The neutrophil to lymphocyte ratio in patients supported with extracorporeal membrane oxygenation

Perfusion ◽  
2018 ◽  
Vol 33 (7) ◽  
pp. 562-567 ◽  
Author(s):  
Gardner Yost ◽  
Geetha Bhat ◽  
Patroklos Pappas ◽  
Antone Tatooles
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Myocardial Damage ◽  
Neutrophil Infiltration ◽  
Neutrophil To Lymphocyte Ratio ◽  
Study Cohort ◽  
Lymphocyte Ratio ◽  
Membrane Oxygenation ◽  
Wide Range ◽  
Group 2 ◽  
Group 1

Introduction: The neutrophil to lymphocyte ratio (NLR) has proven to be a robust predictor of mortality in a wide range of cardiovascular diseases. This study investigated the predictive value of the NLR in patients supported by extracorporeal membrane oxygenation (ECMO) systems. Methods: This study included 107 patients who underwent ECMO implantation for cardiogenic shock. Median preoperative NLR was used to divide the cohort, with Group 1 NLR <14.2 and Group 2 with NLR ≥14.2. Survival, the primary outcome, was compared between groups. Results: The study cohort was composed of 64 (60%) males with an average age 53.1 ± 14.9 years. Patients in Group 1 had an average NLR of 7.5 ± 3.5 compared to 27.1 ± 19.9 in Group 2. Additionally, those in Group 2 had significantly higher preoperative blood urea nitrogen (BUN) and age. Survival analysis indicated a thirty-day survival of 56.2%, with significantly worsened mortality in patients with NLR greater than 14.2, p=0.047. Discussion: Our study shows the NLR has prognostic value in patients undergoing ECMO implantation. Leukocytes are known contributors to myocardial damage and neutrophil infiltration is associated with damage caused by myocardial ischemia.

Extracellular histones indicate the prognosis in patients undergoing extracorporeal membrane oxygenation therapy

Perfusion ◽  
2018 ◽  
Vol 34 (3) ◽  
pp. 211-216 ◽  
Author(s):  
Zongmei Wen ◽  
Yang Jin ◽  
Xuemei Jiang ◽  
Meng Sun ◽  
Nazzarena Arman ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Systemic Inflammation ◽  
Organ Injury ◽  
Entire Study ◽  
Membrane Oxygenation ◽  
Extracellular Histones ◽  
Group 2 ◽  
Ecmo Therapy ◽  
Group 1

Introduction: Extracellular histones have been recently identified as damage-associated molecular-pattern (DAMP) molecules involved with the pathogenesis of various inflammatory diseases. This study intended to investigate whether extracellular histones can indicate the prognosis in critically ill patients supported by extracorporeal membrane oxygenation (ECMO) therapy. Methods: A total of 56 patients undergoing ECMO were analysed retrospectively. Median concentrations of extracellular histones in patients before ECMO were assessed and used to divide the patients into two groups (Group 1 <48 µg/ml and Group 2 ⩾48 µg/ml). Mortality rate, Sequential Organ Failure Assessment (SOFA) scores and systemic inflammation were compared between the groups. Results: There were relatively higher concentrations of extracellular histones in Group 2 patients (57.78 µg/ml [48.4, 71.3]) than in Group 1 patients (36.76 µg/ml [28.5, 39.3], p<0.0001). The hospital mortality rate was 55.4% for the entire study subjects, with significantly worsened mortality in Group 2 in contrast to Group 1 (58.8% vs. 50%, p=0.031). Moreover, Group 2 patients had significantly higher SOFA scores and more pronounced systemic inflammation than Group 1 patients prior to ECMO initialization. Conclusions: Extracellular histones are known contributors to cell damage and organ injury. Our study showed that extracellular histones have a predictive value in the assessment of outcome of patients undergoing ECMO therapy and may be helpful for risk stratification in clinical settings.

scholarly journals Pre-operative Neutrophil-to-Lymphocyte Ratio is Associated with Post-operative Opioid Requirements and Length of Stay after Thoracotomy

2020 ◽  
Vol 8 (B) ◽  
pp. 1000-1004
Author(s):  
I Wayan Suranadi ◽  
Tjokorda Gde Agung Senapathi ◽  
Ayu Dilia Febriani Wisnawa ◽  
Christopher Ryalino
Keyword(s):  
Length Of Stay ◽  
Oral Morphine ◽  
Neutrophil To Lymphocyte Ratio ◽  
Hospital Length Of Stay ◽  
Positive Correlation ◽  
Lymphocyte Ratio ◽  
Weak Positive Correlation ◽  
Post Operative Pain ◽  
Group 2 ◽  
Group 1

