Bae Myung Il, Shim Jae-Kwang, Song Jong Wook, Ko Seo Hee, Choi Young Seo, Kwak Young-Lan
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Inflamm Res. 2023 Jun 2;16:2375-2385. doi: 10.2147/JIR.S411057. eCollection 2023.
The neutrophil-to-lymphocyte ratio (NLR) is an extensively analyzed prognostic inflammatory index in cardiac patients. The degree of change in NLR values before and after surgery (delta-NLR) can represent the inflammatory response induced by surgery and serve as a meaningful prognostic biomarker in surgical patients; however, this has not been well investigated. We aimed to investigate the predictive value of the perioperative NLR and delta-NLR for outcomes of off-pump coronary artery bypass (OPCAB) surgery by evaluating "days alive and out of hospital (DAOH)", a novel patient-centered outcome.
In this single-center retrospective study, perioperative data, including NLR data, from 1322 patients were analyzed. The primary endpoint was DOAH at 90 days postoperatively (DAOH 90), and the secondary endpoint was long-term mortality. Linear regression analysis and Cox regression analysis were performed to identify independent risk factors for the endpoints. In addition, Kaplan-Meier survival curves were plotted to assess long-term mortality.
The median NLR values significantly increased from 2.2 (1.6-3.1) at baseline to 7.4 (5.4-10.3) postoperatively, with median delta-NLR values of 5.0 (3.2-7.6). Preoperative NLR and delta-NLR were independent risk factors for short DAOH 90 in the linear regression analysis. In Cox regression analysis, delta-NLR, but not preoperative NLR, was an independent risk factor for long-term mortality. When patients were divided into two groups according to delta-NLR, the high delta-NLR group had a shorter DAOH 90 than the low delta-NLR group. Kaplan-Meier curves showed higher long-term mortality in the high delta-NLR group than in the low delta-NLR group.
In OPCAB patients, preoperative NLR and delta-NLR were significantly associated with DAOH 90, and delta-NLR was an independent risk factor for long-term mortality, indicating their role in risk assessment, which is essential for perioperative management.
中性粒细胞与淋巴细胞比值（NLR）是心脏病患者中一项经过广泛分析的预后炎症指标。手术前后NLR值的变化程度（ΔNLR）可代表手术引发的炎症反应，并作为手术患者中有意义的预后生物标志物；然而，对此尚未进行充分研究。我们旨在通过评估“存活并出院天数（DAOH）”这一以患者为中心的新结局指标，来研究围手术期NLR和ΔNLR对非体外循环冠状动脉搭桥术（OPCAB）手术结局的预测价值。
在这项单中心回顾性研究中，分析了1322例患者的围手术期数据，包括NLR数据。主要终点是术后90天的DAOH（DAOH 90），次要终点是长期死亡率。进行线性回归分析和Cox回归分析以确定终点的独立危险因素。此外，绘制Kaplan-Meier生存曲线以评估长期死亡率。
NLR中位数从基线时的2.2（1.6 - 3.1）显著增加至术后的7.4（5.4 - 10.3），ΔNLR中位数为5.0（3.2 - 7.6）。在线性回归分析中，术前NLR和ΔNLR是DAOH 90较短的独立危险因素。在Cox回归分析中，ΔNLR而非术前NLR是长期死亡率的独立危险因素。根据ΔNLR将患者分为两组时，高ΔNLR组的DAOH 90比低ΔNLR组短。Kaplan-Meier曲线显示高ΔNLR组的长期死亡率高于低ΔNLR组。
在OPCAB患者中，术前NLR和ΔNLR与DAOH 90显著相关，且ΔNLR是长期死亡率的独立危险因素，表明它们在风险评估中的作用，这对围手术期管理至关重要。
