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Pre-operative neutrophil–lymphocyte ratio predicts low cardiac output in children after cardiac surgery

Published online by Cambridge University Press:  05 March 2020

Ilias Iliopoulos ,
Matthew N. Alder ,
David S. Cooper ,
Enrique G. Villarreal Open the ORCID record for Enrique G. Villarreal [Opens in a new window] ,
Rohit Loomba Open the ORCID record for Rohit Loomba [Opens in a new window] ,
Rashmi D. Sahay ,
Lin Fei ,
Paul E. Steele  and
Saul Flores
Ilias Iliopoulos
Affiliation:
Department of Pediatrics, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Matthew N. Alder
Affiliation:
Division of Critical Care, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
David S. Cooper
Affiliation:
Department of Pediatrics, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Enrique G. Villarreal*
Affiliation:
Instituto Tecnologico y de Estudios Superiores de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico Department of Pediatrics, Section of Critical Care Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Rohit Loomba
Affiliation:
Department of Pediatrics, Division of Advocate Children’s Hospital/Chicago Medical School, Chicago, IL, USA
Rashmi D. Sahay
Affiliation:
Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Lin Fei
Affiliation:
Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Paul E. Steele
Affiliation:
Division of Pathology and Laboratory Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Saul Flores
Affiliation:
Department of Pediatrics, Section of Critical Care Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
*
Author for correspondence: E. G. Villarreal, MD, Research Scholar, Cardiac Intensive Care Unit, Section of Critical Care and Cardiology at Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA. Tel: +1 312 282 6935. Fax: +832 825 2969. E-mail: quique_villarreal93@hotmail.com
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Abstract

Neutrophil–lymphocyte ratio has been associated with clinical outcomes in several groups of cardiac patients, including patients with coronary artery disease, cardiac failure, and cardiac transplant recipients. We hypothesised that pre- and/or post-operative haematological cell counts are associated with clinical outcomes in children undergoing cardiac surgery for CHD. We performed a post hoc analysis of data collected as part of a prospective observational cohort study (n = 83, data available n = 47) of children evaluated for glucocorticoid receptor levels after cardiac surgery (July 2015–January 2016). The association of neutrophil–lymphocyte ratio with low cardiac output syndrome, time to inotrope free, and vasoactive-inotropic score was examined using proportional odds analysis, cox regression, and linear regression models, respectively. A majority (80%) of patients were infants (median/interquartile range 4.1/0.2–7.6 months) with conotruncal (36%) and left-sided obstructed lesions (28%). Two patients required mechanical circulatory support and three died. Higher pre-operative neutrophil–lymphocyte ratio was associated with higher cumulative odds of severe/moderate versus mild low cardiac output on post-operative day 1 (odds ratio 2.86; 95% confidence interval 1.18–6.93; p = 0.02). Pre-operative neutrophil–lymphocyte ratio was not significantly associated with time to inotrope free or vasoactive-inotrope score. Post-operative neutrophil–lymphocyte ratio was also not associated with outcomes. In children after congenital heart surgery, higher pre-operative neutrophil–lymphocyte ratio was associated with a higher chance of low cardiac output in the early post-operative period. Pre-operative neutrophil–lymphocyte ratio maybe a useful prognostic marker in children undergoing congenital heart surgery.

