Investigation of Systemic Immune Inflammatory Index and Prognostic Nutritional Index in Prediction of Major Adverse Cardiovascular and Cerebral Events Occurring After Coronary Artery Bypass Operations

Yıl 2021, Cilt: 5 Sayı: 3, 263 - 269, 31.12.2021

Mustafa Abanoz Mesut Engin

https://doi.org/10.30565/medalanya.929006

Cited By: 3

Öz

Aim: The most valuable treatment method for coronary artery disease is coronary artery bypass graft (CABG) surgery. Major cardiovascular and cerebral events (MACCE) are important challenges, and it is particularly important to reveal possible risk factors in this regard. In this study, we aimed to investigate the predictive areas of the prognostic nutritional index (PNI) and the systemic immune inflammation index (SII) on early postoperatively developing MACCE, in patients who underwent isolated CABG operation

Methods: The patients between the ages of 20 and 85 years who underwent consecutive isolated CABG operation in our clinic between May 15th, 2016, and May 15th, 2020, were included in the study retrospectively. In the postoperative period (within a month), those who did not develop MACCE were recorded as Group 1, and those who developed MACCE as Group 2.

Results: A total of 297 consecutive patients were included in the study. Group 1 had 263 patients with a median age of 63 (32-80), Group 2 had 34 patients with a median age of 70 (36-85) (P=0.008). There was no difference between the groups in terms of gender, history of cerebrovascular events, smoking, body mass index, hyperlipidemia, ejection fraction, and chronic obstructive pulmonary disease rates. As a result of multivariate analysis, advanced age (OR: 1.230 CI 95%: 1.050-1.319 P=0.024), NLR (OR: 1.974 CI 95%: 1.614-3.120, P=0.009), SII (OR: 3.880, CI 95%: 2.690-6.150, P<0.001) and PNI (OR: 2.424, CI 95%: 1.880-3.880, P=0.002) values were determined as independent predictors for predicting early postoperative MACCE.

Conclusion: With this study we revealed that SII and PNI values, which are among the inflammatory parameters and which can be obtained cheaply and easily, may be good predictors for MACCE emerging after CABG operations.

Anahtar Kelimeler

Coronary artery bypass grafting, Inflammation, Nutritional index, Postoperative complication

Koroner Arter Bypass Operasyonları Sonrasında Ortaya Çıkan Major Advers Kardiyovasküler Ve Serebral Olayları Öngörmede Sistemik Immun Inflamatuar Indeks Ve Prognostik Nutrisyonel Indeksin Yerlerinin Araştırılması

Öz

Amaç: Koroner arter hastalığı için en değerli tedavi yöntemi koroner arter baypas greft (KABG) ameliyatıdır. Başlıca kardiyovasküler ve serebral olaylar (MACCE) önemli sorunlardır ve bu konuda olası risk faktörlerini ortaya çıkarmak çok önemlidir. Bu çalışmada, izole KABG operasyonu geçiren hastalarda erken postoperatif gelişen MACCE üzerine prognostik nutrisyonel indeks (PNI) ve sistemik immün inflamasyon indeks (SII)’in prediktif yerlerini araştırmayı amaçladık.

Yöntemler: Kliniğimizde 15.05.2016-15.05.2020 tarihleri arasında ardışık izole KABG operasyonu geçiren 20-85 yaşları arasındaki hastalar retrospektif olarak çalışmaya dahil edildi. Postoperatif dönemde (bir ay içinde) MACCE gelişmeyenler Grup 1, MACCE gelişenler Grup 2 olarak kaydedildi.