BACKGROUND: Surgical pain and prolonged hospital length of stay (LOS) affect a large proportion of patients after thoracotomy. Inflammation plays a crucial role in the mechanism and progression of pain and the outcomes. AIM: The objective of this study was to investigate the association between the pre-operative neutrophil-to-lymphocyte ratio (NLR) and post-operative pain and LOS in patients undergoing thoracotomy. METHODS: This was a retrospective, observational study on 157 patients who underwent thoracotomy under general anesthesia. We classified the subjects into two study groups: Group with for patients with NLR <2 and Group 2 for NLR ≥2. We measured the post-operative pain by gathering the data of post-operative opioid needs. We used Pearson’s and Spearman’s correlation tests to assess the association of the parameters. RESULTS: The mean of total oral morphine equivalent in the first 48 h following thoracotomy in Group 1 was 140.8 ± 60.4 mg compared to Group 2’s 109.7 ± 55.8 (p < 0.05). The median hospital’s LOS was longer in Group 2 compared to Group 1 (7 vs. 10, p < 0.001). We found a weak positive correlation between pre-operative NLR (R = 0.267, p = 0.002) and post-operative opioid requirements, and a weak positive correlation between pre-operative NLR and the hospital’s LOS (R = 0.345, p < 0.001). CONCLUSION: Pre-operative NLR correlates with post-operative opioid requirements and the time hospital’s LOS in patients who underwent elective thoracotomy.

Safety of therapeutic hypothermia in children on veno-arterial extracorporeal membrane oxygenation after cardiac surgery

2015 ◽  
Vol 25 (7) ◽  
pp. 1367-1373 ◽  
Author(s):  
Song Lou ◽  
Graeme MacLaren ◽  
Eldho Paul ◽  
Derek Best ◽  
Carmel Delzoppo ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Therapeutic Hypothermia ◽  
Odds Ratio ◽  
Clinical Course ◽  
Complication Rates ◽  
Membrane Oxygenation ◽  
Hypothermia Group ◽  
Group 2 ◽  
Group 1

AbstractObjectiveThe aim of this study was to evaluate whether the use of therapeutic hypothermia in patients receiving extracorporeal membrane oxygenation after paediatric cardiac surgery is associated with increased complication rates.MethodsWe undertook a retrospective study to compare the complication rates and clinical course of children after cardiac surgery in two groups – extracorporeal membrane oxygenation without therapeutic hypothermia (group 1) and extracorporeal membrane oxygenation with therapeutic hypothermia (group 2). Therapeutic hypothermia was performed via the extracorporeal membrane oxygenation circuit heater–cooler device.ResultsA total of 96 patients were included in this study (59 in group 1 and 37 in group 2). Complications were comparable between group 1 and group 2, except that more patients with therapeutic hypothermia had hypertension while on extracorporeal membrane oxygenation. Therapeutic hypothermia was not independently associated with in-hospital mortality (adjusted odds ratio 1.16, 95% CI: 0.33–4.03; p=0.82).ConclusionTherapeutic hypothermia can be safely provided to children on extracorporeal membrane oxygenation after cardiac surgery without an increase in complication rates.

scholarly journals Could neutrophil-to-lymphocyte ratio be a new mortality predictor value in severe burns?

2019 ◽  
pp. 026-028
Author(s):  
Ciftci Ali ◽  
Esen Osman ◽  
Yazicioglu M Burc ◽  
Haksal M Celalettin ◽  
Tiryaki Cagri ◽  
...  
Keyword(s):  
Intensive Care ◽  
Absolute Lymphocyte Count ◽  
Neutrophil To Lymphocyte Ratio ◽  
Burn Injuries ◽  
Lymphocyte Ratio ◽  
Severe Burns ◽  
Training And Research ◽  
Severe Burn Injuries ◽  
Group 2 ◽  
Group 1

