Preoperatif Nötrofil-Lenfosit Oranının ve Eritrosit Dağılım Genişliğinin İzole Kalp Kapak Ameliyatlarında Postoperatif Prognoza Etkisi

Öz

Kırmızı kan hücresi dağılım genişliği (RDW) ve nötrofil-lenfosit oranının (NLR), çeşitli klinik durumlar yanında kardiyovasküler cerrahide prognostik değere sahip olduğu belirtilmektedir. Bu çalışmada, izole kalp kapak ameliyatı geçiren hastalarda preoperatif NLR ve RDW değerinin postoperatif mortalite ve morbiditede etkisi olup olmadığını gözlemlemeyi amaçladık. Bu çalışma 2016-2020 tarihleri arasında izole kalp kapak replasman cerrahisi uygulanan hastaların tıbbi kayıtlarının geriye dönük incelenmesi ile oluşturulmuştur. Ameliyat öncesi RDW ve NLR değerleri, ameliyat sonrası ekstübasyon, mekanik ventilasyon, yoğun bakım kalış ve hastanede kalış süreleri, ameliyat sonrası serebrovasküler hastalık (SVH) ve yeni başlayan atriyal fibrilasyon (AF) varlığı ve diyaliz gereksinimi kaydedildi. Toplam 68 hastanın verileri değerlendirildi. Tüm hastaların ameliyat öncesi ortalama NLR değeri 4,67±3,67, ameliyat öncesi ortalama RDW değeri ise 15,06±2,19 idi. NLR ve RDW değerleri postoperatif AF gelişen hastalarda sırasıyla 4,91(p=0.756) ve 15,48 (p=0.032); postoperatif SVH gelişen hastalarda sırasıyla 3,34 ve 17,56; diyaliz gerektiren hastalarda sırasıyla 9,26 ve 14,93 olarak belirlendi. Kalp kapak replasman ameliyatı geçiren hastalarda ameliyat öncesi NLO ve RDW değerleri yüksek olmasına rağmen bu iki belirtecin bu hasta popülasyonunda ameliyat sonrası istenmeyen olaylar açısından prognostik değere sahip olduğunu söylemek mümkün değildir.

Anahtar Kelimeler

• Kalp Kapak Ameliyatı
• Nötrofil-Lenfosit Oranı
• Kırmızı Kan Hücresi Dağılım Genişliği

Effect of the Neutrophil-Lymphocyte Ratio and Red Blood Cell Distribution Width On Postoperative Prognosis

Öz

It has been stated that red blood cell distribution width (RDW) and neutrophil-lymphocyte ratio (NLR) have prognostic value in cardiovascular surgery, as well as various clinical conditions. This study aimed to determine whether preoperative NLR and RDW values had an effect on postoperative mortality and morbidity in patients undergoing isolated heart valve surgery. Methods: This study was retrospectively conducted by examining the medical records of patients who underwent isolated heart valve replacement surgery between 2016 and 2020. Preoperative RDW and NLR values, postoperative extubation, mechanical ventilation, intensive care unit stay, and hospital stay, presence of postoperative cerebrovascular disease (CVD) and new-onset atrial fibrillation (AF), and dialysis requirement were recorded. The data of 68 patients were evaluated. In all the patients, the mean preoperative NLR value was 4.67±3.67, and the mean preoperative RDW value was 15.06±2.19. The NLR and RDW values were determined as 4.91(p=0.756) and 15.48 (p=0.032); respectively in the patients that developed postoperative AF, 3.34 and 17.56, respectively in those that developed postoperative CVD, and 9.26 and 14.93, respectively in those that required dialysis. Although preoperative the NLR and RDW values were high among the patients undergoing heart valve replacement surgery, it is not possible to state that these two markers have prognostic value for postoperative adverse events in this patient population.