Bulgular: Çalışmaya toplam 297 ardışık hasta dahil edildi. Grup 1'de medyan yaşı 63 (32-80) olan 263 hasta, Grup 2'de medyan yaşı 70 (36-85) olan 34 hasta vardı (P = 0.008). Gruplar arasında cinsiyet, serebrovasküler olay öyküsü, sigara kullanımı, vücut kitle indeksi, hiperlipidemi, ejeksiyon fraksiyonu ve kronik obstrüktif akciğer hastalığı oranları açısından fark yoktu. Çok değişkenli analizin sonucunda ileri yaş (OR: 1.230 CI 95%: 1.050-1.319 P=0.024), NLR (OR: 1.974 CI 95%: 1.614-3.120, P=0.009), SII (OR: 3.880, CI 95%: 2.690-6.150, P<0.001) and PNI (OR: 2.424, CI 95%: 1.880-3.880, P=0.002) değerleri erken postoperatif MACCE'yi öngörmede bağımsız prediktörler olarak tespit edildi.

Sonuç: Bu çalışma ile, ucuz ve kolay elde edilebilen inflamatuar parametreler arasında yer alan SII ve PNI değerlerinin, KABG operasyonlarından sonra ortaya çıkan MACCE için iyi prediktörler olabileceğini ortaya koyduk.

Anahtar Kelimeler

Koroner arter baypas greft, İnflamasyon, Nutrisyonel indeks, Postoperatif komplikasyon

