Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting

Schlant R.C., Forman S., Stamler J., Canner P.L.

Croal B.L., Hillis G.S., Gibson P.H., Fazal M.T., El-Shafei H., Gibson G., Jeffrey R.R., Buchan K.G., West D., Cuthbertson B.H.

Background— Cardiac surgery may be associated with significant perioperative and postoperative morbidity and mortality. Underlying pathology, surgical technique, and postoperative complications may all influence outcome. These factors may be reflected as a rise in postoperative troponin levels. Interpretation of troponin levels in this setting may therefore be complex. This study assessed the prognostic significance of such measurements, taking into account potential confounding variables. Methods and Results— One-thousand three hundred sixty-five patients undergoing cardiac surgery underwent measurement of cardiac troponin I (cTnI) at 2 and 24 hours after surgery. The relationship of these measurements to subsequent mortality was established. After taking into account all other variables, cTnI levels measured at 24 hours were independently predictive of mortality at 30 days (odds ratio [OR] 1.14 per 10 μg/L, 95% confidence interval [CI] 1.05 to 1.24, P =0.002), 1 year (OR 1.10 per 10 μg/L, 95% CI 1.03 to 1.18, P =0.006), and 3 years (OR 1.07 per 10 μg/L, 95% CI 1.00 to 1.15, P =0.04). Cardiac TnI levels in the highest quartile at 24 hours were associated with a particularly poor outcome. Conclusions— cTnI levels measured 24 hours after cardiac surgery predict short-, medium-, and long-term mortality and remain independently predictive when adjusted for all other potentially confounding variables, including operation complexity.

Biancari F., Kangasniemi O., Luukkonen J., Vuorisalo S., Satta J., Pokela R., Juvonen T.

The European system for cardiac operative risk evaluation score (EuroSCORE) has been shown to be of value in identifying patients at high risk for adverse immediate postoperative outcome after adult cardiac surgery. The aim of the present study was to evaluate EuroSCORE in predicting the 12-year outcome of patients who underwent on-pump coronary artery bypass surgery (CABG).We calculated the EuroSCORE in 917 patients who underwent CABG. The median follow-up was 11.7 years.Both additive and logistic EuroSCORE had an area under the receiver operating characteristic curve of 0.856 for prediction of 30-day postoperative death. Among 912 operative survivors, the 10-year survival rates according to quintiles of additive EuroSCORE were 87.9%, 83.9%, 85.2%, 76.0%, and 51.3% (p < 0.0001). The 10-year survival rates according to quintiles of logistic EuroSCORE were 87.9%, 85.4%, 86.5%, 76.9%, and 58.9% (p < 0.0001).EuroSCORE is a relevant predictor of immediate and late outcome after on-pump CABG.

Duffy B.K., Gurm H.S., Rajagopal V., Gupta R., Ellis S.G., Bhatt D.L.

The neutrophil to lymphocyte (N/L) ratio is a recently described independent predictor of death/myocardial infarction in patients who have undergone coronary angiography. We hypothesized that an elevated N/L ratio would be a predictor of long-term mortality in patients undergoing percutaneous coronary intervention (PCI). A total of 1,046 patients who underwent PCI were divided into tertiles based on their preprocedural N/L ratio (mean N/L ratio, tertile 1, 1.7 +/- 0.5; tertile 2: 3.2 +/- 0.6; tertile 3, 11.2 +/- 12.9). Vital status was assessed using the Social Security Death Index. There were a total of 144 deaths over a mean follow-up of 32 months. The best survival was seen in tertile 1, with an increase in long-term mortality seen in tertiles 2 and 3 (p

Newall N., Grayson A.D., Oo A.Y., Palmer N.D., Dihmis W.C., Rashid A., Stables R.H.

Elevated preprocedural systemic markers of inflammation, including white blood cell count, have been associated with adverse clinical outcomes after percutaneous coronary intervention. The relationship between preoperative white blood cell count and clinical outcomes after coronary artery bypass grafting is less clear despite increasing evidence that neutrophils participate in reperfusion injury. We sought to determine the relationship between preoperative white blood cell count and in hospital major morbidity and 1-year survival after coronary artery bypass grafting.We prospectively studied 3,024 consecutive isolated coronary artery bypass graft procedures. Preoperative white blood cell count was determined by automated counter, perioperative cardiac enzyme release by the creatine kinase-myocardial band isoenzyme, and all-cause mortality over the first postoperative year taken from a national death registry. Multivariate logistic regression and Cox proportional hazards analyses were performed.Preoperative white blood cell count offered as a continuous variable and as five predetermined groups was independently associated with cardiac enzyme release three or more times the upper limit of the reference range (adjusted odds ratio = 1.5 per 10 x 10(9)/L increase, 95% confidence interval: 1.2 to 2.0, p = 0.002) and higher 1-year mortality (adjusted hazard ratio = 1.6 per 10 x 10(9)/L increase, 95% confidence interval: 1.2 to 2.1, p < 0.001).Higher preoperative white blood cell count is independently associated with higher perioperative myonecrosis and 1-year mortality after coronary artery bypass grafting.

