Retrospective evaluation of ultrafiltration during cardiac surgery with cardiopulmonary bypass in adult patients with increased neutrophil to lymphocyte ratio

Abstract

Aim: The aim of this study was to investigate the efficacy of the ultrafiltration (UF) in adult patients undergoing open-heart surgery with cardiopulmonary bypass (CPB) by evaluating the neutrophil to lymphocyte ratio (NLR). Methods: A retrospective case-control study was conducted on 288 adult patients who underwent CPB in a University hospital from January 2016 to December 2018. The study groups were composed of a control group (n=116) of patients who underwent surgery without UF and the study group (n=172) of patients who underwent surgery with UF. All perioperative clinical data, including neutrophil, lymphocyte and platelet count, BUN, creatinine, and C-reactive protein (CRP) values were collected. The efficacy of UF and its association with NLR, neutrophil, lymphocyte and platelet count, postoperative bleeding, extubation time, duration of intensive care unit (ICU) stay and in-hospital stay were analyzed. Results: Neutrophil count, NLR and CRP significantly increased post-operatively compared to pre-operative values (P<0.05). The increased post-operative levels of NLR and decreased platelet counts were significantly associated with UF (P<0.05). Multivariate linear regression analysis revealed that elevated NLR was significantly and independently associated with UF. Conclusion: UF followed by CPB in adult patients undergoing cardiac surgery was associated with increased post-operative NLR and low platelet counts, which nonetheless, were not associated with postoperative complications. UF should be chosen only for selective patients with low hematocrit and should not be chosen to attenuate whole body inflammatory response after CPB in adult cardiac surgery patients.

Keywords

• adult patients
• cardiopulmonary bypass
• ultrafiltration
• neutrophil lymphocyte ratio
• platelet
• inflammation

Erişkin hastalarda kardiyopulmoner baypas ile uygulanan konvansiyonel ultrafiltrasyonun nötrofil / lenfosit oranı ile retrospektif olarak değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı, nötrofil / lenfosit oranını (NLO) değerlendirerek, kardiyopulmoner baypas (CPB) ile açık kalp cerrahisi geçiren yetişkin hastalarda ultrafiltrasyonun (UF) etkinliğini araştırmaktır. Yöntemler: Ocak 2016'dan Aralık 2018'e kadar bir Üniversite hastanesinde CPB uygulanan 288 yetişkin hasta üzerinde retrospektif bir kohort çalışması yapılmıştır. Nötrofil, lenfosit ve trombosit sayısı, BUN, kreatinin ve C-reaktif protein (CRP) dahil olmak üzere tüm perioperatif klinik veriler geriye dönük olarak toplandı. UF'nin etkinliği ve NLO, nötrofil, lenfosit ve trombosit sayısı, postoperatif kanama, ekstübasyon süresi, yoğun bakım ünitesinde (YBÜ) kalış süresi ve hastanede kalış süresi ile ilişkisi analiz edildi. Bulgular: Nötrofil sayısı, NLO ve CRP ameliyat öncesi değerlere göre ameliyat sonrası anlamlı olarak arttı (P<0,05). Ameliyat sonrası artan NLO seviyeleri ve azalmış trombosit sayıları UF ile anlamlı olarak ilişkili idi (P<0,05). Çok değişkenli doğrusal regresyon analizi, yükselmiş NLR’nin UF ile anlamlı ve bağımsız olarak ilişkili olduğunu ortaya çıkarmıştır. Sonuç: Açık kalp cerrahisi uygulanan yetişkin hastalarda UF uygulamaları, artmış postoperatif NLO ve düşük trombosit sayıları ile ilişkiliydi, ancak yine de postoperatif komplikasyonlarla ilişkili değildi. UF, yalnızca düşük hematokriti olan seçici hastalar için seçilmeli ve yetişkin kalp cerrahisi hastalarında CPB'den sonra tüm vücut enflamatuar yanıtını hafifletmek için seçilmemelidir.

Anahtar Kelimeler

• Erişkin hasta
• Kardiyo-pulmoner baypas
• Ultrafiltrasyon
• Nötrofil lenfosit oranı
• Trombosit
• Enflamasyon

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