Kaynakça

• 1. Pala A, Taner T, Tatli AB, Ozsin KK, Yavuz S. The Effect of Preoperative Hematocrit Level on Early Outcomes After Coronary Artery Bypass Surgery. Cureus. 2020;12(4):e7811. doi: 10.7759/cureus.7811.
• 2. Çoner A, Akıncı S, Akbay E, Budak AB, Saba T, Müderrisoğlu H. Development of De Novo Chronic Total Occlusion in Native Coronary Arteries of Coronary Artery Bypass Grafting Surgery Patients Acta Med. Alanya. 2020;4(3):230-5. doi: 10.30565/medalanya.731636.
• 3. Gurbuz O, Kumtepe G, Ozkan H, Karal IH, Velioglu Y, Ercan A, et al. Predictive Value of Neutrophil-Lymphocyte Ratio for Long-Term Cardiovascular Event Following Coronary Artery Bypass Grafting. Braz J Cardiovasc Surg. 2020;35(3):274-84. doi: 10.21470/1678-9741-2018-0362.
• 4. Raffaele S, Nicola I, Noemi L, Michele P, Michele A, Umberto MB, et al. Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio as Biomarkers for Cardiovascular Surgery Procedures: A Literature Review. Rev Recent Clin Trials. 2021;16(2):173-9 doi: 10.2174/1574887115999201027145406.
• 5. Agus HZ, Kahraman S, Arslan C, Yildirim C, Erturk M, Kalkan AK, et al. Systemic immune-inflammation index predicts mortality in infective endocarditis. J Saudi Heart Assoc. 2020;32(1):58-64. doi: 10.37616/2212-5043.1010.
• 6. Kim Y, Choi H, Jung SM, Song JJ, Park YB, Lee SW. Systemic immune-inflammation index could estimate the cross-sectional high activity and the poor outcomes in immunosuppressive drug-naïve patients with antineutrophil cytoplasmic antibody-associated vasculitis. Nephrology (Carlton) 2019;24(7):711-7. doi: 10.1111/nep.13491.
• 7. Çakır ÖÖ. The Relationship Between Blood Neutrophil to Lymphocyte Ratio and Tumor Size, Tumor Number, Macrovascular Invasion in Patients with Hepatocellular Carcinoma. Acta Med. Alanya. 2019;3(3):207-12. doi:10.30565/medalanya.551550.
• 8. Dey S, Kashav R, Kohli JK, Magoon R, Shri I, Walian A, et al. Systemic Immune-Inflammation Index Predicts Poor Outcome After Elective Off-Pump CABG: A Retrospective, Single-Center Study. J Cardiothorac Vasc Anesth. 2021;35(8):2397-404. doi: 10.1053/j.jvca.2020.09.092.
• 9. Engin M, Ozsin KK, Savran M, Guvenc O, Yavuz S, Ozyazicioglu AF. Visceral Adiposity Index and Prognostic Nutritional Index in Predicting Atrial Fibrillation after On-Pump Coronary Artery Bypass Operations: a Prospective Study. Braz J Cardiovasc Surg. 2021;36(4):522-9. doi: 10.21470/1678-9741-2020-0044.
• 10. Teker Acıkel ME, Korkut AB. Impact of Controlling Nutritional Status Score (CONUT) and Prognostic Nutritional Index (PIN) on Patients Undergoing Coronary Artery Bypass Graft Surgery. Heart Surg Forum. 2019;22(4):E294-7. doi: 10.1532/hsf.2493.
• 11. Landis C. Why the inflammatory response is important to the cardiac surgical patient. J Extra Corpor Technol. 2007;39(4):281-4. PMID: 18293820.
• 12. Kaya MG. Inflammation and coronary artery disease: as a new biomarker neutrophil/lymphocyte ratio. Arch Turk Soc Cardiol. 2013;41(3):191-2. doi: 10.5543/tkda.2013.84484.
• 13. Abanoz M, Engin M. The effect of the relationship between post-cardiotomy neutrophil/lymphocyte ratio and platelet counts on early major adverse events after isolated coronary artery bypass grafting. Turk Gogus Kalp Damar Cerrahisi Derg. 2021;29(1):36-44. doi: 10.5606/tgkdc.dergisi.2021.20873.
• 14. Langer HF, Gawaz M. Platelet-vessel Wall interactions in atherosclerotic disease. Thromb Haemost. 2008;99(3):480-6. doi: 10.1160/TH07-11-0685.
• 15. Blake GJ, Ridker PM. Inflammatory bio-markers and cardiovascular risk prediction. J Intern Med. 2002;252(4):283-94. doi: 10.1046/j.1365-2796.2002.01019.x.
• 16. Laffey JG, Boylan JF, Cheng DC. The systemic inflammatory response to cardiac surgery: Implications for the anesthesiologist. Anesthesiology. 2002;97(1):215–52. doi: 10.1097/00000542-200207000-00030.
• 17. 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. doi: 10.1017/S1047951120000487.
• 18. Sun H, Que J, Peng Y, Ye H, Xiang H, Han Y, et al. The neutrophil-lymphocyte ratio: A promising predictor of mortality in coronary care unit patients - A cohort study. Int Immunopharmacol. 2019;74:105692. doi: 10.1016/j.intimp.2019.105692.
• 19. Şaşkın H, Düzyol Ç, Özcan KS, Aksoy R, Idiz M. Preoperative Platelet to Lymphocyte Ratio Is Associated with Early Morbidity and Mortality after Coronary Artery Bypass Grafting. Heart Surg Forum. 2015;18(6):E255-62. doi: 10.1532/hsf.1341.
• 20. Gungor H, Babu AS, Zencir C, Akpek M, Selvi M, Erkan MH, et al. Association of Preoperative Platelet-to-Lymphocyte Ratio with Atrial Fibrillation after Coronary Artery Bypass Graft Surgery. Med Princ Pract. 2017;26(2):164-8. doi: 10.1159/000453614.
• 21. Navani RV, Baradi A, Colin Huang KL, Jin D, Jiao Y, Nguyen JK, et al. Preoperative Platelet-to-Lymphocyte Ratio Is Not Associated With Postoperative Atrial Fibrillation. Ann Thorac Surg. 2020;110(4):1265-70. doi: 10.1016/j.athoracsur.2020.02.008.
• 22. Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212–22. doi: 10.1158/1078-0432.CCR-14-0442.
• 23. Yang YL, Wu CH, Hsu PF, Chen SC, Huang SS, Chan WL, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest. 2020;50(5):e13230. doi: 10.1111/eci.13230.
• 24. Arques S. Human serum albumin in cardiovascular diseases. Eur J Intern Med. 2018;52:8-12. doi: 10.1016/j.ejim.2018.04.014.
• 25. Lee SI, Ko KP, Choi CH, Park CH, Park KY, Son KH. Does the prognostic nutritional index have a predictive role in the outcomes of adult cardiac surgery? J Thorac Cardiovasc Surg 2020;160(1):145-153.e3. doi: 10.1016/j.jtcvs.2019.08.069.