Gasz B., Lenard L., Benko L., Borsiczky B., Szanto Z., Lantos J., Szabados S., Alotti N., Papp L., Roth E.

<i>Objective:</i> Leukocyte activation is thought to be responsible for the adverse effects and postoperative complications following cardiopulmonary bypass (CPB). A novel cell surface molecule, CD97, is a sensitive marker of leukocyte and primary lymphocyte activation. The present study aimed to determine the activation of different leukocyte subsets by comparing the expression of CD97 and adhesion molecules (CD11, CD18) in patients receiving coronary surgery with or without CPB. <i>Methods:</i> 30 patients were enrolled and scheduled for coronary bypass surgery under CPB (20 patients, group A) and with off-pump (OP) operation (10 patients, group B). Blood samples were taken before and during surgery, and over the following first week. <i>Results:</i> Here, we report an early decrease in CD97 expression of granulocytes (PMN) and monocytes (MC) followed by an intensive increase reaching the maximum on postoperative days 2 and 3 in patients operated with CPB. The rate of active CD97-positive lymphocytes showed a marked, gradual increase until postoperative day 3 and remained elevated up to day 7 after CPB. OP surgery resulted in moderate alteration in the presence of CD97 on PMN, MC and lymphocytes. The expression of adhesion molecules was similar to CD97 in all leukocyte subsets. <i>Conclusion:</i> The findings about CD97 expression suggest considerable leukocyte activation following coronary bypass with CPB compared to OP surgery. The collected data show that the lymphocytes are highly activated and involved in leukocyte sequestration after CPB. Moreover, the importance of CD97 in CPB-related inflammatory response can be stated.

Upadhya B., Applegate R.J., Sane D.C., Deliargyris E.N., Kutcher M.A., Gandhi S.K., Baki T.T., Call J.T., Little W.C.

Elevation of white blood cells (WBCs) is associated with worse outcomes in patients with coronary artery disease (CAD), including patients undergoing percutaneous coronary intervention (PCI) of native coronary arteries, but this relation has not been studied in patients with saphenous vein graft disease undergoing PCI. A total of 530 patients who underwent PCI of saphenous vein grafts from May 1997 to July 2002 were followed for >3 years. Major adverse coronary events (MACEs) were assessed as a composite of death, myocardial infarction, or revascularization during follow-up (mean 2.7 years). Patients with MACEs (n = 287) were younger and had more thrombotic and ostial lesions (p < 0.05) than those without MACEs (n = 243). The preprocedural WBC count was also significantly higher in the MACE group than in the non-MACE group (8.1 x 10(3)/mul, range 6.6 to 10.1, vs 7.0 x 10(3)/mul, range 5.6 to 8.2; p < 0.001). After adjusting for covariates, multiple logistic regression analysis revealed the preprocedural WBC count to be an independent predictor for MACEs (odds ratio 1.2; 95% confidence interval 1.1 to 1.3, p < 0.001). Patients in the highest quartile of the preprocedural WBC level had a significantly increased risk of MACEs (lowest vs highest quartile, 41.3% vs 72.4%; odds ratio 3.7; 95% confidence interval 2.2 to 6.3). Thus, an elevated preprocedural WBC count is associated with increased risk of MACEs in patients undergoing PCI for saphenous vein graft lesions.

De Maria R.

Objectives: To assess the value of the European system for cardiac operative risk evaluation (EuroSCORE), a validated model for prediction of in-hospital mortality after cardiac surgery, in predicting long term event-free survival.Design and setting: Single institution observational cohort study.Patients: Adult patients (n  =  1230) who underwent cardiac surgery between January 2000 and August 2002.Results: Mean age was 65 (11) years and 32% were women. Type of surgery was isolated coronary artery bypass grafting in 62%, valve surgery in 23%, surgery on the thoracic aorta in 4%, and combined or other procedures in 11%. Mean EuroSCORE was 4.53 (3.16) (range 0–21); 366 were in the low (0–2), 442 in the medium (3–5), 288 in the high (6–8), and 134 in the very high risk group (⩾ 9). Information on deaths or events leading to hospital admission after the index discharge was obtained from the Regional Health Database. Out of hospital deaths were identified through the National Death Index. In-hospital 30 day mortality was 2.8% (n  =  34). During 2024 person-years of follow up, 44 of 1196 patients discharged alive (3.7%) died. By Cox multivariate analysis, EuroSCORE was the single best independent predictor of long term all cause mortality (hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.03 to 2.34, p < 0.0001). In the time to first event analysis, 227 either died without previous events (n  =  20, 9%) or were admitted to hospital for an event (n  =  207, 91%). EuroSCORE (HR 1.60, 95% CI 1.36 to 1.89, p < 0.0001), the presence of ⩾ 2 co-morbidities versus one (HR 1.49, 95% CI 1.09 to 2.02, p < 0.0001), and > 96 hours’ stay in the intensive care unit after surgery (HR 2.04, 95% CI 1.42 to 2.95, p  =  0.0001) were independently associated with the combined end point of death or hospital admission after the index discharge.Conclusions: EuroSCORE and a prolonged intensive care stay after surgery are associated with long term event-free survival and can be used to tailor long term postoperative follow up and plan resource allocation for the cardiac surgical patient.

