Predictive value of neutrophil to lymphocyte ratio on acute kidney injury after on-pump coronary artery bypass: a retrospective, single-center study

Abstract

Objective To investigate the predictive value of preoperative neutrophil to lymphocyte ratio (NLR) on acute kidney injury (AKI) after on-pump coronary artery bypass (ONCAB). Methods Patients who underwent elective ONCAB for coronary heart disease were included. NLR was calculated according to the results of preoperative routine blood test, patients were divided into non-AKI and AKI groups, and the differences in clinical baseline data between the two groups were compared. Results A total of 154 patients were included in this study, including 57 (37%) with postoperative AKI and 97 (63%) without AKI. Compared with the patients in non-AKI group, those in AKI group had higher NLR (2.63 (1.83, 3.505) vs. 2.06 (1.7, 2.56), p = 0.002), higher serum creatinine (78 (67, 98.5) vs. 70.9 ± 16.8 umol/L, p < 0.001), longer cardiopulmonary bypass time, and longer aortic cross clamp time. After dividing patient into tertiles based on NLR, those with higher NLR had higher risk of postoperative AKI than those with lower NLR (30% vs. 25% vs. 55.8%, p for trend = 0.003). Patients in Tertile2 and Tertile3 had higher NLR compared to those in Tertile1 (p < 0.05); multivariate logistic regression analysis showed patients with elevated preoperative NLR and blood creatinine had higher risk of postoperative AKI. ROC curve showed that patients’ preoperative NLR combined with blood creatinine had better predictive value for postoperative AKI. Conclusion Elevated preoperative NLR is associated with AKI after ONCAB, and had prognostic utility independent of other recognized risk factors.

The prognostic value of elevated neutrophil–lymphocyte ratio for cardiac surgery‐associated acute kidney injury: A systematic review and meta‐analysis

“…From 10 studies 41–50 involving 7660 patients, we found a statistically significant association between elevated preoperative NLR and postoperative AKI (OR 1.45, 95% CI 1.18–1.77) (Figure 2).…”

“…Twelve studies 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 involving 10,724 participants undergoing cardiac surgery were included. Detailed characteristics of included studies can be found in Table 1 .…”

“…Four studies 39 , 40 , 42 , 49 were deemed at low risk of bias; the remaining eight studies were deemed high risk. The complete PROBAST assessment can be found in the Supporting Information.…”

“…Inter‐study statistical heterogeneity was substantial ( I 2 statistic 93.5%). All but two studies 42 , 49 were deemed to have high risk of bias in one PROBAST domain. We explored potential sources of heterogeneity using meta‐regression.…”

Syndecan-1 as a marker to predict acute kidney injury after isolated coronary artery bypass graft operations

“…Neutrophil lymphocyte ratio (NLR) is one of the most commonly used parameters. In a recent study, it was shown that a preoperative high NLR value could predict the risk of AKI after CABG operations accompanied by CPB 3 . Syndecan-1 (SDC-1) is an important indicator of endothelial glycocalyx damage, which plays an important role in the pathophysiology of AKI 4 .…”