Retrospective evaluation of ultrafiltration during cardiac surgery with cardiopulmonary bypass in adult patients with increased neutrophil to lymphocyte ratio

Year 2020, Volume: 4 Issue: 12, 1209 - 1214, 01.12.2020

Şahin Şahinalp , Kadir Çeviker , M.f.tolga Soyal , Ali Gür

https://doi.org/10.28982/josam.814941

Cited By: 1

Abstract

Aim: The aim of this study was to investigate the efficacy of the ultrafiltration (UF) in adult patients undergoing open-heart surgery with cardiopulmonary bypass (CPB) by evaluating the neutrophil to lymphocyte ratio (NLR).
Methods: A retrospective case-control study was conducted on 288 adult patients who underwent CPB in a University hospital from January 2016 to December 2018. The study groups were composed of a control group (n=116) of patients who underwent surgery without UF and the study group (n=172) of patients who underwent surgery with UF. All perioperative clinical data, including neutrophil, lymphocyte and platelet count, BUN, creatinine, and C-reactive protein (CRP) values were collected. The efficacy of UF and its association with NLR, neutrophil, lymphocyte and platelet count, postoperative bleeding, extubation time, duration of intensive care unit (ICU) stay and in-hospital stay were analyzed.
Results: Neutrophil count, NLR and CRP significantly increased post-operatively compared to pre-operative values (P<0.05). The increased post-operative levels of NLR and decreased platelet counts were significantly associated with UF (P<0.05). Multivariate linear regression analysis revealed that elevated NLR was significantly and independently associated with UF.
Conclusion: UF followed by CPB in adult patients undergoing cardiac surgery was associated with increased post-operative NLR and low platelet counts, which nonetheless, were not associated with postoperative complications. UF should be chosen only for selective patients with low hematocrit and should not be chosen to attenuate whole body inflammatory response after CPB in adult cardiac surgery patients.

Keywords

adult patients, cardiopulmonary bypass, ultrafiltration, neutrophil lymphocyte ratio, platelet, inflammation

Erişkin hastalarda kardiyopulmoner baypas ile uygulanan konvansiyonel ultrafiltrasyonun nötrofil / lenfosit oranı ile retrospektif olarak değerlendirilmesi

Abstract

Amaç: Bu çalışmanın amacı, nötrofil / lenfosit oranını (NLO) değerlendirerek, kardiyopulmoner baypas (CPB) ile açık kalp cerrahisi geçiren yetişkin hastalarda ultrafiltrasyonun (UF) etkinliğini araştırmaktır.
Yöntemler: Ocak 2016'dan Aralık 2018'e kadar bir Üniversite hastanesinde CPB uygulanan 288 yetişkin hasta üzerinde retrospektif bir kohort çalışması yapılmıştır. Nötrofil, lenfosit ve trombosit sayısı, BUN, kreatinin ve C-reaktif protein (CRP) dahil olmak üzere tüm perioperatif klinik veriler geriye dönük olarak toplandı. UF'nin etkinliği ve NLO, nötrofil, lenfosit ve trombosit sayısı, postoperatif kanama, ekstübasyon süresi, yoğun bakım ünitesinde (YBÜ) kalış süresi ve hastanede kalış süresi ile ilişkisi analiz edildi.
Bulgular: Nötrofil sayısı, NLO ve CRP ameliyat öncesi değerlere göre ameliyat sonrası anlamlı olarak arttı (P<0,05). Ameliyat sonrası artan NLO seviyeleri ve azalmış trombosit sayıları UF ile anlamlı olarak ilişkili idi (P<0,05). Çok değişkenli doğrusal regresyon analizi, yükselmiş NLR’nin UF ile anlamlı ve bağımsız olarak ilişkili olduğunu ortaya çıkarmıştır.
Sonuç: Açık kalp cerrahisi uygulanan yetişkin hastalarda UF uygulamaları, artmış postoperatif NLO ve düşük trombosit sayıları ile ilişkiliydi, ancak yine de postoperatif komplikasyonlarla ilişkili değildi. UF, yalnızca düşük hematokriti olan seçici hastalar için seçilmeli ve yetişkin kalp cerrahisi hastalarında CPB'den sonra tüm vücut enflamatuar yanıtını hafifletmek için seçilmemelidir.

Keywords

Erişkin hasta, Kardiyo-pulmoner baypas, Ultrafiltrasyon, Nötrofil lenfosit oranı, Trombosit, Enflamasyon