Horne B.D., Anderson J.L., John J.M., Weaver A., Bair T.L., Jensen K.R., Renlund D.G., Muhlestein J.B.

We sought to determine the predictive ability of total white blood cell (WBC) count and its subtypes for risk of death or myocardial infarction (MI). An elevated WBC count has been associated with cardiovascular risk, but which leukocyte subtypes carry this risk is uncertain. Consecutive patients without acute MI who were assessed angiographically for coronary artery disease (CAD) and were followed up long-term were studied. The predictive ability for death/MI of quartile (Q) 4 versus Q1 total WBC, neutrophil (N), lymphocyte (L), and monocyte (M) counts and N/L ratio were assessed using Cox regressions. A total of 3,227 patients was studied. Mean age was 63 years; 63% of patients were male, and 65% had CAD. In multivariable modeling entering standard risk factors, presentation, and CAD severity, the total WBC (hazard ratio [HR] 1.4, p = 0.01) and M (HR 1.3, p < 0.02) were weaker and N (HR 1.8, p < 0.001), L (HR 0.51, p < 0.001), and N/L ratio (HR 2.2, p < 0.001) were independent predictors of death/MI. When WBC variables were entered together, N/L ratio and M were retained as independent predictors. Risk associations persisted in analyses restricted to CAD patients or including acute MI patients. Total WBC count is confirmed to be an independent predictor of death/MI in patients with or at high risk for CAD, but greater predictive ability is provided by high N (Q4 >6.6 × 10 3 /μl) or low L counts. The greatest risk prediction is given by the N/L ratio, with Q4 versus Q1 (>4.71 versus

Hansson G.K.

ecent research has shown that inflammation plays a key role in coronary artery disease (CAD) and other manifestations of atherosclerosis. Immune cells dominate early atherosclerotic lesions, their effector molecules accelerate progression of the lesions, and activation of inflammation can elicit acute coronary syndromes. This review highlights the role of inflammation in the pathogenesis of atherosclerotic CAD. It will recount the evidence that atherosclerosis, the main cause of CAD, is an inflammatory disease in which immune mechanisms interact with metabolic risk factors to initiate, propagate, and activate lesions in the arterial tree. A decade ago, the treatment of hypercholesterolemia and hypertension was expected to eliminate CAD by the end of the 20th century. Lately, however, that optimistic prediction has needed revision. Cardiovascular diseases are expected to be the main cause of death globally within the next 15 years owing to a rapidly increasing prevalence in developing countries and eastern Europe and the rising incidence of obesity and diabetes in the Western world. 1 Cardiovascular diseases cause 38 percent of all deaths in North America and are the most common cause of death in European men under 65 years of age and the second most common cause in women. These facts force us to revisit cardiovascular disease and consider new strategies for prediction, prevention, and treatment.

Stewart R.A., White H.D., Kirby A.C., Heritier S.R., Simes R.J., Nestel P.J., West M.J., Colquhoun D.M., Tonkin A.M.

Background— Elevated serum inflammatory marker levels are associated with a greater long-term risk of cardiovascular events. Because 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors (statins) may have an antiinflammatory action, it has been suggested that patients with elevated inflammatory marker levels may have a greater reduction in cardiovascular risk with statin treatment. Methods and Results— We evaluated the association between the white blood cell count (WBC) and coronary heart disease mortality during a mean follow-up of 6.0 years in the Long-Term Intervention With Pravastatin in Ischemic Disease (LIPID) Study, a clinical trial comparing pravastatin (40 mg/d) with a placebo in 9014 stable patients with previous myocardial infarction or unstable angina. An increase in baseline WBC was associated with greater coronary heart disease mortality in patients randomized to placebo (hazard ratio for 1×10 9 /L increase in WBC, 1.18; 95% CI, 1.12 to 1.25; P <0.001) but not pravastatin (hazard ratio, 1.02; 95% CI, 0.96 to 1.09; P =0.56; P for interaction=0.004). The numbers of coronary heart disease deaths prevented per 1000 patients treated with pravastatin were 0, 9, 30, and 38 for baseline WBC quartiles of <5.9, 6.0 to 6.9, 7.0 to 8.1, and >8.2×10 9 /L, respectively. WBC was a stronger predictor of this treatment benefit than the ratio of total to high-density lipoprotein cholesterol and a global measure of cardiac risk. There was also a greater reduction ( P =0.052) in the combined incidence of cardiovascular mortality, nonfatal myocardial infarction, and stroke with pravastatin as baseline WBC increased (by quartile: 3, 41, 61, and 60 events prevented per 1000 patients treated, respectively). Conclusions— These data support the hypothesis that individuals with evidence of inflammation may obtain a greater benefit from statin therapy.

