Sargın Murat, Taşdemir Mete Müge, Bayer Erdoğan Sevinç, Kuplay Hüseyin, Baştopçu Murat, Bayraktar Fatih, Acarel Murat, Aykut Aka Serap
Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Department of Anesthesiology and Reanimation, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2019 Jun 21;27(3):314-319. doi: 10.5606/tgkdc.dergisi.2019.17891. eCollection 2019 Jul.
This study aims to investigate the relationship between the neutrophil-to-lymphocyte ratio and renal injury in patients under extracorporeal membrane oxygenation support for postcardiotomy shock.
Between January 2007 and July 2018, a total of 119 patients (38 males, 81 females; mean age 54.4±13.0 years; range, 24 to 74 years) who received extracorporeal membrane oxygenation support for postcardiotomy shock and survived at least 48 hours in our center were retrospectively analyzed. Pre- and postoperative neutrophil-to-lymphocyte ratios, demographic characteristics, renal function parameters, and extracorporeal membrane oxygenationrelated data of the patients were recorded. Occurrence and stages of renal injury was determined using the revised Acute Kidney Injury Network and Kidney Disease Improving Global Outcomes criteria.
No significant relationship was found between preoperative neutrophil-to-lymphocyte ratio and renal injury (p>0.05). Postoperative neutrophil-to-lymphocyte ratio was higher in patients who developed renal injury, compared to patients without renal injury (8.68 [0.84-42.00] vs. 4.02 [1.04-21.21], respectively, p=0.004). When patients were grouped for renal injury stage according to the revised Acute Kidney Injury Network (p=0.015) and Kidney Disease Improving Global Outcomes (p=0.006) criteria, the patients with more severe renal injury had higher neutrophil-to-lymphocyte ratio. The receiver operating characteristics analysis revealed a cut-off value of 6.71 for the neutrophil-to-lymphocyte ratio for the detection of renal injury. Patients with a value above 6.71 had an odds ratio of 5.941 for occurrence of renal injury.
Postoperative, but not preoperative neutrophil-tolymphocyte ratio is associated with presence and severity of renal injury in patients under extracorporeal membrane oxygenation support for postcardiotomy shock. Neutrophil-to-lymphocyte ratio is a simple and inexpensive marker of inflammation in this patient population.
本研究旨在探讨体外膜肺氧合支持下心内直视术后休克患者中性粒细胞与淋巴细胞比值和肾损伤之间的关系。
回顾性分析2007年1月至2018年7月在本中心接受体外膜肺氧合支持治疗心内直视术后休克且存活至少48小时的119例患者（男性38例，女性81例；平均年龄54.4±13.0岁；范围24至74岁）。记录患者术前和术后的中性粒细胞与淋巴细胞比值、人口统计学特征、肾功能参数以及体外膜肺氧合相关数据。使用修订的急性肾损伤网络和改善全球肾脏病预后组织标准确定肾损伤的发生情况和分期。
术前中性粒细胞与淋巴细胞比值和肾损伤之间未发现显著相关性（p>0.05）。发生肾损伤的患者术后中性粒细胞与淋巴细胞比值高于未发生肾损伤的患者（分别为8.68[0.84 - 42.00]和4.02[1.04 - 21.21]，p = 0.004）。根据修订的急性肾损伤网络（p = 0.015）和改善全球肾脏病预后组织（p = 0.006）标准将患者按肾损伤分期分组时，肾损伤更严重的患者中性粒细胞与淋巴细胞比值更高。受试者工作特征分析显示，检测肾损伤的中性粒细胞与淋巴细胞比值临界值为6.71。比值高于6.71的患者发生肾损伤的比值比为5.941。
对于接受体外膜肺氧合支持治疗心内直视术后休克的患者，术后而非术前的中性粒细胞与淋巴细胞比值与肾损伤的存在及严重程度相关。中性粒细胞与淋巴细胞比值是该患者群体中一种简单且廉价的炎症标志物。
