Vol. 45 | No. 2 | July-December 2017 Back

Open Access

Correlation of Preoperative Neutrophil Lymphocyte Ratio with EuroSCORE as a Predictor of In-Hospital Mortality Following an Isolated Coronary Artery Bypass Graft: A 7-year Retrospective Study

Cashmere Malaine C. Sayruddin, Elaine Gallardo
Dec 2017 DOI 10.69944/pjc.73b5f495ff

Abstract

Background Patients undergoing coronary artery bypass graft (CABG) are risk stratified preoperatively by  computing the EuroSCORE. Studies have shown that neutrophil-to-lymphocyte ratio (NLR) is a specific predictor of increased cardiovascular risk. This study aimed to determine the correlation between NLR and EuroSCORE and postoperative in-hospital mortality following isolated CABG. 

Methods This was a seven -year retrospective chart review that included patients who underwent isolated  elective or urgent CABG. The patients’ EuroSCORE was computed based on patient records. Correlation was assessed using Pearson’s correlation test and receiver operating characteristics (ROC) curve analysis was used to determine the optimum cut-off level of preoperative NLR to predict mortality. 

Results Out of the 103 included patients, only seven died (all following urgent CABG). Compared to  survivors, those who died had a higher proportion of diabetes mellitus (DM) (p=0.030), a lower clearance (p=0.024), a higher EuroScore (p<0.001) and a higher NLR (p<0.001). Logistic multivariate analysis showed that only the presence of DM was associated with mortality. A threshold NLR value of 4.7 was able to predict mortality (AUC= 1.0, sensitivity: 43%, specificity: 100%). 

Conclusion NLR is a practical, clinically acceptable biomarker linked to predicting mortality following an  isolated CABG. 

Keywords Neutrophil-to-lymphocyte ratio, EuroSCORE, mortality, CABG.

References
  1. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 2002;105 (9):1135–1143.
  2. Libby P, Ridker PM, Hansson GK; Leducq Transatlantic Network on Atherothrombosis. Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol 2009;54:2129-38.
  3. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003;107:499-511.
  4. Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005;45 (10):1638–1643.
  5. Lee C, Folsom AR, Nieto FJ, Chambless LE, Shahar E, Wolfe DA. White blood cell count and incidence of coronary heart disease and ischemic stroke and mortality from cardiovascular disease in African-American and White men and women: atherosclerosis risk in communities study. Am J Epidemiol 2001;154 (8):758–764.
  6. Haim M, Boyko V, Goldbourt U, Battler A, Behar S. Predictive value of elevated white blood cell count in patients with preexisting coronary heart disease: the Bezafibrate Infarction Prevention Study. Arch Intern Med 2004;164 (4):433–439.
  7. Grau AJ, Boddy AW, Dukovic DA, Buggle F, Lichy C, Brandt T, et al. Leukocyte count as an independent predictor of recurrent ischemic events. Stroke 2004;35:1147-52.
  8. Bagger JP, Zindrou D, Taylor KM. Leukocyte count: a risk factor for coronary artery bypass graft mortality. Am J Med 2003;115:660-3.
  9. Newall N, Grayson AD, Oo AY, Palmer ND, Dihmis WC, Rashid A, et al. 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 2006;81:583-9.
  10. Gibson PH, Croal BL, Cuthbertson BH, Small GR, Ifezulike AI, Gibson G, et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J 2007;154:995-1002.
  11. Ünal EU, Durukan AB, Özen A, Kubat E, Kocabeyoğlu SS, Yurdakök O, et al. Neutrophil/lymphocyte ratio was a mortality predictor following coronary artery bypass graft surgery. Türk Göğüs Kalp Damar Cerrahisi Dergisi 2013;21 (3):588-593.
  12. Ay D, Erdolu B, Yumun G, Aydin U, Demir A, Tiryakioglu O, Vural AH. Comparing the effectiveness of neutrophil lymphocyte ratio as a mortality predictor on middle and advanced age coronary artery bypass graft patients. North Clin Istanbul 2014;1 (2); 95-100.
  13. Nashef SA, Roques F, Michel P, Gauducheau E, LemeshowS, Salamon R. European system for cardiac operativerisk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999;16:9-13.
  14. Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C,Goldstone AR, et al. EuroSCORE II. Eur J Cardiothorac Surg 2012;41:734-44; discussion 744-5.
  15. Gogbashian A, Sedrakyan A, Treasure T. EuroSCORE:a systematic review of international performance. Eur J Cardiothorac Surg 2004;25:695-700.
  16. Metzler B, Winkler B. SYNTAX, STS and EuroSCORE -how good are they for risk estimation in atherosclerotic heartdisease? Thromb Haemost 2012;108:1065-71.
  17. Madjid M, Awan I, Willerson JT, CasscellsSW. Leukocyte count and coronary heart disease: implications for risk assessment. J Am Coll Cardiol 2004;44:1945- 1956.
  18. Grau AJ, Boddy AW, Dukovic DA, et al. Leukocyte count as an independent predictor of recurrent ischemic events. Stroke 2004;35:1147-1152.
  19. Hansson G. Inflammation, atherosclerosis, and coronary heart disease. N Engl J Med 2005;352: 1685-1695.
  20. Ommen SR, Gibbons RJ, Hodge DO, Thomson SP. Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. Am J Cardiol 1997;79:812-4.
License

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.