HARRIS N., JOU J.M., DEVOTO G., LOTZ J., PAPPAS J., WRANOVICS D., WILKINSON M., FLETCHER S.R., KRATZ A.

Coller B.S.

The association between leukocytosis and increased morbidity and mortality of ischemic vascular disease has been observed for more than half a century, and recent studies in >350 000 patients confirm the robustness of the association and the dramatically higher relative and absolute acute and chronic mortality rates in patients with high versus low leukocyte counts. Although there is reason to believe that the association is not causal (that is, that leukocytosis is simply a marker of inflammation), there is also reason to believe that the leukocytosis directly enhances acute thrombosis and chronic atherosclerosis. Leukocytosis also is associated with poor prognosis and vaso-occlusive events in patients with sickle cell disease, and experimental data suggest a direct role for leukocytes in microvascular obstruction. The only way to test whether leukocytes contribute directly to poor outcome in ischemic cardiovascular disease is to assess the effect of modifying leukocyte function or number. Because selective blockade of leukocyte integrin αMβ2 and P-selectin have thus far been disappointing as therapeutic strategies in human cardiovascular and cerebrovascular disease, I discuss the potential risks and benefits of short-term treatment with hydroxyurea to decrease the leukocyte count in select populations of patients at the highest risk of short-term death.

Madjid M., Awan I., Willerson J.T., Casscells S.W.

Inflammation is a key feature of atherosclerosis and its clinical manifestations. The leukocyte count is a marker of inflammation that is widely available in clinical practice. This paper reviews the available epidemiologic evidence for a relationship between the leukocyte count and coronary heart disease (CHD). Numerous epidemiologic and clinical studies have shown leukocytosis to be an independent predictor of future cardiovascular events, both in healthy individuals free of CHD at baseline and in patients with stable angina, unstable angina, or a history of myocardial infarction. This relationship has been observed in prospective and retrospective cohort studies, as well as in case-control studies. It is strong, consistent, temporal, dose-dependent, and biologically plausible. The relationship persists after adjustment for multiple CHD risk factors, including smoking. Elevated differential cell counts, including eosinophil, neutrophil, and monocyte counts, also predict the future incidence of CHD. Leukocytosis affects CHD through multiple pathologic mechanisms that mediate inflammation, cause proteolytic and oxidative damage to the endothelial cells, plug the microvasculature, induce hypercoagulability, and promote infarct expansion. In summary, leukocytosis has been consistently shown to be an independent risk factor and prognostic indicator of future cardiovascular outcomes, regardless of disease status. The leukocyte count is inexpensive, reliable, easy to interpret, and ordered routinely in inpatient and outpatient settings. However, its diagnostic and prognostic utility in CHD is widely unappreciated. Further studies are needed to assess the true impact of leukocytosis on CHD, compare it with other inflammatory markers such as C-reactive protein and lipoprotein phospholipase A(2) levels, and promote its use in CHD prediction.

Grau A.J., Boddy A.W., Dukovic D.A., Buggle F., Lichy C., Brandt T., Hacke W.

Background and Purpose— Inflammatory markers predict first-time ischemic events. We investigated whether leukocyte and differential counts predict recurrent events and ischemic events in high-risk populations, and whether such events are preceded by acutely exacerbated inflammation. Methods— We studied 18 558 patients with ischemic stroke, myocardial infarction, or peripheral arterial disease who participated in the trial of Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE), a study that compared the occurrence of ischemic stroke, myocardial infarction, or vascular death under randomized treatment with aspirin or clopidogrel. Leukocyte counts were frequently assessed during followup. Results— Compared with the quartile with lowest leukocyte counts at baseline (<5.9×10 9 /L), patients in the top quartile (>8.2×10 9 /L) had higher risks for ischemic stroke (relative risk 1.30; P =0.007), myocardial infarction (relative risk 1.56, P <0.001), and vascular death (relative risk 1.51; P <0.001) after adjustment for other risk factors. Neutrophil counts contributed most to increased risk. Assessments of regression dilution effects based on replicate measurements show that these risk associations may underestimate the real associations by 30 to 50%. Treatment with aspirin or clopidogrel did not influence predictive effects by leukocytes. In the week before a recurrent event, but not at earlier time points, the leukocyte count was significantly increased over baseline levels (n=211; mean difference +0.46×10 9 /L; P =0.005). Conclusions— Leukocyte counts and mainly neutrophil counts are independently associated with ischemic events in these high-risk populations. An increase of leukocyte counts over baseline levels heralds a period of increased risk lasting about one week.

