The Neutrophil Lymphocyte Ratio as a Successful Extubation Predictor of Prolonged Intubation in Pediatric Heart Surgery

Abstract

Background: Postoperative mechanical ventilation is required in patients undergoing congenital heart surgery. However, the duration of mechanical ventilation may be extended as a result in some patients. Inflammation is a normal and expected process following surgery and the intensive care process. However, increased and prolonged inflammation increases the risk of mortality and morbidity. The neutrophil lymphocyte ratio (NLR) can be used as a new marker of inflammation in cardiovascular diseases. The aim of our study was to evaluate the association between NLR and successful extubation in pediatric patients undergoing cardiovascular surgery with prolonged intubation. Methods: Pre-extubation blood samples were used for the baseline data. Extubation failure was defined as reintubation within 24 hours of extubation for study purposes. Total white blood cell (WBC), neutrophil and lymphocyte count were recorded pre-extubation, and the NLR was calculated. Results: Ninety-nine patients who had undergone congenital heart surgery were classified. Statistically significant differences were observed with regard to the blood results for the two groups for WBC (P = 0.001), neutrophil count (P = 0.001), lymphocyte count (P = 0.003), and NLR (P = 0.001). Following multivariate logistic regression analysis, the NLR, WBC, neutrophil count, lymphocyte count remained significant predictors of successful extubation. Conclusions: The NLR was found to vary significantly in children in whom extubation failed compared to that in children in whom extubation was successful (following prolonged intubation) and was also predictive of successful extubation in our study.