Retrospective evaluation of ultrafiltration during cardiac surgery with cardiopulmonary bypass in adult patients with increased neutrophil to lymphocyte ratio

Abstract

Aim: The aim of this study was to investigate the efficacy of the ultrafiltration (UF) in adult patients undergoing open-heart surgery with cardiopulmonary bypass (CPB) by evaluating the neutrophil to lymphocyte ratio (NLR). Methods: A retrospective case-control study was conducted on 288 adult patients who underwent CPB in a University hospital from January 2016 to December 2018. The study groups were composed of a control group (n=116) of patients who underwent surgery without UF and the study group (n=172) of patients who underwent surgery with UF. All perioperative clinical data, including neutrophil, lymphocyte and platelet count, BUN, creatinine, and C-reactive protein (CRP) values were collected. The efficacy of UF and its association with NLR, neutrophil, lymphocyte and platelet count, postoperative bleeding, extubation time, duration of intensive care unit (ICU) stay and in-hospital stay were analyzed. Results: Neutrophil count, NLR and CRP significantly increased post-operatively compared to pre-operative values (P<0.05). The increased post-operative levels of NLR and decreased platelet counts were significantly associated with UF (P<0.05). Multivariate linear regression analysis revealed that elevated NLR was significantly and independently associated with UF. Conclusion: UF followed by CPB in adult patients undergoing cardiac surgery was associated with increased post-operative NLR and low platelet counts, which nonetheless, were not associated with postoperative complications. UF should be chosen only for selective patients with low hematocrit and should not be chosen to attenuate whole body inflammatory response after CPB in adult cardiac surgery patients.