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

Authors

Keywords:

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

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.

Downloads

Download data is not yet available.

References

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.

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.

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.

Sarkar M, Prabhu V. Basics of cardiopulmonary bypass. Indian J Anaesth. 2017 Sep;61(9):760-767. doi: 10.4103/ija.IJA_379_17.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Downloads

Published

2020-12-01

Issue

Section

Research Article

How to Cite

1.
Şahinalp Şahin, Çeviker K, Soyal M, Gür A. Retrospective evaluation of ultrafiltration during cardiac surgery with cardiopulmonary bypass in adult patients with increased neutrophil to lymphocyte ratio. J Surg Med [Internet]. 2020 Dec. 1 [cited 2022 Aug. 10];4(12):1209-14. Available from: https://jsurgmed.com/article/view/814941