Sonmezoz G.B., Yilmaz M.

AbstractIntroductionThe aim of this study was to determine the relationship between albuminuria and neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR) and monocyte‐to‐high density lipoprotein‐cholesterol ratio (MHR).MethodsPatients with type 2 diabetes mellitus diagnosis, aged over 18, had estimated glomerular filtration rate (eGFR) ≥60 mL/dk/1.73 m2 included. Patients were divided into groups according to ACR values: <30 mg/g (group 1), 30–300 mg/g (group 2) and >300 mg/g (group 3). We examined whether there was a significant difference in NLR, PLR, and MHR among the three groups.ResultsA total of 360 patients were included in the study. NLR was significantly higher in group 3 than in group 1 (p = 0.016). There was no significant difference in PLR or MHR among the three groups (p = 0.312 and p = 0.687, respectively). A significant difference was detected in NLR in comparison between the groups with and without diabetic nephropathy, but there was no significant difference in PLR or MHR (p = 0.028; p = 0.950 and p = 0.389, respectively). NLR correlated with creatinine and ACR (r: 0.166, p = 0.002; r: 0.144, p = 0.006, respectively). MHR correlated positively with creatinine (r: 0.25.3, p = 0.016, respectively).ConclusionNLR was significantly higher in the diabetic nephropathy group than in the non‐diabetic nephropathy group. This may suggest that NLR can be used as a prognostic marker in diabetic nephropathy. Although there was no significant relationship between MHR and albuminuria, MHR positively correlated with creatinine and negatively correlated with eGFR. Therefore, MHR may be useful in monitoring the development and progression of chronic kidney disease in diabetic patients rather than in the early stages. However, further studies are needed.

Aghaei M., Bahreiny S.S., Zayeri Z.D., Davari N., Abolhasani M.M., Saki N.

ABSTRACTBackground and AimsSeveral studies were performed to evaluate the relationship between CBC and patients with diabetes mellitus (DM). In this review, we discussed the prognostic value of CBC parameters in DM patients.MethodsEnglish literature was searched and retrieved from the Google Scholar search engine and PubMed database (1980–2024). “Diabetes mellitus,” “Blood cell count,” “Mean platelet volume,” “Leukocytes,” and “Inflammation” were used as keywords.ResultsDM increases vascular inflammation and oxidative stress, while vascular inflammation affects erythropoiesis and red blood cell deformation, thus increasing red cell distribution width (RDW). Mean platelet volume (MPV) is another useful prognostic biomarker for DM patients. Additionally, elevated neutrophil‐lymphocyte ratio (NLR) levels are associated with poor glycemic control in T2DM patients, so it can be used as a screening tool in diabetic follow‐up.ConclusionRDW can be used as a valuable independent biomarker to assess the prognosis of patients with DM. MPV can also be used as a noninvasive, widely available, and low‐cost marker as a key factor as well as a Prognostic/diagnostic biomarker that could be used for DM patients. Total white blood cell count, NLR, Mean platelet volume lymphocyte ratio (MPVLR), and monocyte to high‐density lipoprotein ratio (MHR) are valuable biomarkers in predicting DM.

Grin O.O., Beloborodova N.V., Grekova M.S., Pautova A.K., Charchyan E.R., Akselrod B.A., Dymova O.V., Rizun L.I., Eremenko A.A., Babaev M.A.

