Mahmood Eitezaz, Knio Ziyad O, Mahmood Feroze, Amir Rabia, Shahul Sajid, Mahmood Bilal, Baribeau Yanick, Mueller Ariel, Matyal Robina
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America.
Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America.
PLoS One. 2017 Sep 5;12(9):e0182118. doi: 10.1371/journal.pone.0182118. eCollection 2017.
Despite showing a prognostic value in general surgical patients, preoperative asymptomatic elevated white blood cell (WBC) count is not considered a risk factor for cardiac surgery. Whereas there is sporadic evidence of its value as a preoperative risk marker, it has not been looked at methodically as a specific index of outcome during cardiac surgery. Using a national database we sought to determine the relationship between preoperative WBC count and postoperative outcome in cardiac surgical patients.
Cardiac surgeries were extracted from the 2007-2013 American College of Surgeons National Surgical Quality Improvement Program database. Leukocytosis was defined by a preoperative WBC count greater than 11,000 cells/μL. A univariate analysis compared the incidence of adverse outcomes for patients with and without leukocytosis. A multivariate logistic regression model was constructed in order to test whether leukocytosis was an independent predictor of morbidity and mortality.
Out of a total of 10,979 cardiac surgery patients 863 (7.8%) had preoperative leukocytosis. On univariate analysis, patients with leukocytosis experienced greater incidences of 30-day mortality, wound complications, and medical complications. Wound complications included surgical site infection as well as wound dehiscence. The medical complications included all other non-surgical causes of increased morbidity and infection leading to urinary tract infection, pneumonia, ventilator dependence, sepsis and septic shock. After stepwise model adjustment, leukocytosis was a strong predictor of medical complications (OR 1.22, 95% CI: 1.09-1.36, p = 0.002) with c-statistic of 0.667. However, after stepwise model adjustment leukocytosis was not a significant predictor of 30-day mortality and wound complications.
Preoperative leukocytosis is associated with adverse postoperative outcome after cardiac surgery and is an independent predictor of infection-related postoperative complications.
尽管术前无症状的白细胞（WBC）计数升高在普通外科患者中显示出预后价值，但它不被视为心脏手术的危险因素。虽然有零星证据表明其作为术前风险标志物的价值，但尚未将其作为心脏手术期间结局的特定指标进行系统研究。我们使用一个全国性数据库来确定心脏手术患者术前WBC计数与术后结局之间的关系。
从2007 - 2013年美国外科医师学会国家外科质量改进计划数据库中提取心脏手术病例。白细胞增多症定义为术前WBC计数大于11,000个细胞/μL。单因素分析比较了有和没有白细胞增多症患者的不良结局发生率。构建多因素逻辑回归模型以测试白细胞增多症是否是发病和死亡的独立预测因素。
在总共10,979例心脏手术患者中，863例（7.8%）术前有白细胞增多症。单因素分析显示，白细胞增多症患者发生30天死亡率、伤口并发症和医疗并发症的发生率更高。伤口并发症包括手术部位感染以及伤口裂开。医疗并发症包括所有其他导致发病率增加和感染的非手术原因，导致尿路感染、肺炎、呼吸机依赖、败血症和感染性休克。经过逐步模型调整后，白细胞增多症是医疗并发症的有力预测因素（比值比1.22，95%置信区间：1.09 - 1.36，p = 0.002），c统计量为0.667。然而，经过逐步模型调整后，白细胞增多症不是30天死亡率和伤口并发症的显著预测因素。
术前白细胞增多症与心脏手术后不良术后结局相关，并且是与感染相关的术后并发症的独立预测因素。
Zotero 插件