Perry Luke A, Liu Zhengyang, Loth Joel, Penny-Dimri Jahan C, Plummer Mark, Segal Reny, Smith Julian
Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Australia.
Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Australia.
J Cardiothorac Vasc Anesth. 2022 May;36(5):1296-1303. doi: 10.1053/j.jvca.2021.07.001. Epub 2021 Jul 9.
Neutrophil-lymphocyte ratio (NLR) is an inflammatory biomarker that has been evaluated across a variety of surgical disciplines and is widely predictive of poor postoperative outcome, but its value in cardiac surgery is unclear. The authors did this systematic review and meta-analysis to determine the impact of elevated perioperative NLR on survival after cardiac surgery.
Systematic review and meta-analysis of study-level data.
Multiple hospitals involved in an international pool of studies.
Adults undergoing cardiac surgery.
None.
The authors searched multiple databases from inception until November 2020. They generated summary hazard ratios (HR) and odds ratios (OR) for the association of elevated preoperative NLR with long-term and short-term mortality following cardiac surgery. They separately reported on elevated postoperative NLR. Between-study heterogeneity was explored using metaregression. The authors included 12 studies involving 13,262 patients undergoing cardiac surgery. Elevated preoperative NLR was associated with worse long-term (>30 days) (hazard ratio [HR] 1.56; 95% CI [confidence interval], 1.18-2.06; 8 studies) and short-term (<30 days) mortality (OR 3.18; 95% CI, 1.90-5.30; 7 studies). One study reported the association of elevated postoperative NLR with long-term mortality (HR 8.58; 95% CI, 2.55-28.85). There was considerable between-study heterogeneity for the analysis of long-term mortality (I statistic 94.39%), which mostly was explained by study-level variables, such as the number of variables adjusted for by included studies and how many of these significantly increased the risk of long-term mortality, high risk of bias, and number of study centers, as well as participant level factors, such as average participant age and hypertension prevalence.
Perioperative NLR is an independent predictor of short-term and long-term postoperative mortality following cardiac surgery. Further research is required to determine which patient-level factors modify the prognostic value of NLR and to evaluate its role in routine clinical practice.
中性粒细胞与淋巴细胞比值（NLR）是一种炎症生物标志物，已在多种外科领域进行评估，且广泛预测术后不良结局，但其在心脏手术中的价值尚不清楚。作者进行了这项系统评价和荟萃分析，以确定围手术期NLR升高对心脏手术后生存的影响。
对研究水平数据进行系统评价和荟萃分析。
参与国际研究库的多家医院。
接受心脏手术的成年人。
无。
作者检索了从数据库建立至2020年11月的多个数据库。他们生成了术前NLR升高与心脏手术后长期和短期死亡率之间关联的汇总风险比（HR）和比值比（OR）。他们分别报告了术后NLR升高的情况。使用元回归探索研究间的异质性。作者纳入了12项研究，涉及13262例接受心脏手术的患者。术前NLR升高与较差的长期（>30天）（风险比[HR]1.56；95%置信区间[CI]，1.18 - 2.06；8项研究）和短期（<30天）死亡率（OR 3.18；95%CI，1.90 - 5.30；7项研究）相关。一项研究报告了术后NLR升高与长期死亡率之间的关联（HR 8.58；95%CI，2.55 - 28.85）。在长期死亡率分析中存在相当大的研究间异质性（I统计量94.39%），这主要由研究水平变量解释，如纳入研究调整的变量数量以及其中有多少显著增加了长期死亡风险、高偏倚风险和研究中心数量，以及参与者水平因素，如参与者平均年龄和高血压患病率。
围手术期NLR是心脏手术后短期和长期术后死亡率的独立预测因素。需要进一步研究以确定哪些患者水平因素改变NLR的预后价值，并评估其在常规临床实践中的作用。
