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Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting
Patrick H Gibson1, Bernard L Croal, Brian H Cuthbertson
1Department of Cardiology, University of Aberdeen and Aberdeen Royal Infirmary, Aberdeen, United Kingdom.
Insights
A high neutrophil-lymphocyte (N/L) ratio before coronary artery bypass grafting (CABG) surgery predicts worse patient survival. This finding is independent of other cardiac surgery risk factors.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Prognostic Biomarkers
Background:
- Elevated preoperative white blood cell count is linked to adverse outcomes post-coronary artery bypass grafting (CABG).
- Leukocyte subtypes, specifically the neutrophil-lymphocyte (N/L) ratio, may offer enhanced prognostic value.
Purpose of the Study:
- To investigate the predictive capability of the preoperative N/L ratio for patient outcomes undergoing CABG.
Main Methods:
- Prospective data collection from 1938 patients undergoing CABG.
- Preoperative differential leukocyte count measurement.
- Follow-up of 3.6 years with all-cause mortality as the primary endpoint.
Main Results:
- The preoperative N/L ratio strongly predicted mortality in univariable and multivariable analyses.
- It remained an independent predictor even when considering the European System for Cardiac Operative Risk Evaluation (EuroSCORE).
- The N/L ratio predicted cardiovascular mortality and death in patients with normal white blood cell counts, particularly in the upper quartile.
Conclusions:
- An elevated N/L ratio is significantly associated with reduced survival after CABG.
- The prognostic value of the N/L ratio is independent of established cardiac surgery risk factors.
Background:
An elevated preoperative white blood cell count has been associated with a worse outcome after coronary artery bypass grafting (CABG). Leukocyte subtypes, and particularly the neutrophil-lymphocyte (N/L) ratio, may however, convey superior prognostic information. We hypothesized that the N/L ratio would predict the outcome of patients undergoing surgical revascularization.
Methods:
Baseline clinical details were obtained prospectively in 1938 patients undergoing CABG. The differential leukocyte was measured before surgery, and patients were followed-up 3.6 years later. The primary end point was all-cause mortality.
Results:
The preoperative N/L ratio was a powerful univariable predictor of mortality (hazard ratio [HR] 1.13 per unit, P < .001). In a backward conditional model, including all study variables, it remained a strong predictor (HR 1.09 per unit, P = .004). In a further model, including the European system for cardiac operative risk evaluation, the N/L ratio remained an independent predictor (HR 1.08 per unit, P = .008). Likewise, it was an independent predictor of cardiovascular mortality and predicted death in the subgroup of patients with a normal white blood cell count. This excess hazard was concentrated in patients with an N/L ratio in the upper quartile (>3.36).
Conclusion:
An elevated N/L ratio is associated with a poorer survival after CABG. This prognostic utility is independent of other recognized risk factors.
