Can Peroperative Neutrophil To Lymphocyte Ratio Change (Deltanlr) Be Used as a Parameter in Predicting Acute Renal Failure Following Coronary Bypass Operations With Cardiopulmonary Bypass?
Inflammation Change and Postoperative Kidney Injury
Keywords:coronary artery bypass, cardiopulmonary bypass, acute kidney injury, neutrophil to lymphocyte ratio, inflammation
Background: Inflammation plays a significant role in the pathogenesis of many diseases as well as postoperative acute renal failure (ARF). Preoperative neutrophil to lymphocyte ratio (NLR) values have a prognostic value for postoperative ARF after cardiovascular surgeries.
Methods: Patients who underwent elective coronary artery bypass graft (CABG) with cardiopulmonary bypass in our clinic between December 15, 2015 and December 15, 2019, retrospectively were included in this study. Patients who did not develop ARF after the operation were categorized as Group 1, and patients who did were included in Group 2. NLR was calculated from the hemograms during three periods (Preoperative (Pre), Postcardiotomy (Pc),
Postoperative Day 1 (Po1). DeltaNLR1 (PcNLR- PreNLR) and DeltaNLR2 (Po1NLR-PreNLR) values were obtained from these calculated values.
Results: The mean ages of patients in Group 1 (N = 274) and Group 2 (N = 61) were 60 ± 9.1 years and 67.7 ± 9.8 years, respectively (P < .001). In the multivariate analysis, being over 65 years of age (Odds ratio [OR]: 1.074, 95% confidence interval [CI]: 1.012-1.194, P = .030), postoperative inotropic need (OR: 0.678, CI 95%: 0.395-0.819, P = .021), increased blood product use (OR: 0.916, CI 95%: 0.779-0.986,
P = .034), preoperative creatinine increase (OR: 1.974, CI 95%: 1.389-4.224, P = .007), PcNLR (OR : 1.988, CI 95%: 1.765-3.774, P <.001), Po1NLR (OR: 1.090, CI 95%: 1.007-2.116, P = .028), DeltaNLR1 (OR: 3.090, CI 95%: 1.698-6.430, P < .001) and DeltaNLR2 (OR: 1.676, CI 95%: 1.322-2.764, P = .003) were identified as independent predictors for predicting postoperative ARF.
Conclusion: In this study, we have shown that peroperative NLR changes can be used as an effective parameter to predict ARF developing following CABG operations.
Amini S, Najafi MN, Karrari SP, et al. 2019. Risk Factors and Outcome of Acute Kidney Injury after Isolated CABG Surgery: a Prospective Cohort Study. Braz J Cardiovasc Surg. 34(1):70-75.
Bonventre JV, Yang L. 2011. Cellular pathophysiology of ischemic acute kidney injury. J Clin Invest. 121:4210–4221.
Engin M, Aydın C. 2020. Investigation of the Effect of HATCH Score and Coronary Artery Disease Complexity on Atrial Fibrillation After On-Pump Coronary Artery Bypass Graft Surgery. Med Princ Pract. May 18.
Erdolu B, As AK, Engin M. 2020. The Relationship between the HATCH Score, Neutrophil to Lymphocyte Ratio and Postoperative Atrial Fibrillation Afer Oﬀ-Pump Coronary Artery Bypass Graf Surgery. Heart Surg Forum. 23(1):E88-E92.
Freeland K, Hamidian Jahromi A, Duvall LM, et al. 2015. Postoperative blood transfusion is an independent predictor of acute kidney injury in cardiac surgery patients. J Nephropathol. 4(4):121-6.
Granata A, Insalaco M, Di Pietro F, et al. 2012. Atheroembolism renal disease: diagnosis and etiologic factors. Clin Ter. 163(4):313–22.
Karkouti K. 2012. Transfusion and risk of acute kidney injury in cardiac surgery. Br J Anaesth. 109(suppl 1):i29-i38.
Karkouti K, Wijeysundera DN, Yau TM, et al. 2011. Inﬂuence of erythrocyte transfusion on the risk of acute kidney injury after cardiac surgery diﬀers in anemic and nonanemic patients. Anesthesiology. 115(3):523-30.
Kim WH, Park JY, Ok SH, et al. 2015. Association Between the Neutrophil/Lymphocyte Ratio and Acute Kidney Injury After Cardiovascular Surgery: A Retrospective Observational Study. Medicine (Baltimore). 94(43):e1867.
Laffey JG, Boylan JF, Cheng DC. 2002. The systemic inflammatory response to cardiac surgery: Implications for the anesthesiologist. Anesthesiology. 97: 215–252.
Lee SI, Lee SY, Choi CH, et al. 2018. Relation between changes in red blood cell distribution width after coronary artery bypass grafting and early postoperative morbidity. J Thorac Dis.10(7):4244-4254.
Li C, Zhang F, Shen Y, et al. 2017. Impact of Neutrophil to Lymphocyte Ratio (NLR) Index and Its Periprocedural Change (NLRD) for Percutaneous Coronary Intervention in Patients With Chronic Total Occlusion. Angiology. 68(7):640-646.
Parlar H, SaSkın H. 2018. Are Pre and Postoperative Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio Associated with Early Postoperative AKI Following CABG? Braz J Cardiovasc Surg. 33(3):233-241.
Ried M, Puehler T, Haneya A, et al. 2011. Acute kidney injury in septua- and octogenarians after cardiac surgery. BMC Cardiovasc Disord. 11(1):52.
Ronco CBR, Kellum JA. 2007. Acute kidney injury. Contrib Nephrol. 156:340–53
Schopka S, Diez C, Camboni D, et al. 2014. Impact of cardiopulmonary bypass on acute kidney injury following coronary artery bypass grafting: a matched pair analysis. J Cardiothorac Surg. 9(1):20.
Seong YW, Han SJ, Jung W, et al. 2019. Perioperative change in neutrophil-to-lymphocyte ratio (NLR) is a prognostic factor in patients with completely resected primary pulmonary sarcomatoid carcinoma. J Thorac Dis. 11(3):819-826.
Sharfuddin AA, Molitoris BA. 2011. Pathophysiology of ischemic acute kidney injury. Nat Rev Nephrol. 7:189–200.
Takaki S, Shehabi Y, Pickering JW, et al. 2015. Perioperative change in creatinine following cardiac surgery with cardiopulmonary bypass is useful in predicting acute kidney injury: a single-centre retrospective cohort study. Interact Cardiovasc Thorac Surg. 21(4):465-9.
Tumer NB, Kunt AT, Gunaydin S. 2019. Preoperative Urinary pH is Associated with Acute Kidney Injury Afer Cardiac Surgery in Non-Diabetic Patients. Heart Surg Forum. 22(5):E456-E461.
Weedle RC, Da Costa M, Veerasingam D, Soo AWS. 2019. The use of neutrophil lymphocyte ratio to predict complications post cardiac surgery. Ann Transl Med. 7(23):778.
Yilmaz H, Cakmak M, Inan O, et al. 2015. Can neutrophil-lymphocyte ratio be independent risk factor for predicting acute kidney injury in patients with severe sepsis? Ren Fail. 37:225–229.
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).