Neutrophil-Lymphocyte Ratio as a Mortality Predictive Paramater In Patıents Wıth Out-of-Hospital Cardiac Arrest

Yıl 2021, Cilt: 3 Sayı: 1, 15 - 20, 15.04.2021

Belgin Akıllı , Hüseyin Mutlu , Yahya Kemal Günaydın , Ramazan Köylü , Levent Oktar Basar Cander

Öz

Introduction:The rates of out-of-hospital cardiac arrest (OHCA) are increasing day by day in a progressive manner. Despite all the improvements in care after cardiac arrest, the majority of fatalities occur in the first 24-hours following the cardiac arrest.In recent years, the ratio of the peripheral neutrophils to lymphocytes (NLR) has been accepted as a prognostic marker in many diseases. We also aimed to investigate the correlation of the NLR with mortality in patients with OHCA.Methods:The study design was planned by retrospective scanning of all OHCA patients with return of spontaneous circulation(ROSC). The demographic features and laboratory data were recorded. The survival rates for the 24-hours and 14-days were calculated.Results: 91 patients were included out of 191 cases who had returned from OHCA to spontaneous circulation. When the patients who had died and survived in the first 24-hours were compared, significant differences were found between the neutrophil counts, NLR, lactate and arrest rhythms on admission (p<0.05). The survival rates calculated by Kaplan Meier curves were significantly lower in the group with NLR values lower than 3.05 (Log Rank 5.07, p=0.02). With the multivariable Cox-regression model, it was determined that the NLR value being lower than 3.05, is a predictive factor for the 24-hour mortality independent of age, gender, blood lactate and creatinine values and the arrest rhythm on admission (Hazard Ratio: 0.34 (0.15-0.79), p=0.01).Conclusion: Among the OHCA patients with ROSC, low NLR levels on admission is an independent predictor of mortality in the first 24-hours.

Anahtar Kelimeler

emregency, NLR, resuscitation

Kaynakça

• [1]- Kim J., Kim K., Lee JH.,  Jo YH, Rhee JE, Kim TY et al. Red blood cell distribution width as an independent predictor of all-cause mortality in out of hospital cardiac arrest. Resuscitation 2012;83: 1248–52
• [2]-Szymanski F.M., Karpinski G., Filipiak K.J.,  Platek A.E., Hrynkiewicz-Szymanska A., Kotkowski M., et al. Usefulness of the D-Dimer Concentration as a Predictor of Mortality in Patients With Out-of-Hospital Cardiac Arrest. Am J Cardiol 2013;112:467-71
• [3]- Kilgannon JH, Roberts BW, Reihl LR, Chansky ME, Jones AE, Dellinger RP et al. Early arterial hypotension is common in the post-cardiac arrest syndrome and associated with increased in-hospital mortality. Resuscitation 2008;79:410–6,
• [4]- Nolan JP, Neumar RW, Adrie C,  Aibiki M, Berg RA, Böttiger BW, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A ScientificStatement from the International Liaison Committee on Resuscitation; theAmerican Heart Association Emergency Cardiovascular Care Committee;the Council on Cardiovascular Surgery and Anesthesia; the Council onCardiopulmonary, Perioperative, and Critical Care; the Council on Clin-ical Cardiology; the Council on Stroke. Resuscitation 2008;79:350–79,
• [5]- Peberdy MA, Callaway CW, Neumar RW,  Geocadin RG, Zimmerman JL, Donnino M, et al. Part 9: post-cardiac arrest care:2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122:S768-S786
• [6]- Galus MA, Stern J. Extreme lymphocytopenia associated with toxic shock syndrome. J Intern Med 1998;244:351-54
• [7]- Jılma B., Blann A., Pernerstorfer T, Stohlawetz P, Eichler HG, Vondrovec B, et al. Regülation of adhesion molecules during human endotoxemia. Amer J Resp Crit Care Med. 1999;159:857-863
• [8]- Zahorec. Ratio neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflamtion and stres in critically ill. Bratisl Lek Listy 2001;102:5-14
• [9]- Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008;102:653-7
• [10]-Azab B, Zaher M, Weiserbs K, Estelle T. Usefulness of neutrophil to lymphocyte ratio in predicting short and long term mortality after Non-ST elevation myocardial infarction. Am J Cardiol 2010;106:470-6
• [11]- Uthamalingam S, Patvardhan EA, Subramanian S Ahmed W, Martin W, Daley M, et al. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol 2011;107:433-8
• [12]- Kayrak M, Erdoğan Hİ, Solak Y, Akilli H, Gül EE, Yildirim O et al. Prognostic value of neutrophil to lymphocyte ratio in patients with acute pulmonary embolism: A redrospective Study. Heart, Lung and Circulation 2014;23:56-62
• [13]-Conquy MA, Cavaillon JM. Compensatory anti-inflammatory response syndrome. Thromb Haemost 2009; 101: 36–47 [14]-Biswas SK, Lopez-Collazo E. Endotoxin tolerance: new mechanisms, molecules and clinical significance. Trends in Immunology 2009;30: 475-87
• [15]-Bone RC, Grodzin CJ, Balk RA. A New Hypothesis for Pathogenesis of the Disease Process. Chest 1997; 112:235-43
• [16]-Cavaillon JM, Adrie C, Fitting C, Conquy MA. Endotoxin tolerance: is there a clinical relevance? J Endotoxin Res 2003;9:101-7
• [17]-Adrie C, Adib-Conquy M, Laurent I,  Monchi M, Vinsonneau C, Fitting C, et al. Successful cardiopulmonary resuscitation after cardiac arrest as a ‘‘sepsis-like’’ syndrome. Circulation 2002;106:562—8.
• [18]-Adrie C, Laurent I, Monchi M, Cariou A, Dhainaou JF, Spaulding C. Postresuscitation disease after cardiac arrest: a sepsis-like syndrome? Curr Opin Crit Care 2004;10:208-12.
• [19]-Sauneufa B, Bouffarda C, Cornet E,  Daubin C, Desmeulles I, Masson R et al. Communication Immature/total granulocyte ratio: A promising tool to assess theseverity and the outcome of post-cardiac arrest syndrome. Resuscitation. 2014 ;85:1115-9
• [20]-Stub D, Bernard S, Duffy SJ, Kaye DM. Post Cardiac Arrest Syndrome: A Review of Therapeutic Strategies Circulation 2011;123:1428-1435 [21]-Vasileiou PVS, Xanthos T, Barouxis D, Pantazopoulos C, Papalois AE, Lelovas P et al. Erythropoietin administration facilitates return of spontaneous circulation and improves survival in a pig model of cardiac arrest. Am J Emerg Med. 2014;32:871-7
• [22]-Dell’anna AM, Vinotti JB, Beumier M, Orbegozo-Cortes D, Donadello K, Scolletta S et al. C-reactive protein levels after cardiac arrest in patients treated with therapeutic hypothermia. Resuscitation. 2014 ;85:932-8.
• [23]-Annborna M, Dankiewicza J, Erlinge D, Hertel S, Rundgren M, Smith JG, et al. Procalcitonin after cardiac arrest – An indicator of severity of illness, ischemia-reperfusion injury and outcome. Resuscitation 2013;84:782–87.