Retrospective Evaluation of the Pre- and Postoperative Neutrophil-Lymphocyte Ratio as a Predictor of Mortality in Patients Who Underwent Coronary Artery Bypass Grafting

Abstract

Background: We aimed to investigate the neutrophil-lymphocyte ratio (NLR) as a predictor of mortality in patients, who had undergone on-pump and off-pump coronary artery bypass grafting (CABG). Methods: This retrospective study comprised of 457 patients, who underwent CABG (323 on-pump and 134 off-pump) between January 2014 and October 2019. Preoperative, postoperative (PO) 1st hour, PO 1st day, and PO 5th day neutrophil-lymphocyte ratios were calculated. The patients were compared, according to demographic, laboratory, and clinical data. A receiver operating characteristics curve was applied to estimate a cut-off value of NLR for mortality. Results: The on-pump group was older (P = 0.001), had a lower Euroscore II (P = 0.036), had a higher graft number (P < 0.001), intensive care unit stay (P = 0.001), and all PO NLRs, except preoperative NLR. There were 14 (3.06%) patients with mortality. Overall (N = 457), PO 1st hour (P = 0.001), PO 1st day (P < 0.001), and PO 5th day (P = 0.016) NLRs were considerably higher in patients with mortality. While none of the NLRs revealed a significant difference in the off-pump group, PO 1st hour (P = 0.004) PO 1st day (P < 0.001), and PO 5th day (P = 0.007) NLRs were higher in patients with mortality in the on-pump group. The increase in odds ratio of PO NLR was higher in patients with mortality in the overall group of PO 1st day and in the on-pump group of PO 1st hour and PO 1st day. The best combination of sensitivity and specificity was reached at a cut-off value of 6.4 for PO 1st hour NLR and 31.8 for PO 1st day NLR. Conclusions: As in indicator of inflammatory state, NLR readily can be used as a predictor of mortality. Regardless of the CABG technique used, postoperative 1st hour and postoperative 1st day NLR >6.4 and 31.8, respectively, are highly related to mortality.

Low-grade inflammation in the prognosis of patients undergoing coronary artery bypass grafting: the value of neutrophil-to-lymphocyte ratio (NLR) and growth differentiation factor 15 (GDF15)

“…In addition, the NLR value above 2.675 prior to the CABG operation was associated with the insolvency of the subcutaneous vein transplant, but this study [22] failed to achieve the required level of statistical signi cance (p = 0.075). In another study [24], increases in NLR > 6.4 and 31.8 in the rst hour and day after surgery, respectively, were closely related to mortality.…”

“…According to the literature, the neutrophil-to-lymphocyte ratio (NLR) predicts the development of postpericardiotomy syndrome (PPS) [16], atrial brillation (AF) [17,18], acute kidney injury (AKI) [19,20], saphenous vein graft failure [21,22], ischemic stroke (IS) [23] and even early postoperative mortality [24][25][26] after CABG. Therefore, NLR is a promising marker of prognosis for patients after CABG.…”

The Role of «Novel» Biomarkers of Systemic Inflammation in the Development of Early Hospital Events after Aortic Valve Replacement in Patients with Aortic Stenosis

“…The NLR was proposed as a straightforward marker of inflammation that is useful for the long-term prognosis in ischemic heart disease and as a prognostic risk factor for the development of postoperative complications, POAF, and mortality after cardiovascular surgery [ 26 , 27 , 28 , 29 , 30 ]. Neutrophils are participants of the inflammatory response.…”

Hemoglobin/Red Cell Distribution Width Ratio is Associated With Poor Prognosis in Patients With Acute Coronary Syndrome in Long-Term Follow-Up

“…The prognostic importance of complete blood count parameters (neutrophil/ lymphocyte ratio, platelet/lymphocyte ratio, mean platelet volume, and neutrophil/monocyte) in coronary artery disease (CAD) has been demonstrated in many studies. [10][11][12] Hemoglobin (Hb) is generally used to define anemia along with other parameters such as hematocrit. However, recent works suggest that Hb is also a predictor of hospital admission of subjects with chronic diseases.…”