Preoperative Platelet to Lymphocyte Ratio Is Associated with Early Morbidity and Mortality after Coronary Artery Bypass Grafting
AbstractObjective: To investigate the association of platelet to lymphocyte ratio to mortality and morbidity after coronary artery bypass grafting operation.
Methods: We evaluated records of 916 patients who underwent coronary artery bypass grafting operation between January 2009 and May 2014 retrospectively. Patients were grouped as Group 1 (n = 604) if the platelet to lymphocyte ratio was above 142 and Group 2 (n = 312) if platelet to lymphocyte ratio was below 142.
Results: The number of patients who developed a neurologic event during the hospital stay and in the first postoperative month was 7 (1.2%) in Group 1 and 12 (3.8%) in Group 2 for which the difference was statistically significant (P = .007). Early term mortality occurred in 3 patients (0.5%) in Group 1 and in 10 patients (3.2%) in Group 2 for which the difference was statistically highly significant (P = .001). In univariate and multivariate regression analysis, the preoperative platelet to lymphocyte ratio was determined as an independent risk factor for occurrence of atrial fibrillation in the early postoperative period, reoperation for sternum dehiscence, occurrence of a neurologic event, prolonged stay in the hospital and mortality.
Conclusion: In this study, elevated levels of platelet to lymphocyte ratio were associated with mortality and morbidity after coronary artery bypass grafting operation.
Aghdaii N, Ferasatkish R, Mohammadzadeh Jouryabi A, Hamidi SH. 2014. Significance of preoperative total lymphocyte count as a prognostic criterion in adult cardiac surgery. Anesth Pain Med 4:e20331.
Azab B, Shah N, Akerman M, McGinn JT Jr. 2012. Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST elevation myocardial infarction. J Thromb Thrombolysis 34:326-34.
Bagger JP, Zindrou D, Taylor KM. 2003. Leukocyte count: a risk factor for coronary artery bypass graft mortality. Am J Med 115:660-3.
Baetta R, Corsini A. 2010. Role of polymorphonuclear neutrophils in atherosclerosis: current state and future perspectives. Atherosclerosis 210:1-13.
Benites-Zapata VA, Hernandez AV, Nagarajan V, Cauthen CA, Starling RC, Tang WH. 2015. Usefulness of neutrophil-to-lymphocyte ratio in risk stratification of patients with advanced heart failure. Am J Cardiol 115:57-61.
Bhat T, Teli S, Rijal J, et al. 2013. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther 11:55-9.
Bhatti I, Peacock O, Lloyd G, Larvin M, Hall RI. 2010. Preoperative hematologic markers as independent predictors of prognosis in resected pancreatic ductal adenocarcinoma: neutrophil-lymphocyte versus platelet-lymphocyte ratio. Am J Surg 200:197-203.
Caligiuri G, Liuzzo G, Biasucci LM, Maseri A. 1998. Immune system activation follows inflammation in unstable angina: pathogenetic implications. J Am Coll Cardiol 32:1295-304.
Davi G, Patrono C. 2007. Platelet activation and atherothrombosis. N Engl J Med 357:2482-94.
De Cocker J, Messaoudi N, Stockman BA, Bossaert LL, Rodrigus IE. 2011. Preoperative prediction of intensive care unit stay following cardiac surgery. Eur J Cardiothorac Surg 39:60-7.
Dernellis J, Panaretou M. 2006. Effects of C-reactive protein and the third and fourth components of complement (C3 and C4) on incidence of atrial fibrillation. Am J Cardiol 97:245-8.
Gary T, Pichler M, Belaj K, at al. 2013. Platelet-to-lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS One 8:e67688.
Gary T, Pichler M, Belaj K, et al. 2013. Neutrophil-to-lymphocyte ratio and its association with critical limb ischemia in PAOD patients. PLoS One 8:e56745.
Gibson PH, Croal BL, Cuthbertson BH, et al. 2007. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J 154:995-1002.
Gibson PH, Cuthbertson BH, Croal BL, et al. 2010. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 105:186-91.
