Abstract
Aims: To evaluate the prognostic value of the preoperative lymphocyte-to-monocyte ratio (LMR) in patients who underwent cardiac surgery.Methods: Clinical data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. The optimal cutoff value of LMR was determined by X-tile software. The Cox proportional hazard model was applied for the identification of independent prognostic factors of 4-year mortality and survival curves were estimated using the Kaplan-Meier method. In order to balance the influence of potential confounding factors, a 1:1 propensity score matching (PSM) method was performed.Results: A total of 1,701 patients were included. The X-tile software indicated that the optimal cutoff value of the LMR for 4-year mortality was 3.58. After PSM, 489 pairs of score-matched patients were generated. The Cox proportional hazard model showed that patients with an LMR < 3.58 had a significantly higher 4-year mortality than patients with an LMR ≥ 3.58 in the entire cohort (HR = 1.925, 95%CI: 1.509–2.456, p < 0.001) and the PSM subset (HR = 1.568, 95%CI: 1.2–2.05, p = 0.001). The survival curves showed that patients with an LMR < 3.58 had a significant lower 4-year survival rate in the entire cohort (71.7 vs. 88.5%, p < 0.001) and the PSM subset (73.2 vs. 81.4%, p = 0.002).Conclusions: A lower LMR (<3.58) was associated with a higher risk of 4-year mortality and can serve as a prognostic predictor of the long-term mortality in cardiac surgery patients.
Highlights
Cardiac surgery, especially with cardiopulmonary bypass (CPB), can provoke a nonspecific inflammatory response, and inflammatory cells play a vital role in the development of inflammation both preoperatively and postoperatively [1]
The lymphocyte-to-monocyte ratio (LMR) has been demonstrated to be associated with the inhospital mortality of patients with acute type A aortic dissection [12] and saphenous vein graft disease in patients who underwent coronary artery bypass grafting (CABG) [13]
We aim to investigate the association between the LMR and the risk of mortality in patients who underwent on-pumped cardiac surgery during a 4-year follow-up
Summary
Especially with cardiopulmonary bypass (CPB), can provoke a nonspecific inflammatory response, and inflammatory cells play a vital role in the development of inflammation both preoperatively and postoperatively [1]. Inflammatory cells, such as neutrophils, lymphocytes and monocytes, are considered typical inflammatory biomarkers and has been verified to have a close relationship with cardiovascular diseases like atherosclerosis and heart failure. These cells can induce diseases but can predict cardiovascular prognosis [2, 3]. Currently no researches reported the association between LMR and the long-term survival for patients undergoing cardiac surgery
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