Abstract
Neutrophil:lymphocyte ratio (NLR) is an emerging biomarker that is used to predict postoperative mortality and morbidity in cardiac and cancer surgeries. The association of this biomarker with systemic illness and its usefulness in risk assessment of preoperative patients has not been fully elucidated. To determine the prevalence of elevated NLR in preoperative patients and to examine the relationship between elevated NLR and the presence of systemic illnesses as well as anaesthesia risk indices such as American Society of Anesthesia (ASA) and the revised cardiac risk index (RCRI) scores. Cross-sectional study Setting: Anaesthesia pre-admission clinic, Toronto Western Hospital, Toronto, Canada Patients: We evaluated 1117 pre-operative patients seen at an anesthesia preadmission clinic. NLR was elevated (>3.3) in 26.6% of target population. In multivariate analysis, congestive cardiac failure, diabetes mellitus and malignancy were independent risk factors predicting raised NLR. After regression analysis, a relationship between NLR and ASA score (Odds Ratio 1.78; 95% CI: 1.42-2.24) and revised cardiac risk index (RCRI, odds ratio 1.33; 95% CI: 1.09-1.64, p-value: 0.0063) was observed. NLR was elevated (> 3.3) in 26.6% of patients. Congestive cardiac failure and malignancy were two constant predictors of elevated NLR at >3.3 and > 4.5. There was a strong association between NLR and anesthesia risk scoring tools of ASA and RCRI.
Highlights
Perioperative major cardiovascular adverse events contribute to significant morbidity and mortality in patients undergoing non-cardiac surgery[1]
Data sampling One thousand, one hundred and seventy-three patients were identified through the Clinical Anaesthesia Information System’ (CAIS) database
We found an independent association between congestive cardiac failure and Neutrophil:lymphocyte ratio (NLR) values > 3.3 and > 4.5
Summary
Perioperative major cardiovascular adverse events contribute to significant morbidity and mortality in patients undergoing non-cardiac surgery[1]. In addition to risk indices, biomarkers may have a role in assisting risk prediction and aid in developing a management plan Biomarkers such as B-natriuretic peptide and C-reactive peptide have been effectively used in the past to stratify risk and optimise patient care to minimise the adverse events in the perioperative setting[3,4,5,6]. These markers have some limitations in their role in routine clinical practice, as they have been shown to provide either modest or no improvement over conventional risk factors in predicting cardiovascular outcome in non-heart failure populations[3]. There was a strong association between NLR and anesthesia risk scoring tools of ASA and RCRI
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