The Effect of Neutrophil/Lymphocyte Ratio Changes on Morbidity in the Perioperative Period of Neonates with Total Abnormal Pulmonary Venous Return Anomaly

Year 2022, Volume: 25 Issue: 3, 257 - 261, 01.12.2022

Dilek Yavuzcan Öztürk Behzat Tüzün

Abstract

Introduction: Total abnormal pulmonary venous return anomaly (TAPVD) is a congenital heart disease characterized by abnormal pulmonary venous drainage to the right atrium. The Neutrophil/Lymphocyte Ratio (NLR) is used to predict mortality and morbidity after congenital heart surgery. In this study, the effect of postoperative NLR changes on prolonged intensive care unit stay in newborns with TAPVD was searched.

Patients and Methods: The newborns with TAPVD who were followed up and operated on in the pediatric cardiac intensive care unit between May 1, 2020, and May 1, 2022, were included in the study. Hematological parameters and NLR changes were recorded before and after the operation (1st-2nd-3rd days). Long ICU duration (PCILOS, being in the longest 25 percent as duration) was accepted as morbidity. The effects of NLO changes on PCILOS were examined.

Results: Twenty-four patients were included in the study. The median age was 18 days (IQR 12 days-24 days) and the median weight was 3 kg (IQR= 2.8-3.2). Fifteen patients were male (63%). Median mechanical ventilator duration, intensive care unit stay, and hospital stay were 40 hours (IQR= 30-48 hours), seven days (IQR= 5-9), and 15 days (IQR= 12-18), respectively. PCILOS duration was determined as >9 days. Three patients (12.5%) died in the postoperative first 30 days. Preoperative NLR value> 1.9 and postoperative 3rd day NLR> 2.8 predicted PCILOS strongly.

Conclusion: High NLR values in the preoperative and early postoperative periods of neonates with total abnormal pulmonary venous return anomaly may be helpful to predict prolonged ICU stay.

Keywords

Newborns, congenital heart defects, intensive care

References

• 1. Zhao L, Pan Z, Wu C, Shen L, Wu Y. Sutureless technique for primary total anomalous pulmonary venous connection repair: An updated meta-analysis. Front Cardiovasc Med 2022;9:890575. [Crossref]
• 2. Yanagawa B, Alghamdi AA, Dragulescu A, Viola N, Al-Radi OO, Mertens LL, et al. Primary sutureless repair for “simple” total anomalous pulmonary venous connection: Midterm results in a single institution. J Thorac Cardiovasc Surg 2011;141(6):1346-54. [Crossref]
• 3. Jones SM, McCracken C, Alsoufi B, Mahle WT, Oster ME. Association of preoperative cell counts with outcomes after operation for congenital heart disease. Ann Thorac Surg 2018;106(4):1234-40. [Crossref]
• 4. Kim S, Eliot M, Koestler DC, Wu WC, Kelsey KT. Association of neutrophil-to-lymphocyte ratio with mortality and cardiovascular disease in the Jackson Heart Study and modification by the Duffy antigen variant. JAMA Cardiol 2018;3(6):455-62. [Crossref]
• 5. Da Silva M, Cleghorn MC, Elnahas A, Jackson TD, Okrainec A, Quereshy FA. Postoperative day one neutrophil-to-lymphocyte ratio as a predictor of 30-day outcomes in bariatric surgery patients. Surg Endosc 2017;31(6):2645-50. [Crossref]
• 6. Parker DM, Everett AD, Stabler ME, Vricella L, Jacobs ML, Jacobs JP, et al. Novel biomarkers improve prediction of 365-day readmission after pediatric congenital heart surgery. Ann Thorac Surg 2020;109(1):164-70. [Crossref]
• 7. Savluk ÖF, Güzelmeriç F, Yavuz Y, Ukil F, Yılmaz AA, Tan Recep BZ, et al. Albumin, globulin and albumin-globulin ratio as a predictor of mortality, morbidity after fontan operations. GKDA Derg 2019;25(3):167-74.
• 8. Gao P, Liu J, Wang X, Zhang P, Jin Y, Bai L, et al. The association between neutrophil-lymphocyte ratio and poor outcomes following infant cardiac surgery. BMC Cardiovasc Disord 2021;21(1):529. [Crossref]
• 9. Whitlock RP, Devereaux PJ, Teoh KH, Lamy A, Vincent J, Pogue J, et al. Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): A randomised, double-blind, placebo-controlled trial. Lancet 2015;386(10000):1243-53. [Crossref]
• 10. Xu H, Sun Y, Zhang S. The relationship between neutrophil to lymphocyte ratio and clinical outcome in pediatric patients after cardiopulmonary bypass surgery: A retrospective study. Front Pediatr 2019;7:308. [Crossref]
• 11. Manuel V, Miana LA, Guerreiro GP, Turquetto A, Santos RM, Fernandes N, et al. Preoperative neutrophil-lymphocyte ratio can predict outcomes for patients undergoing tetralogy of fallot repair. Braz J Cardiovasc Surg 2021;36(5):607-13. [Crossref]
• 12. Manuel V, Miana LA, Jatene MB. Neutrophil-lymphocyte ratio in congenital heart surgery: What is known and what is new? World J Pediatr Congenit Heart Surg 2022;13(2):208-16. [Crossref]
• 13. Manuel V, Miana LA, Guerreiro GP, Tenório DF, Turquetto A, Penha JG, et al. Prognostic value of the preoperative neutrophil-lymphocyte ratio in patients undergoing the bidirectional Glenn procedure. J Card Surg 2020;35(2):328-34. [Crossref]
• 14. Savluk OF, Guzelmeric F, Yavuz Y, Ukil F, Yilmaz A, Cevirme D, et al. Neutrophil-lymphocyte ratio as a mortality predictor for Norwood stage I operations. Gen Thorac Cardiovas Surg 2019;67(8):669-76. [Crossref]
• 15. Özcanoğlu HD, Öztürk E, Özalp S, Sağlam S, Kahraman IA, Recep BT, et al. The effect of variations in the neutrophil/lymphocyte ratio on the length of post-operative ICU stay in cases diagnosed with transposition of the great arteries. GKDA Derg 2022;28(2):129-34. [Crossref]
• 16. Iliopoulos I, Alder MN, Cooper DS, Villarreal EG, Loomba R, Sahay RD, et al. Pre-operative neutrophil-lymphocyte ratio predicts low cardiac output in children after cardiac surgery. Cardiol Young 2020;30(4):521-5. [Crossref]
• 17. Manuel V, Miana LA, Turquetto A, Guerreiro GP, Fernandes N, Jatene MB. The role of the neutrophil-lymphocyte ratio for pre-operative risk stratification of acute kidney injury after tetralogy of Fallot repair. Cardiol Young 2021;31(6):1009-14. [Crossref]