Elevated preoperative neutrophil/lymphocyte ratio as a predictor of increased long-term survival in minimal invasive coronary artery bypass surgery compared to sternotomy

Abstract

BackgroundNeutrophil lymphocyte ratio (NLR) is a predictor of major adverse cardiovascular outcomes. Our study explores the value of NLR in predicting long-term mortality after minimally invasive coronary artery bypass surgery (MICS) via lateral left-thoracotomy versus conventional sternotomy coronary artery bypass grafting (CABG) surgery.MethodsA total of 1126 consecutive patients (729 sternotomy CABG and 397 MICS) from a single tertiary center between 2005 and 2008 were followed until 2011. We stratified the patients into equal tertiles according to preoperative NLR. The primary outcome, all-cause mortality, was compared among the NLR tertiles.ResultsOut of the 1126 patients included in the study, 1030 (91%) patients underwent off-pump CABG . The first (NLR <2.3) tertile had a significantly lower 5-year mortality (30/371 =8%) in comparison to the second (NLR =2.3-3.4) and third (NLR ≥3.5) tertiles (49/375 =13% and 75/380 =20%), respectively with p < 0.0001. After multivariate adjustment, NLR was a significant independent predictor of mortality (hazard ratio [HR] per each unit increase of NLR was 1.05, 95% confidence interval [CI] 1.01-1.10, p = 0.008). MICS and sternotomy CABG groups with NLR <3 had similar mortality (21/221 =9.5% and 40/403 =9.9%), p = 1. However among patients with NLR ≥3, MICS had a significantly lower mortality (23/176 = 13.1%) compared to the sternotomy CABG (70/326 =21.5%), p = 0.02. According to the multivariate analysis of patients with NLR ≥3, MICS had a significantly lower mortality compared to sternotomy CABG (HR = 0.44, 95% CI 0.24-0.78, p = 0.005).ConclusionElevated preoperative NLR is an independent predictor of long-term mortality after CABG. Among the patients with NLR ≥ 3, MICS was associated with a significantly improved survival compared with sternotomy CABG.

Does preoperative neutrophil-lymphocyte ratio indicate postoperative morbidity after repair of tetralogy of Fallot?

“…This can be explained by the fact that our study was lack of mortality, which was estimated to develop at higher pNLRs as in adult cohorts. [3][4][5] In contrary to Gürsoy et al, [8] although the pNLR in the current series was approximate to the Gürsoy et al's cohort, it was probably not high enough for the development of morbidity in our cohort. This circumstance may be a reflection of the retrospective design of the study and extensive implementation of the exclusion criteria leading to a sterile patient cohort in which 142 patients with predisposing risk factors for morbidity were excluded.…”

“…[1,2] The pNLR has been investigated in cardiovascular diseases in search of a powerful predictor of outcome. [3][4][5][6][7][8] However, as the pNLR has not been extensively evaluated in cyanotic pediatric cardiac surgery cases, we investigated whether the pNLR could predict postoperative morbidity in TOF in whom complete repair was performed.…”

“…The independent predictability of pNLR for the long-term mortality among CABG patients was also discussed and pNLR was found to be directly proportional with mortality. While the five-year mortality in cases with pNLR <2.3 was 8%, 2.3-3.4 was 13% and pNLR ≥3.5 was 20%, [14] Ünal et al [7] calculated a cut-off value of 2.81 for prediction of mortality.…”

“…[1,2] Recently, preoperative neutrophil-lymphocyte ratio (pNLR) which has been suggested as an indicator of inflammatory status has come into view in cardiovascular diseases as a powerful predictor of outcome. [3][4][5][6][7][8] To the best of our knowledge, although pNLR has been suggested as a valuable predictor of mortality in adults. [3][4][5][6][7] the literature is scarce in regard to the predictive value of pNLR on morbidity in a cyanotic pediatric cardiac surgery cohort.…”

“…[3][4][5][6][7][8] To the best of our knowledge, although pNLR has been suggested as a valuable predictor of mortality in adults. [3][4][5][6][7] the literature is scarce in regard to the predictive value of pNLR on morbidity in a cyanotic pediatric cardiac surgery cohort. Therefore, in this study, we aimed to investigate the impact of preoperative pNLR on postoperative morbidity after the complete repair of tetralogy of Fallot (TOF).…”