Aim. To identify biomarkers for prediction and early diagnosis of infectious and inflammatory complications in patients after aortic surgery.Materials and methods. The study included 57 patients who underwent surgical procedures on the aorta and its branches under cardiopulmonary bypass and myocardial ischemia. The cohort was divided into two groups: patients with an uneventful postoperative period (group 1, N=35) and patients with local infectious and inflammatory complications after surgery (group 2, N=22). Serum levels of procalcitonin (PCT), interleukins (IL-6 and IL-10), and aromatic microbial metabolites (AMM) were measured before surgery, upon admission, and six hours after admission to the ICU. On postoperative days 3 and 6 neutrophil, lymphocyte, and platelet counts were assessed, and neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated.Results. There were no significant differences in sex, age, or comorbidities between groups 1 and 2. Patients in group 2 had a more severe intraoperative period and required a longer ICU stay. Predictive markers of complications included IL-6143.35 pg/mL at ICU admission (sensitivity 42.9%, specificity 90.9%, AUC 0.789, 95% CI 0.669–0.909, P0.001); PCT0.12 ng/mL 6 hours after ICU admission (sensitivity 90.9%, specificity 54.3%, AUC 0.762, 95% CI 0.634–0.891, P0. 001); NLR 7.8 on postoperative day 3 (sensitivity 72.7%, specificity 68.6%, AUC 0.710, 95% CI 0.571–0.850, P=0.003); and AMM (before and after surgery) 0.185 (sensitivity 77.3%, specificity 71.4%, AUC 0.780, 95% CI 0.651–0.909, P0.001).Conclusion. Values of IL-6, PCT, NLR, and AMM reflect different features of the inflammation and can be used for prediction and early diagnosis of infectious and inflammatory complications in cardiac surgery patients.

Bou Chebl R., Haidar S., Kattouf N., Assaf M., Alwan J., Khamis M., Abdeldaem K., Makki M., Tamim H., Abou Dagher G.

Li H., Chen M., Wang Y., Cui W., Lou Y., Chen D., Deng H., Shen Z.

Nair S., Ha F.J., Baradi A., Nanayakkara S., Soden L., Jin D., Whitbourn R., Wilson A., Palmer S.

Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are simple biomarkers that reflect systemic inflammation and are associated with adverse cardiovascular disease outcomes. The utility of NLR and PLR for risk prediction following transcatheter aortic valve implantation (TAVI) is not clear.

Rödel A., Fernandes Y., Brisolara J., De Carvalho J., Moresco R.

ABSTRACTIntroductionEstimating patient risk before heart surgery (HS) is crucial. Perioperative inflammation is associated with several complications and mortality. This study investigated blood cell count inflammatory indices (BCCII) to predict risks, including neutrophil‐to‐lymphocyte ratio (NLR), derivate NLR (DNLR), neutrophil‐to‐platelet‐lymphocyte ratio (NLPR), lymphocyte‐to‐monocyte ratio, platelet‐to‐lymphocyte ratio (PLR), Systemic Inflammatory Index (SII), Systemic Inflammatory Reaction Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI).MethodsData from a cohort of patients undergoing on‐pump HS at a single center in Brazil were retrospectively analyzed. Data were obtained from medical records and a laboratory analyzer, and SPSS version 20.0 was used for index calculations and statistical analyses.ResultsIn total, 444 surgeries were performed, and 40 in‐hospital deaths occurred. Except for PLR, all other indexes were independent predictors of death after multivariate adjustment (all p < 0.05). Discrimination performance was absent for PLR and AISI, and NLR, NLPR, and DNLR demonstrated the best area under the receiver operating characteristic curve (AUC > 0.7; all p < 0.0001). For survivors (n = 404), all indexes exhibited a correlation with the length of hospital stay (all p < 0.03), and NLR, NLPR, and DNLR were predictors (p < 0.026) of poor operative outcomes (acute myocardial infarction, cerebrovascular attack, cardiac arrest, low cardiac output, prolonged mechanical ventilation, renal failure, and sepsis).ConclusionsAll BCCII scores were associated with length of hospital stay. Apart from PLR, all indexes were independent predictors of in‐hospital mortality. Accuracy was highest for NLR, NLPR, and DNLR; for survivors, these three factors were good predictors of poor operative outcomes.

Zhou W., Wang H., Li C., Ma Q., Gu Y., Sheng S., Ma S., Zhu F.

BackgroundCardiopulmonary bypass (CPB) triggers a strong inflammatory response in cardiovascular surgery patients during the perioperative period. This article mainly focuses on the perioperative application of novel inflammatory biomarkers in cardiovascular surgeries involving CPB.MethodsPatients were divided into a CPB group and a non-CPB group according to whether they underwent CPB during cardiovascular surgery. Novel inflammatory biomarkers and clinical results were recorded. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), platelet × neutrophil/lymphocyte ratio (SII), and monocyte × platelet × neutrophil/lymphocyte ratio (PIV) were calculated. The primary outcomes were perioperative prognosis between the CPB and non-CPB groups. The secondary outcomes included perioperative alterations of novel inflammatory biomarkers in the CPB group and predictive values of novel inflammatory biomarkers for postoperative infection and acute kidney injury.ResultsA total of 332 patients were initially included in the study. Before propensity score matching (PSM), there were 96 patients in the CPB group and 236 patients in the non-CPB group. After PSM, both groups included 58 patients each. Compared with the non-CPB group, the CPB group had a higher proportion of intraoperative transfusion of blood products (63.79% vs. 6.90%, P &lt; 0.001), specifically for red blood cells (58.62% vs. 3.45%, P &lt; 0.001) and plasma (41.38% vs. 1.72, P &lt; 0.001), exhibited a higher drainage fluid volume within 24 h [380 (200–550) ml vs. 200 (24–330) ml, P = 0.002], and required longer durations of mechanical ventilation [14.3 (6.6–21.3) h vs. 5.75 (4.08–10.1) h, P &lt; 0.001] and ICU stay [48.78 (44.92–89.38) h vs. 27.16 (21.67–46.25) h, P &lt; 0.001]. After surgery, NLR [14.00 (9.93–23.08) vs. 11.55 (7.38–17.38), P = 0.043] was higher in the CPB group, while the PIV, PLR, and SII in the CPB group were lower than those in the non-CPB group on the first day after surgery.ConclusionsCardiovascular surgeries involving CPB exhibit a poorer prognosis compared to non-CPB procedures. Novel inflammatory biomarkers, including PLR, PIV, and SII, may offer valuable insights into the degree of postoperative inflammation, with NLR emerging as a potentially reliable prognostic indicator.

