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

Abstract

The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasing, but mortality remains high. Early assessment of prognosis is challenging and valid markers are lacking. This study aimed to investigate Neutrophil–Lymphocyte Ratio (NLR), Platelet-Lymphocyte-Ratio (PLR) and Procalcitonin (PCT) for early assessment of prognosis in patients undergoing VA-ECMO. This retrospective single-center cohort study included 344 consecutive patients ≥ 18 years who underwent VA-ECMO due to cardiogenic shock. Main exposures were NLR, PLR and PCT measured within 24 h after VA-ECMO initiation. The primary endpoint was all-cause in-hospital mortality. In total, 92 patients were included into final analysis (71.7% male, age 57 ± 14 years). In-hospital mortality rate was 48.9%. Receiver operating characteristics (ROC) curve revealed an area under the curve (AUC) of 0.65 [95% confidence interval (CI) 0.53–0.76] for NLR. The AUCs of PLR and PCT were 0.47 [95%CI 0.35–0.59] and 0.54 [95%CI 0.42–0.66], respectively. Binary logistic regression showed an adjusted odds ratio of 3.32 [95%CI 1.13–9.76] for NLR, 1.0 [95%CI 0.998–1.002] for PLR and 1.02 [95%CI 0.99–1.05] for PCT. NLR is independently associated with in-hospital mortality in patients undergoing VA-ECMO. However, discriminative ability is weak. PLR and PCT seem not to be suitable for this purpose.

Neutrophile-to-Lymphocyte Ratio (NLR) Identifies Patients with Coronavirus Infectious Disease 2019 (COVID-19) at High Risk for Deterioration and Mortality—A Retrospective, Monocentric Cohort Study

“…As shown by Lin and coworkers, both hematological markers are subjected to different extent by genetic and environmental factors, including BMI and smoking status, whereas the association between inflammatory markers (e.g., CRP and interleukin-6) was low [22]. The limited prognostic yield of PLR has also been reported in patients undergoing extracorporeal membrane oxygenation due to respiratory failure and cardiogenic shock [23]. Consistent with these and other findings, the NLR seems to be superior to the PLR in terms of predicting disease severity and mortality in patients with COVID-19 [24].…”

Oncostatin M for characterizing the inflammatory burden and outcome of V‐V ECMO in ARDS patients

“…7 In this study, the number of circulating cells known to be sources of OSM (neutrophils, lymphocytes, and monocytes) were not different between group A and B despite a clear difference in pOSM levels (Tables 1A and 1B). Consequently, the NLR and PLR that have been widely reported as markers of outcomes of ECMO support [18][19][20] did not show any difference between group A and B or those who survived and those who died (Figure 3C,D). The possibility that this initial study may differ from the reported studies may be attributed to the number of patients, etiology/type of pathogens, underlying diseases, administered medications (such as glucocorticoids), and the stage of disease progression.…”