Hansson GK. 2005. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 352:1685-9.
Horne BD, Anderson JL, John JM, et al. 2005. Intermountain Heart Collaborative Study Group. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 45:1638-43.
Kaya MG. 2013. Editorial comment: Inflammation and coronary artery disease: as a new biomarker neutrophil/lymphocyte ratio. Arch Turk Soc Cardiol 41:191-2.
Kundi H, Balun A, Çiçekcioğlu H, et al. 2015. Association between platelet to lymphocyte ratio and saphenous vein graft disease in patients with stable angina pectoris. Anatol J Cardiol doi: 10.5152/akd.2015.6224.
Kwon HC, Kim SH, Oh SY, et al. 2012. Clinical significance of preoperative neutrophil-lymphocyte versus platelet-lymphocyte ratio in patients with operable colorectal cancer. Biomarkers 17:216-22.
Libby P, Ridker PM, Maseri A. 2002. Inflammation and atherosclerosis. Circulation 105:1135-43.
Libby P, Ridker PM, Hansson GK. 2009. Leducq transatlantic network on atherothrombosis. Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol 54:2129-38.
Min JJ, Nam K, Kim TK, et al. 2014. Relationship between early postoperative C-reactive protein elevation and long-term postoperative major adverse cardiovascular and cerebral events in patients undergoing off-pump coronary artery bypass graft surgery: a retrospective study. Br J Anaesth 113:391-401.
Newall N, Grayson AD, Oo AY, at al. 2006. Preoperative white blood cell count is independently associated with higher perioperative cardiac enzyme release and increased 1-year mortality after coronary artery bypass grafting. Ann Thorac Surg 81:583-9.
Ommen SR, Gibbons RJ, Hodge DO, Thomson SP. 1997. Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. Am J Cardiol 79:812-4.
Oylumlu M, Yıldız A, Oylumlu M, et al. 2015. Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality patients with acute coronary syndrome. Anadolu Kardiyol Derg 15:277-83.
Pinna Pintor P, Bobbio M, Colangelo S, Veglia F, Marras R, Diena M. 2003. Can Euroscore predict direct costs of cardiac surgery? Eur J Cardiothorac Surg 23:595-8.
Proctor MJ, Morrison DS, Talwar D, et al. 2011. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer 47:2633-41.
Temiz A, Gazi E, Güngör Ö, et al. 2014. Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with ST-elevated myocardial infarction. Med Sci Monit 20:660-5.
Thomson SP, McMahon LJ, Nugent CA. 1980. Endogenous cortisol: a regulator of the number of lymphocytes in peripheral blood. Clin Immunol Immunopathol 17:506-14.
Unal D, Eroglu C, Kurtul N, Oguz A, Tasdemir A. 2013. Are neutrophil/lymphocyte and platelet/lymphocyte rates in patients with non-small cell lung cancer associated with treatment response and prognosis? Asian Pac J Cancer Prev 14:5237-42.
Ünal EU, Durukan AB, Özen A, et al. 2013. Neutrophil/lymphocyte ratio as a mortality predictor following coronary artery bypass graft surgery. Turk Gogus Kalp Dama 21:588-93.
Wang D, Yang JX, Cao DY, et al. 2013. Preoperative neutrophil-
lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma. Onco Targets Ther 6:211-6.
Yayla Ç, Canpolat U, Akyel A, et al. 2015. Association between platelet to lymphocyte ratio and saphenous vein graft disease angiology. pii: 0003319715578258. [Epub ahead of print].
Yüksel M, Yıldız A, Oylumlu M, et al. 2014. The association between platelet/lymphocyte ratio and coronary artery disease severity. Anadolu Kardiyol Derg doi: 10.5152/akd.2014.5565. [Epub ahead of print].
Zouridakis EG, Garcia-Moll X, Kaski JC. 2000. Usefulness of the blood lymphocyte count in predicting recurrent instability and death in patients with unstable angina pectoris. Am J Cardiol 86:449-51.