Dynamic Change of Lymphocyte-to-Monocyte Is Associated With the Occurrence of POCD After Cardiovascular Surgery: A Prospective Observational Study

Qi Zhao,Jing Guan,Xiaoyu Xie,Rui Gao,Xu Cheng,Changliang Liu,Tao Zhu,Yanhua Qiu,Hai Chen,Xueying Zhang,Chan Chen,Peilin Lv

doi:10.3389/fnbeh.2021.646528

Abstract

Objective: Postoperative cognitive dysfunction (POCD) is a common and severe complication of cardiovascular surgery. Lymphocyte-to-monocyte ratio (LMR) has been reported to be an independent predictor of lots of diseases associated with inflammation, but the association between the LMR and POCD is not clear. The present study aimed to investigate the potential value of LMR level to predict POCD in patients undergoing cardiovascular surgery.Methods: A prospective observational study was performed on the patients diagnosed with heart diseases undergoing cardiovascular surgeries with cardiopulmonary bypass. The leukocyte counts were measured by blood routine examination preoperatively. Then we calculated the LMR by dividing the lymphocyte count by the monocyte count. Neurocognitive functions were assessed 1 day before and 7 days after surgery. Perioperative factors were recorded to explore the relationship between LMR and POCD.Results: In total, 75 patients finished the whole study, while 34 patients developed POCD. The preoperative LMR level in the POCD group was higher than that in the non-POCD group. A cutoff value of 4.855 was identified to predict POCD occurrence according to ROC curve. The perioperative dynamic change of LMR level in the POCD group was higher than those in the non-POCD group. A cutoff value of 2.255 was identified to predict POCD occurrence according to ROC curve and the dynamic LMR change had similar varying trend with preoperative LMR level.Conclusions: The dynamic change of LMR level in the peripheral blood is associated with occurrence of POCD, and preoperative LMR level seems to be a prognostic biomarker of postoperative cognitive dysfunction in patients after cardiovascular surgery.

Highlights

Postoperative cognitive dysfunction (POCD) is a common and severe complication after cardiovascular surgery, especially in elderly patients (Ghaffary et al, 2015)
According to the neurocognitive evaluation, 34 (45.3%) patients were diagnosed as having postoperative cognitive dysfunction
There was no difference between the two groups in gender, age, education level, body mass index, NYHA classification, cardiovascular risk factors, duration of anesthesia, operation, CPB and aortic cross-clamp, and hepatic and renal function

Summary

Introduction

Postoperative cognitive dysfunction (POCD) is a common and severe complication after cardiovascular surgery, especially in elderly patients (Ghaffary et al, 2015). POCD was defined as a significant reduction in cognitive performance after surgery, and diagnosed as decline in multiple neurocognitive domains, including memory, attention, coordination, orientation, verbal fluency, and executive function (Vacas et al, 2013), which would induce longer hospital stay, and increase mortality. POCD could increase the long-term risk of Alzheimer’s disease (AD) potentially (Bilotta et al, 2010; Hu et al, 2010). More and more studies were performed to explore the underlying molecular mechanism and possible strategies for POCD prevention.

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