p= 0.031). So nuç: Kolay bir şekilde hesaplanabilen nötrofil/lenfosit oranı KABG cerrahisi sonrası erken dönem mortaliteyi öngörmede bağımsız bir faktör olarak kullanılabilir. Anah tar söz cük ler: Koroner arter baypas greftleme; lenfosit; mortalite; nötrofil. Background: In this study, we aimed to investigate the newly introduced inflammatory biomarker, neutrophil/ lymphocyte ratio, as a mortality predictor following coronary artery bypass graft (CABG) surgery. Methods: Between December 2011 and April 2012, 210 consecutive patients who underwent isolated CABG surgery in our clinic were prospectively analyzed. The baseline characteristics of the patients and preoperative neutrophil/ lymphocyte ratio were determined. The postoperative follow-up was 86.1±38.9 days. The primary endpoint was all-cause mortality. Results: Eight patients (3.8%) died of whom four deaths occurred during the first 30 days of follow-up. Univariate analyses revealed a significant difference in the preoperative neutrophil/lymphocyte ratio between the groups in which mortality was seen and the group in which no mortality was observed (p=0.037). The Receiver operating characteristic (ROC) curve showed a threshold value of 2.81 for neutrophil/lymphocyte ratio (AUC=0.72, sensitivity: 75%, specificity: 67%). Logistic regression analysis of the variables with significant differences between two groups revealed that the neutrophil/lymphocyte ratio over its threshold value was an independent predictor for mortality (OR 6.47, 95% CI 1.18-35.38, p=0.031). Conclusion: Neutrophil/lymphocyte ratio, which can be easily calculated, can be used as an independent factor in predicting early mortality following CABG surgery.
BackgroundAn elevated mean platelet volume is associated with increased platelet activation and thus may predict thrombotic events. The goal of this study was to investigate the association of the mean platelet volume and the major adverse events after coronary artery bypass surgery.MethodsBaseline clinical details and preoperative hematologic parameters were obtained prospectively in 205 consecutive patients undergoing coronary artery bypass surgery. Postoperative mortality and major adverse events were recorded in the early postoperative period (median of 72 days, interquartile range 58.5-109 days).ResultsCombined adverse events occurred in 37 patients (18.0%) during the early follow-up. The preoperative mean platelet volume and hematocrit levels were found to be associated with postoperative adverse events (p<0.001 for both variables). In multivariate logistic regression models, the preoperative mean platelet volume and hematocrit levels were strong independent predictors of combined adverse events after surgery (respectively OR 1.89, p=0.037; OR 0.87, p=0.011). After receiver-operating-characteristics curve analysis, using a cut-point of 8.75 fL, the preoperative mean platelet volume level predicted adverse events with a sensitivity of 54% and specificity of 70%. In a further model with cut-off points, higher preoperative mean platelet volume levels remained a powerful independent predictor of postoperative myocardial infarction (OR 3.60, p=0.013) and major adverse cardiac events (OR 2.53, p=0.045).ConclusionsAn elevated preoperative mean platelet volume is associated with an adverse outcome after coronary artery bypass grafting. In conclusion, we can say that mean platelet volume is an important, simple, readily available, and cost effective tool and can be useful in predicting the postoperative adverse events in patients undergoing coronary artery bypass grafting.
BackgroundSince the advent of cardiopulmonary bypass, many efforts have been made to avoid the complications related with it. Any component of the pump participates in occurrence of these adverse events, one of which is the type of prime solution. In this study, we aimed to compare the effects of 6% hydroxyethyl starch 130/0.4 with a commonly used balanced electrolyte solution on postoperative outcomes following coronary bypass surgery.MethodsTwo hundred patients undergoing elective coronary bypass surgery were prospectively studied. The patients were randomized in to two groups. First group received a balanced electrolyte solution and the second group received 6% hydoxyethyl starch 130/0.4 as prime solution. The postoperative outcomes of the patients were studied.ResultsThe mean age of the patients was 61.81 ± 10.12 in the crystalloid group whereas 61.52 ± 9.29 in the HES group. There were 77 male patients in crystalloid group and 74 in HES group. 6% hydroxyethyl starch 130/0.4 did not have any detrimental effects on renal and pulmonary functions. The intensive care unit stay and postoperative hospital length of stay were shorter in hydroxyethyl starch group (p < 0.05 for each). Hydroxyethyl starch did not increase postoperative blood loss, amount of blood and fresh frozen plasma used, but it decreased platelet concentrate requirement. It did not have any effect on occurrence of post-coronary bypass atrial fibrillation (p > 0.05).Conclusions6% hydroxyethyl starch 130/0.4 when used as a prime solution did not adversely affect postoperative outcomes including renal functions and postoperative blood transfusion following coronary bypass surgery.
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