Abstract
ObjectiveTo investigate the predictive value of preoperative neutrophil to lymphocyte ratio (NLR) on acute kidney injury (AKI) after on-pump coronary artery bypass (ONCAB).MethodsPatients who underwent elective ONCAB for coronary heart disease were included. NLR was calculated according to the results of preoperative routine blood test, patients were divided into non-AKI and AKI groups, and the differences in clinical baseline data between the two groups were compared.ResultsA total of 154 patients were included in this study, including 57 (37%) with postoperative AKI and 97 (63%) without AKI. Compared with the patients in non-AKI group, those in AKI group had higher NLR (2.63 (1.83, 3.505) vs. 2.06 (1.7, 2.56), p = 0.002), higher serum creatinine (78 (67, 98.5) vs. 70.9 ± 16.8 umol/L, p < 0.001), longer cardiopulmonary bypass time, and longer aortic cross clamp time. After dividing patient into tertiles based on NLR, those with higher NLR had higher risk of postoperative AKI than those with lower NLR (30% vs. 25% vs. 55.8%, p for trend = 0.003). Patients in Tertile2 and Tertile3 had higher NLR compared to those in Tertile1 (p < 0.05); multivariate logistic regression analysis showed patients with elevated preoperative NLR and blood creatinine had higher risk of postoperative AKI. ROC curve showed that patients’ preoperative NLR combined with blood creatinine had better predictive value for postoperative AKI.ConclusionElevated preoperative NLR is associated with AKI after ONCAB, and had prognostic utility independent of other recognized risk factors.
Highlights
Coronary heart disease is the most common cause of death [1]
Relevant definitions: (1) the diagnosis of chronic kidney disease was referred to the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines [9]. (2) acute kidney injury (AKI) was diagnosed according to the modified KDIGO guidelines [10] by meeting any of the following: (i) rapid decline in renal function within 48 h after surgery with an absolute increase in serum creatinine ≥ 26.5 umol/L (0.3 mg/dl); (ii) increase in serum creatinine to ≥ 1.5 times the basal value at 7 days; (iii) urine volume < 0.5 mL/(kg h) with duration > 6 h
This study retrospectively analyzed the association between preoperative neutrophil to lymphocyte ratio (NLR) and the incidence of AKI after on-pump coronary artery bypass (ONCAB) in 154 cases
Summary
Coronary heart disease is the most common cause of death [1]. Coronary artery bypass grafting (CABG) remains the mainstay of treatment for patients with severe1 3 Vol.:(0123456789)General Thoracic and Cardiovascular Surgery multivessel disease, especially for those combined with left main stem lesions in coronary artery disease, in which CABG can reconstruct blood flow and relieve myocardial ischemic and hypoxic symptoms. Coronary artery bypass grafting (CABG) remains the mainstay of treatment for patients with severe. Despite the great improvements in surgical approaches and supervised treatment in cardiac surgery, the incidence and mortality associated with acute kidney injury (AKI) has not been significantly reduced in recent years [2]. Several studies have shown that AKI is a common complication after CABG, up to 5–30%, of which 1–2% of patients may require renal replacement therapy [3]. Studies showed that NLR had the positive correlation and synchronous changes with various classical inflammatory indices, indicating the state of renal function during the inflammation and disease processes [7]. Existing studies have shown the conflicting predictive value of preoperative NLR for postoperative AKI in patients undergoing CABG alone [6, 8]. We aimed to investigate the correlation between preoperative NLR and postoperative AKI after ONCAB, and the combined predictive value of preoperative NLR with other indicators
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