Keywords

Neutrophil–lymphocyte ratiohemographic indicespaediatric cardiac surgerylow cardiac outputcardiac intensive care
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 4 , April 2020 , pp. 521 - 525
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Wrigley, BJ, Lip, GY and Shantsila, E.The role of monocytes and inflammation in the pathophysiology of heart failure. Eur J Heart Fail 2011; 13: 1161–1171.CrossRefGoogle ScholarPubMed
Weir, RA, Miller, AM, Petrie, CJet al.Interleukin-21--a biomarker of importance in predicting myocardial function following acute infarction? Cytokine 2012; 60: 220–225.CrossRefGoogle ScholarPubMed
Mann, DL.Innate immunity and the failing heart: the cytokine hypothesis revisited. Circ Res 2015; 116: 1254–1268.CrossRefGoogle ScholarPubMed
Fertin, M, Dubois, E, Belliard, A, Amouyel, P, Pinet, F and Bauters, C.Usefulness of circulating biomarkers for the prediction of left ventricular remodeling after myocardial infarction. Am J Cardiol 2012; 110: 277–283.CrossRefGoogle ScholarPubMed
Madjid, M, Awan, I, Willerson, JT and Casscells, SW.Leukocyte count and coronary heart disease: implications for risk assessment. J Am Coll Cardiol 2004; 44: 1945–1956.CrossRefGoogle ScholarPubMed
Kaptoge, S, Di Angelantonio, E, Pennells, Let al.C-reactive protein, fibrinogen, and cardiovascular disease prediction. N Engl J Med 2012; 367: 1310–1320.Google ScholarPubMed
Blake, GJ, Rifai, N, Buring, JE and Ridker, PM.Blood pressure, C-reactive protein, and risk of future cardiovascular events. Circulation 2003; 108: 2993–2999.CrossRefGoogle ScholarPubMed
Pearson, TA, Mensah, GA, Alexander, RWet 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.CrossRefGoogle ScholarPubMed
Papa, A, Emdin, M, Passino, C, Michelassi, C, Battaglia, D and Cocci, F.Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta 2008; 395: 27–31.CrossRefGoogle ScholarPubMed
Azab, B, Zaher, M, Weiserbs, KFet al.Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction. Am J Cardiol 2010; 106: 470–476.CrossRefGoogle Scholar
Tamhane, UU, Aneja, S, Montgomery, D, Rogers, EK, Eagle, KA and Gurm, HS.Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008; 102: 653–657.10.1016/j.amjcard.2008.05.006CrossRefGoogle ScholarPubMed
Nunez, J, Nunez, E, Bodi, Vet al.Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol 2008; 101: 747–752.CrossRefGoogle ScholarPubMed
Gurm, HS, Bhatt, DL, Lincoff, AMet al.Impact of preprocedural white blood cell count on long term mortality after percutaneous coronary intervention: insights from the EPIC, EPILOG, and EPISTENT trials. Heart 2003; 89: 1200–1204.CrossRefGoogle ScholarPubMed
Flores, S, Cooper, DS, Opoka, AMet al.Characterization of the glucocorticoid receptor in children undergoing cardiac surgery. Pediatr Crit Care Med 2018; 19: 705–712.CrossRefGoogle ScholarPubMed
Hannan, RL, Ybarra, MA, White, JA, Ojito, JW, Rossi, AF and Burke, RP.Patterns of lactate values after congenital heart surgery and timing of cardiopulmonary support. Ann Thorac Surg 2005; 80: 1468–1473; discussion 1473–1464.CrossRefGoogle ScholarPubMed
Gaies, MG, Gurney, JG, Yen, AHet al.Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11: 234–238.CrossRefGoogle ScholarPubMed
Silberman, S, Abu-Yunis, U, Tauber, Ret al.Neutrophil-lymphocyte ratio: Prognostic impact in heart surgery. Early outcomes and late survival. Ann Thorac Surg 2018; 105: 581–586.CrossRefGoogle ScholarPubMed
Yost, GL, Joseph, CR, Tatooles, AJ and Bhat, G.Neutrophil-to-lymphocyte ratio predicts outcomes in patients implanted with left ventricular assist devices. Asaio j 2015; 61: 664–669.CrossRefGoogle ScholarPubMed