Zakharova N.V., Nasyrova R.F., Rakhmatullin A.I., Rumiantceva M.N., Sizykh K.I., Kostin F.N.

To date, hematologic inflammation coefficients (HICs) have been considered as biological markers linking the functions of the immune, endocrine, and autonomous nervous systems. HICs are markers of immune abnormalities that accompany various pathologic conditions and, to a large extent, determine disease prognosis, survival time, and function. According to the results of a meta-analysis covering the results of examination of more than 168 thousand patients, it was found that the ratio of neutrophils to lymphocytes (NLR) is associated with higher levels in patients with metabolic syndrome and can potentially be used for early detection of this pathology. Given these facts, it seems reasonable to test the assumption of the role of HICs in the pathogenesis of psychiatric disorders, their participation in the mechanisms of development of comorbid conditions, or predicting the outcome and effects of therapy. In 2024, the team of the Bekhterev Center began to perform work under the state assignment of the Ministry of Health of the Russian Federation, the purpose of which was to develop and validate a model for predicting individual risks of metabolic disorders in patients with psychiatric disorders, on the basis of which interpretive software will be presented. The team of authors of this article focused on conducting a systematic review of publications to test this hypothesis.

Turgut Ü.K., Erdemoğlu E., Dağdelen C., Özkaya M.O., Sezik M.

Bulut A., Sengul I., Sengul D., Bayburt F.A., Cinar E.

Telang S., Mayfield C.K., Palmer R., Liu K.C., Wier J., Hong K., Lieberman J.R., Heckmann N.D.

Background: Morbidly obese patients are an ever-growing high-risk population undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) for end-stage osteoarthritis. This study sought to identify preoperative laboratory values that may serve as predictors of periprosthetic joint infection (PJI) in morbidly obese patients undergoing THA or TKA. Methods: All morbidly obese patients with preoperative laboratory data before undergoing primary elective TKA or THA were identified using the Premier Healthcare Database. Patients who developed PJI within 90 days after surgery were compared with patients without PJI. Laboratory value thresholds were defined by clinical guidelines or primary literature. Univariate and multivariable regression analyses were utilized to assess the association between PJI and preoperative laboratory values, including total lymphocyte count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), albumin level, platelet count, albumin-globulin ratio, hemoglobin level, and hemoglobin A1c. Results: Of the 6,780 patients identified (TKA: 76.67%; THA: 23.33%), 47 (0.69%) developed PJI within 90 days after surgery. The rate of PJI was 1.69% for patients with a hemoglobin level of <12 g/dL (for females) or <13 g/dL (for males), 2.14% for those with a platelet count of <142,000/µL or >417,000/µL, 1.11% for those with an NLR of >3.31, 1.69% for those with a PLR of >182.3, and 1.05% for those with an SII of >776.2. After accounting for potential confounding factors, we observed an association between PJI and an abnormal preoperative NLR (adjusted odds ratio [aOR]: 2.38, 95% confidence interval [CI]: 1.04 to 5.44, p = 0.039), PLR (aOR: 4.86, 95% CI: 2.15 to 10.95, p < 0.001), SII (aOR: 2.44, 95% CI: 1.09 to 5.44, p = 0.029), platelet count (aOR: 3.50, 95% CI: 1.11 to 10.99, p = 0.032), and hemoglobin level (aOR: 2.62, 95% CI: 1.06 to 6.50, p = 0.038). Conclusions: This study identified preoperative anemia, abnormal platelet count, and elevated NLR, PLR, and SII to be associated with an increased risk of PJI among patients with a body mass index of ≥40 kg/m2. These findings may help surgeons risk-stratify this high-risk patient population. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Poletti S., Mazza M.G., Benedetti F.

