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Can Neutrophil-to-Lymphocyte Ratio, Platelet Volume, and Platelet Distribution Width Be Used as Indicators of
Bilge Tuncer1, Fulya Çelik2, Burak Çelik3
1Department of Anesthesiology and Reanimation, Ankara Bilkent City Hospital, Ankara 06800, Turkey.
Insights
This study found no significant link between common blood inflammatory markers and postoperative delirium in children. Higher lymphocyte counts, but not neutrophil/lymphocyte ratio, were associated with delirium symptoms.
Area of Science:
- Pediatric Anesthesiology
- Pediatric Critical Care
- Inflammation and Immunology
Background:
- Postoperative delirium is a common complication in children after general anesthesia.
- Inflammation and oxidative stress are implicated in the development of delirium.
- Understanding the role of inflammatory markers is crucial for managing pediatric postoperative delirium.
Purpose of the Study:
- To investigate the relationship between specific hematologic inflammatory markers and the occurrence of postoperative delirium in children.
- To assess the potential predictive value of these markers in pediatric anesthesia patients.
Main Methods:
- A prospective, observational study included 221 children undergoing elective surgeries (adenoidectomy, tonsillectomy, ventilation tube insertion).
- Patients were evaluated using the Pediatric Anesthesia Emergence Delirium (PAED) Scale and the Face, Legs, Activity, Cry, and Consolability (FLACC) Scale.
- Blood samples were analyzed for neutrophil/lymphocyte ratio, mean platelet volume, platelet distribution width, and lymphocyte count.
Main Results:
- Delirium was observed in 80 out of 221 patients.
- No significant differences were found in neutrophil/lymphocyte ratio, mean platelet volume, or platelet distribution width between patients with and without delirium.
- Lymphocyte count, PAED scores, and FLACC scores were significantly higher in patients who experienced delirium.
Conclusions:
- Hematologic inflammatory markers, except for lymphocyte count, did not show a statistically significant relationship with postoperative delirium in this pediatric cohort.
- While lymphocyte count was higher in delirious patients, its predictive value requires further investigation.
- Larger, controlled studies are necessary to confirm the predictive value of these inflammatory markers for pediatric postoperative delirium.
Abstract:
Background/Objectives: Postoperative delirium is a frequent complication in children undergoing general anesthesia. It has been suggested that inflammation and oxidative stress contribute to the pathophysiology of delirium. The aim of our study was to investigate the relationship between inflammatory markers and delirium. Methods: A total of 221 children in the ASA 1-3 risk group who underwent adenoidectomy, tonsillectomy, and/or ventilation tube application were included in our single-center, prospective, and observational study approved by the Ethics Committee, numbered E1-23-3197. Patients whose parental consent was obtained were either premedicated with oral midazolam preoperatively or taken to surgery without premedication, depending on the anesthesiologist's preference. After induction with sevoflurane, rocuronium and fentanyl were administered intravenously. Sevoflurane and infusion of remifentanil were administered for maintenance. At the end of the operation, patients were transferred to the recovery unit and followed up for 30 min. They were evaluated with the Face, Legs, Activity, Cry, and Consolability (FLACC) Scale and Pediatric Anesthesia Emergence Delirium (PAED) Scale. Results: Delirium was observed in 80 patients. There was no significant difference between patients with and without delirium in terms of neutrophil/lymphocyte ratio, mean platelet volume, or platelet distribution volume. Lymphocyte count, PAED score, and FLACC score were statistically higher in patients with delirium (W = 4407.5, p-value = 0.006997; W = 0, p-value < 2.2 × 10-16; W = 9489, p-value < 2.2 × 10-16, respectively). Conclusions: No statistically significant relationship was found between hematologic inflammatory markers and delirium. Controlled studies with larger sample sizes are needed to determine whether these markers have strong predictive value.