References

• 1. Laffey JG, Boylan JF, Cheng DC. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology. 2002 Jul;97(1):215-52. doi: 10.1097/00000542-200207000-00030.
• 2. Wan S, LeClerc JL, Vincent JL. Inflammatory response to cardiopulmonary bypass: mechanisms involved and possible therapeutic strategies. Chest. 1997 Sep;112(3):676-92. doi: 10.1378/chest.112.3.676.
• 3. Allan CK, Newburger JW, McGrath E, Elder J, Psoinos C, Laussen PC, et al. The relationship between inflammatory activation and clinical outcome after infant cardiopulmonary bypass. Anesth Analg. 2010 Nov;111(5):1244-51. doi: 10.1213/ANE.0b013e3181f333aa.
• 4. Sarkar M, Prabhu V. Basics of cardiopulmonary bypass. Indian J Anaesth. 2017 Sep;61(9):760-767. doi: 10.4103/ija.IJA_379_17.
• 5. Chew MS. Does modified ultrafiltration reduce the systemic inflammatory response to cardiac surgery with cardiopulmonary bypass? Perfusion. 2004;19 Suppl 1:S57-60. doi: 10.1191/0267659104pf719oa.
• 6. Gaynor JW. Use of ultrafiltration during and after cardiopulmonary bypass in children. J Thorac Cardiovasc Surg. 2001 Aug;122(2):209-11. doi: 10.1067/mtc.2001.115925.
• 7. Mongero LB, Tesdahl EA, Stammers A, Weinstein S. The influence of ultrafiltration on red blood cell transfusion during cardiopulmonary bypass. Perfusion. 2019 May;34(4):303-309. doi: 10.1177/0267659118821026.
• 8. Song J, Zheng Q, Ma X, Zhang Q, Xu Z, Zou C, et al. Predictive Roles of Neutrophil-to-Lymphocyte Ratio and C-Reactive Protein in Patients with Calcific Aortic Valve Disease. Int Heart J. 2019 Mar 20;60(2):345-351. doi: 10.1536/ihj.18-196.
• 9. Özer A, Mardin B, Kılıç Y, Oktar L, İriz E, Arslan M, et al. The effect of neutrophil-lymphocyte ratio on the postoperative course of coronary artery bypass graft surgery. Turk J Med Sci. 2018 Oct 31;48(5):1036-1040. doi: 10.3906/sag-1804-94.
• 10. Mongero L, Stammers A, Tesdahl E, Stasko A, Weinstein S. The effect of ultrafiltration on end-cardiopulmonary bypass hematocrit during cardiac surgery. Perfusion. 2018 Jul;33(5):367-374. doi: 10.1177/0267659117747046.
• 11. Aldemir M, Baki ED, Adali F, Çarşanba G, Tecer E, Taş HU. Comparison of neutrophil:lymphocyte ratios following coronary artery bypass surgery with or without cardiopulmonary bypass. Cardiovasc J Afr. 2015 Jul-Aug;26(4):159-64. doi: 10.5830/CVJA-2015-015.
• 12. Rex S, Brose S, Metzelder S, de Rossi L, Schroth S, Autschbach R, et al. Normothermic beating heart surgery with assistance of miniaturized bypass systems: the effects on intraoperative hemodynamics and inflammatory response. Anesth Analg. 2006 Feb;102(2):352-62. doi: 10.1213/01.ane.0000194294.67624.1a.
• 13. Hatemi AC, Çeviker K, Tongut A, Özgöl İ, Mert M, Kaya A. Oxidant Status following Cardiac Surgery with Phosphorylcholine-Coated Extracorporeal Circulation Systems. Oxid Med Cell Longev. 2016;2016:3932092. doi: 10.1155/2016/3932092.
• 14. Al-Ruzzeh S, Ambler G, Asimakopoulos G, Omar RZ, Hasan R, Fabri B, et al. United Kingdom Multi-Center Comparative Analysis of Early Clinical Outcome. Off-Pump Coronary Artery Bypass (OPCAB) surgery reduces risk-stratified morbidity and mortality: a United Kingdom Multi-Center Comparative Analysis of Early Clinical Outcome. Circulation. 2003 Sep 9;108 Suppl 1:II1-8. doi: 10.1161/01.cir.0000087440.59920.a1.
• 15. Valtonen M, Vähäsilta T, Kaila-Keinänen T, Kuttila K. New mini-extracorporeal circulation system (ECC.O) is a safe technique in coronary surgery. Scand Cardiovasc J. 2007 Oct;41(5):345-50. doi: 10.1080/14017430701446933.
• 16. Elçi ME, Kahraman A, Mutlu E, İspir CS. Effects of Minimal Extracorporeal Circulation on the Systemic Inflammatory Response and the Need for Transfusion after Coronary Bypass Grafting Surgery. Cardiol Res Pract. 2019 Jun 4;2019:1726150. doi: 10.1155/2019/1726150.
• 17. Torina AG, Silveira-Filho LM, Vilarinho KA, Eghtesady P, Oliveira PP, Sposito AC, et al. Use of modified ultrafiltration in adults undergoing coronary artery bypass grafting is associated with inflammatory modulation and less postoperative blood loss: a randomized and controlled study. J Thorac Cardiovasc Surg. 2012 Sep;144(3):663-70. doi: 10.1016/j.jtcvs.2012.04.012.
• 18. Soliman R, Fouad E, Belghith M, Abdelmageed T. Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery. Ann Card Anaesth. 2016 Jan-Mar;19(1):45-51. doi: 10.4103/0971-9784.173019.
• 19. Xu H, Sun Y, Zhang S. The Relationship Between Neutrophil to Lymphocyte Ratio and Clinical Outcome in Pediatric Patients After Cardiopulmonary Bypass Surgery: A Retrospective Study. Front Pediatr. 2019 Jul 31;7:308. doi: 10.3389/fped.2019.00308.
• 20. Giakoumidakis K, Fotos NV, Patelarou A, Theologou S, Argiriou M, Chatziefstratiou AA, et al. Perioperative neutrophil to lymphocyte ratio as a predictor of poor cardiac surgery patient outcomes. Pragmat Obs Res. 2017 Feb 15;8:9-14. doi: 10.2147/POR.S130560.
• 21. Bogă M, Islamoğlu, Badak I, Cikirikçioğlu M, Bakalim T, Yağdi T, et al. The effects of modified hemofiltration on inflammatory mediators and cardiac performance in coronary artery bypass grafting. Perfusion. 2000 Mar;15(2):143-50. doi: 10.1177/026765910001500209.
• 22. Weerasinghe A, Taylor KM. The platelet in cardiopulmonary bypass. Ann Thorac Surg. 1998 Dec;66(6):2145-52. doi: 10.1016/s0003-4975(98)00749-8.
• 23. Kiziltepe U, Uysalel A, Corapcioglu T, Dalva K, Akan H, Akalin H. Effects of combined conventional and modified ultrafiltration in adult patients. Ann Thorac Surg. 2001 Feb;71(2):684-93. doi: 10.1016/s0003-4975(00)02518-2.