AbstractMajor depressive disorder (MDD) and bipolar disorder (BD) are highly disabling illnesses defined by different psychopathological, neuroimaging, and cognitive profiles. In the last decades, immune dysregulation has received increasing attention as a central factor in the pathophysiology of these disorders. Several aspects of immune dysregulations have been investigated, including, low-grade inflammation cytokines, chemokines, cell populations, gene expression, and markers of both peripheral and central immune activation. Understanding the distinct immune profiles characterizing the two disorders is indeed of crucial importance for differential diagnosis and the implementation of personalized treatment strategies. In this paper, we reviewed the current literature on the dysregulation of the immune response system focusing our attention on studies using inflammatory markers to discriminate between MDD and BD. High heterogeneity characterized the available literature, reflecting the heterogeneity of the disorders. Common alterations in the immune response system include high pro-inflammatory cytokines such as IL-6 and TNF-α. On the contrary, a greater involvement of chemokines and markers associated with innate immunity has been reported in BD together with dynamic changes in T cells with differentiation defects during childhood which normalize in adulthood, whereas classic mediators of immune responses such as IL-4 and IL-10 are present in MDD together with signs of immune-senescence.

Oksuz F., Yarlioglues M., Karacali K., Erat M., Celik I.E., Duran M.

Objective Saphenous vein graft disease (SVGD) remains a challenging issue for patients with coronary artery bypass grafting (CABG). It is associated with poor outcomes and atherosclerosis is the major cause of SVGD. Uric acid to albumin ratio (UAR) is a new marker which associated with cardiovascular mortality. We aim to evaluate the relationship between the SVGD and UAR. Methods We retrospectively enrolled 237 patients who underwent elective coronary angiography (CAG) for stable angina or positive stress test results >1 year after CABG. The patients were divided into two groups; SVGD (+) patients and SVGD (−) patients. The SVGD was defined as presence of at least 50% stenosis in at least 1 SVG. Results UAR were significantly higher in the SVGD (+) group (P < 0.001). Similarly, Hs-CRP, white blood cell count, and neutrophil count were significantly higher in SVGD (+) group (P = 0.03, P = 0.027 P = 0.01, respectively). In multivariate logistic regression analysis, time interval after CABG [OR = 1.161, 95% confidence interval (CI) 1.078–1.250; P < 0.001] and UAR (OR = 2.691, 95% CI 1.121–6.459; P < 0.001) were found to be independent predictors of SVGD. Conclusion Our results suggested that UAR could be a simple and available marker to predict SVGD in patients with CABG who underwent elective percutaneous coronary intervention.

ARTAC I., KARAKAYALI M., OMAR T., ILIS D., Arslan A., Hakan SAHIN M., Kina S., KARABAG Y., RENCUZOGULLARI D.I.

Lower extremity peripheral artery disease (PAD) is the third most common clinical manifestation of atherosclerosis after coronary artery disease and stroke. Despite successful endovascular treatment (EVT), mortality and morbidity rates still remain higher in patients with PAD. Naples prognostic score (NPS) is a novel scoring system, reflects the patient's nutritional and immunological statuses as well as systemic inflammatory responses. In this study, we aimed to investigate the relationship between NPS and long-term outcomes in patients with PAD.The population of this retrospective study consisted of 629 PAD patients who underwent EVT at Kafkas University Hospital between 2020 and 2023. For each patient, the NPS was calculated and then patients were divided into 3 groups based on their NPS. The primary end point of the study was the rate of major adverse cardiovascular (MACEs) and limb events (MALEs), that is, all-cause death or development of critical limb ischemia with consequent amputation.Of a total of 629 patients, 62 were classified into group 0 (NPS 0), 315 into group 1 (NPS 1 or 2), and 252 into group 2 (NPS 3 or 4). The distribution of patients' baseline characteristics, angiographic features and MACEs and MALEs according to the NPS groups was analyzed. Significant adverse outcomes differences were observed among the 3 groups (P < 0.001). Multivariate logistic regression analysis revealed that age, diabetes mellitus, chronic kidney disease, lowest preprocedure ankle-brachial index, left ventricular ejection fraction and NPS (hazard ratio 1.916, 95% confidence interval [CI] 1.530-2.398, P < 0.001) were independent predictors of MACE whereas diabetes mellitus, presence of previous PAD, hemoglobin level, in-hospital acute thrombotic occlusion and NPS (odds ratio 1.963, 95% CI 1.489-2.588, P < 0.001) were independent predictors of MALE.The inflammatory and nutritional state reflected by NPS levels was strongly associated with all-cause mortality and amputation after EVT in patients with PAD. Furthermore, NPS was found to be an independent predictor of these clinical outcomes.