Uthamalingam, S, Patvardhan, EA, Subramanian, Set al.Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol 2011; 107: 433–438.CrossRefGoogle ScholarPubMed
Polat, N, Yildiz, A, Bilik, MZet al.The importance of hematologic indices in the risk stratification of patients with acute decompensated systolic heart failure. Turk Kardiyol Dern Ars 2015; 43: 157–165.Google ScholarPubMed
Huang, WM, Cheng, HM, Huang, CJet al.Hemographic indices are associated with mortality in acute heart failure. Sci Rep 2017; 7: 17828.CrossRefGoogle ScholarPubMed
Cooper, HA, Exner, DV, Waclawiw, MA and Domanski, MJ.White blood cell count and mortality in patients with ischemic and nonischemic left ventricular systolic dysfunction (an analysis of the Studies Of Left Ventricular Dysfunction [SOLVD]). Am J Cardiol 1999; 84: 252–257.CrossRefGoogle Scholar
Huehnergarth, KV, Mozaffarian, D, Sullivan, MDet al.Usefulness of relative lymphocyte count as an independent predictor of death/urgent transplant in heart failure. Am J Cardiol 2005; 95: 1492–1495.CrossRefGoogle ScholarPubMed
Shah, AD, Denaxas, S, Nicholas, O, Hingorani, AD and Hemingway, H.Neutrophil counts and initial presentation of 12 cardiovascular diseases: A CALIBER cohort study. J Am Coll Cardiol 2017; 69: 1160–1169.CrossRefGoogle ScholarPubMed
Briasoulis, A, Androulakis, E, Christophides, T and Tousoulis, D.The role of inflammation and cell death in the pathogenesis, progression and treatment of heart failure. Heart Fail Rev 2016; 21: 169–176.CrossRefGoogle ScholarPubMed
Frangogiannis, NG.Regulation of the inflammatory response in cardiac repair. Circ Res 2012; 110: 159–173.CrossRefGoogle ScholarPubMed
Frangogiannis, NG.The inflammatory response in myocardial injury, repair, and remodelling. Nat Rev Cardiol 2014; 11: 255–265.CrossRefGoogle ScholarPubMed
Horckmans, M, Ring, L, Duchene, Jet al.Neutrophils orchestrate post-myocardial infarction healing by polarizing macrophages towards a reparative phenotype. Eur Heart J 2017; 38: 187–197.Google ScholarPubMed
Brinkmann, V, Reichard, U, Goosmann, Cet al.Neutrophil extracellular traps kill bacteria. Science 2004; 303: 1532–1535.CrossRefGoogle ScholarPubMed
Dalli, J, Montero-Melendez, T, Norling, LVet al.Heterogeneity in neutrophil microparticles reveals distinct proteome and functional properties. Mol Cell Proteomics 2013; 12: 2205–2219.10.1074/mcp.M113.028589CrossRefGoogle ScholarPubMed
Soehnlein, O, Steffens, S, Hidalgo, A and Weber, C.Neutrophils as protagonists and targets in chronic inflammation. Nat Rev Immunol 2017; 17: 248–261.CrossRefGoogle ScholarPubMed
Horne, BD, Anderson, JL, John, JMet al.Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005; 45: 1638–1643.CrossRefGoogle ScholarPubMed
Segel, GB, Halterman, MW and Lichtman, MA.The paradox of the neutrophil’s role in tissue injury. J Leukoc Biol 2011; 89: 359–372.CrossRefGoogle ScholarPubMed
Habib, M, Thawabi, M, Hawatmeh, Aet al.Value of neutrophil to lymphocyte ratio as a predictor of mortality in patients undergoing aortic valve replacement. Cardiovasc Diagn Ther 2018; 8: 164–172.CrossRefGoogle ScholarPubMed
Sliwa, K, Woodiwiss, A, Candy, Get al.Effects of pentoxifylline on cytokine profiles and left ventricular performance in patients with decompensated congestive heart failure secondary to idiopathic dilated cardiomyopathy. Am J Cardiol 2002; 90: 1118–1122.CrossRefGoogle ScholarPubMed
Krum, H, Ashton, E, Reid, Cet al.Double-blind, randomized, placebo-controlled study of high-dose HMG CoA reductase inhibitor therapy on ventricular remodeling, pro-inflammatory cytokines and neurohormonal parameters in patients with chronic systolic heart failure. J Card Fail 2007; 13: 1–7.CrossRefGoogle ScholarPubMed