Do platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) have a predictive value on pediatric extracorporeal membrane oxygenation (ECMO) results?

Abstract

Background: It is difficult to predict the complications and prognosis of ECMO, which is gaining widespread use in patients with pediatric surgery. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are emerging inflammatory markers that can be calculated from complete blood count, which is a cheap and easily accessible laboratory analysis. The ratios between cellular elements in peripheral blood have been demonstrated to provide information on inflammation, infection, and immune response. Methods: Sixty-seven patients who needed ECMO application after undergoing pediatric cardiovascular surgery in our clinic, between May 2005 and April 2020, were included in this study. The age of patients varied between 4 days and 17 years with a mean of 30.59 ± 147.26 months. Results: The relationships between PLR or NLR values and various blood parameters and blood gas results were found to be statistically nonsignificant in our group of pediatric ECMO recipients. Even if the effect of PLR and NLR values on mortality and prognosis is statistically nonsignificant in patients who need ECMO after congenital heart surgery, PLR and NLR are typically elevated in the postoperative period. An increase in these values above a certain threshold may be a statistically significant indicator for the prediction of mortality. Conclusions: There are few studies in the literature concerning PLR and NLR values in patients with pediatric heart surgery. We consider this study will make way for new studies in the future.

New trend: Surgical correction of Ebstein's anomaly using modified cone repair and a combination of different techniques

“…The results of this study indicate that tricuspid valve delamination, surgical valve rotation, right ventricular oblique plication, and tricuspid ring annuloplasty, when used to modify cone‐type repairs, have beneficial effects on preserving valve coaptation and functions in the early and midterm, as well as on right‐ventricle remodeling 7,13,15 …”

“…A Glenn shunt was implanted, but the patient developed low flow and multiorgan failure, which led to death. Two of our patients needed extracorporeal membrane oxygenation, and our extracorporeal membrane oxygenation rate was calculated as 20% 7 . Pleural effusion was observed in two patients in the postoperative period.…”

“…If surgical modifications are chosen appropriately, they are tolerated well by the patient and contribute positively to the outcome. In the presence of severe right ventricle dysfunction, uncontrollable arrhythmias, and cyanosis, the choice of 1.5 ventricles is preferred.The results of this study indicate that tricuspid valve delamination, surgical valve rotation, right ventricular oblique plication, and tricuspid ring annuloplasty, when used to modify cone-type repairs, have beneficial effects on preserving valve coaptation and functions in the early and midterm, as well as on right-ventricle remodeling 7,13,15.…”

Neutrophil-lymphoycyte-ratio, platelet-lymphocyte-ratio and procalcitonin for early assessment of prognosis in patients undergoing VA-ECMO

“…Referring to PLR, this is the first study that investigated this marker in adult VA-ECMO patients. There is only one study by Arslanoglu and colleagues that assessed the prognostic value of PLR in 67 pediatric cardiac surgery patients with VA-ECMO 23 . This study found out that there was no significant relationship between PLR and various postoperative blood parameters and blood gas values.…”

The beneficial role of simple inflammatory blood indices in pediatric cardiology

“…20 At the same time, lymphocyte count indicates physiological stress but is inversely proportional to inflammation. 21 The NLR combines 2 leukocyte subtypes and may have high predictive value in several cardiovascular and noncardiac disorders.…”