Anahtar Kelimeler

• Heart Valve Surgery
• Neutrophil-Lymphocyte Ratio
• Red Blood Cell Distribution Width

Kaynakça

1. 1. Assulyn T, Khamisy-Farah R, Nseir W, Bashkin A, Farah R. Neutrophil-to-lymphocyte ratio and red blood cell distribution width as predictors of microalbuminuria in type 2 diabetes. J Clin Lab Anal. 2020;34(7):e23259
2. 2. Zhu J, Zeng C, Zhang L, Shu S, Liu Y, Chen G, et al. Red blood cell distribution width and neutrophil-to-lymphocyte ratio in predicting adverse outcomes of acute kidney injury in hospitalized patients. Kidney Dis (Basel). 2020:6:371-381
3. 3. Yamada S, Yoshihisa A, Kaneshiro T, Amami K, Hijioka N, Oikawa M, et al. The relationship between red cell distribution width and cardiac autonomic function in heart failure. J Arrhythm. 2020;36:1076-1082
4. 4. Arıman A, Merder E. The prognostic importance of neutrophil-to-lymphocyte ratio in testicular cancer. Urologia. 2021;88:200-205
5. 5. 5. Weedle RC, Da Costa M, Veerasinggam D, Soo AWS. The use of neutrophil lymphocyte ratio to predict complications postcardiac surgery. Ann Transl Med. 2019;7:778
6. 6. Huo LK, Chen KY, Tse G, Liu T. Association of inflammatory markers based on routine blood with prognosis in patients underwent percutaneous coronary intervention. Medicine (Baltimore) 2004;103 (19):e38118.
7. 7. Gibson PH, Croal BL, Cuthbertson BH, Small GR, Ifezulike AI,Gibson G, et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J. 2007;154:995-1002
8. 8. Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol. 2005;45:1638-1643

9. 9. Cho KI, Cho SH, Her AY, Singh GB, Shin ES. Prognostic utility of neutrophil-to-lymphocyte ratio n adverse clinical outcomes in patients with severe calcific aortic stenosis. PLoS One. 2016;11:e1061530
10. 10. 10. Hunziker S, A Cell L, Lee J, Howell MD. Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patient. Crit Care. 2012;16:89
11. 11. Lazzeroni D, Moderato L, Marazzi PL, Pallegrino C, Musiari E, Castiglioni P, et al. Red blood cell distribution width as a novel prognostic marker after myocardial revascularization or cardiac valve surgery. Sci Rep. 2021;11:7889
12. 12. Qureshi M, Ahmed A, Massie V, Marshall E, Harky A. Determinants of atrial fibrillation after cardiac surgery. Rev Cardiovasc Med. 2021;22:329-341
13. 13. Xin L, Chenghao C, Shuwen H, Shenglin G, Chenggxin Z. Association of red blood cell distribution width with post-operative new-onset atrial fibrillation following cardiac valve replacement surgery: a retrospective study. Biomarkers. 2022;27: 286-292
14. 14. Ertaş G, Aydin C, Sönmez O, Erdoğan E, Turfan M, Tasal A, et al. Red cell distribution width predicts new-onset atrial fibrillation after coronary artery bypass grafting. Scand Cardiovasc J. 2013;47:132-135
15. 15. Kılıcgedik A, Naser A, Gurbuz AS, Kulahcioglu S, Bakal RB, Unkun T, et al. Red cell distribution width with CHADS2 and CHA2DS2-VASc score is associated with post-operative atrial fibrillation after coronary artery bypass grafting. The Heart Surgery Forum. 2018;21 :E170–E174
16. 16. Ani C, Ovbiagele B. Elevated red blood cell distribution width predicts mortality in persons with known stroke. J Neurol Sci. 2009;277:103-108
17. 17. Kim J, Kim YD, Song TJ, Park JH, Lee HS, Nam CM, et al. Red blood cell distribution width is associated with poor clinical outcome in acute cerebral infarction. Tromb Haemost. 2012;108:349-356
18. 18. Patel KV, Mohanty JG, Kanapuru B, Hesdorffer C, Ershler WB, Rifkind JM. Association of the red cell distribution width red blood cell deformability. Adv Exp Biol. 2013;765:211-216
19. 19. Duchnowski P, Hryniewiecki T, Kusmierczyk M, Szymanski P. Red cell distribution width is a pronostic marker of perioperative stroke in patients undergoing cardiac valve surgery. Interact Cardiovasc Thorac Surg. 2017;25:925-929
20. 20. Haran C, Gimpel D, Clark H, McCormack DJ. Preoperative neutrophil and lymphocyte ratio as a predictor of mortality and morbidity after cardiac surgery. Heart Lung Circ. 2021;30(3):414-418