Background: The aim of our study was to demonstrate if there is any relation between the neutrophil-to-lymphocyte ratio (NLR) and mortality in severe burns Methods: The records of 366 patients who were admitted to Intensive Care Unit of Burn Center of Derince Training and Research Hospital between January 2012 and December 2015 were evaluated retrospectively. The cases who were hospitalized in service or did not require intensive care were not included in the study. The cases were divided into two groups: ex-group (Group 1) and discharge group (Group 2). In both groups demographic information such as age, gender, burn scores, neutrophil counts and lymphocyte counts during admission to the hospital were recorded. NLR is the ratio of absolute neutrophil count to the absolute lymphocyte count. Results: NLR was 10.94±7.63 in the exitus group and 5.5±5.56 in the discharged group. NLR was increased in mortality group and this value was statistically significant (p=0.00). Independent relationship between prognoses and NLR was shown with logistic regression analyses (Odds Ratio 0.895, 95% confidence interval 0.856-0.936, p=0.00). Conclusion: NLR has increased in mortality group. Our study showed that NLR is correlated with probability of mortality after severe burn injuries. Therefore, it can be used as a cheap, easily obtained and new mortality predictor in severe burns.

scholarly journals Can Peroperative Neutrophil To Lymphocyte Ratio Change (Deltanlr) Be Used as a Parameter in Predicting Acute Renal Failure Following Coronary Bypass Operations With Cardiopulmonary Bypass?

2021 ◽  
Vol 24 (1) ◽  
pp. E194-E200
Author(s):  
Sefer Usta ◽  
Mustafa Abanoz
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Cardiopulmonary Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Bypass ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Group 2 ◽  
Group 1

Background: Inflammation plays a significant role in the pathogenesis of many diseases as well as postoperative acute renal failure (ARF). Preoperative neutrophil to lymphocyte ratio (NLR) values have a prognostic value for postoperative ARF after cardiovascular surgeries. Methods: Patients who underwent elective coronary artery bypass graft (CABG) with cardiopulmonary bypass in our clinic between December 15, 2015 and December 15, 2019, retrospectively were included in this study. Patients who did not develop ARF after the operation were categorized as Group 1, and patients who did were included in Group 2. NLR was calculated from the hemograms during three periods (Preoperative (Pre), Postcardiotomy (Pc), Postoperative Day 1 (Po1). DeltaNLR1 (PcNLR- PreNLR) and DeltaNLR2 (Po1NLR-PreNLR) values were obtained from these calculated values. Results: The mean ages of patients in Group 1 (N = 274) and Group 2 (N = 61) were 60 ± 9.1 years and 67.7 ± 9.8 years, respectively (P < .001). In the multivariate analysis, being over 65 years of age (Odds ratio [OR]: 1.074, 95% confidence interval [CI]: 1.012-1.194, P = .030), postoperative inotropic need (OR: 0.678, CI 95%: 0.395-0.819, P = .021), increased blood product use (OR: 0.916, CI 95%: 0.779-0.986, P = .034), preoperative creatinine increase (OR: 1.974, CI 95%: 1.389-4.224, P = .007), PcNLR (OR : 1.988, CI 95%: 1.765-3.774, P <.001), Po1NLR (OR: 1.090, CI 95%: 1.007-2.116, P = .028), DeltaNLR1 (OR: 3.090, CI 95%: 1.698-6.430, P < .001) and DeltaNLR2 (OR: 1.676, CI 95%: 1.322-2.764, P = .003) were identified as independent predictors for predicting postoperative ARF. Conclusion: In this study, we have shown that peroperative NLR changes can be used as an effective parameter to predict ARF developing following CABG operations.

Preoperative Platelet to Lymphocyte Ratio Is Associated with Early Morbidity and Mortality after Coronary Artery Bypass Grafting

2015 ◽  
Vol 18 (6) ◽  
pp. 255 ◽  
Author(s):  
Hüseyin Şaşkın ◽  
Çagrı Düzyol ◽  
Kazım Serhan Özcan ◽  
Rezan Aksoy ◽  
Mustafa Idiz
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Platelet To Lymphocyte Ratio ◽  
Artery Bypass Grafting ◽  
Lymphocyte Ratio ◽  
Group 2 ◽  
Group 1

<strong>Objective:</strong> To investigate the association of platelet to lymphocyte ratio to mortality and morbidity after coronary artery bypass grafting operation.<br /><strong>Methods:</strong> We evaluated records of 916 patients who underwent coronary artery bypass grafting operation between January 2009 and May 2014 retrospectively. Patients were grouped as Group 1 (n = 604) if the platelet to lymphocyte ratio was above 142 and Group 2 (n = 312) if platelet to lymphocyte ratio was below 142.<br /><strong>Results:</strong> The number of patients who developed a neurologic event during the hospital stay and in the first postoperative month was 7 (1.2%) in Group 1 and 12 (3.8%) in Group 2 for which the difference was statistically significant (P = .007). Early term mortality occurred in 3 patients (0.5%) in Group 1 and in 10 patients (3.2%) in Group 2 for which the difference was statistically highly significant (P = .001). In univariate and multivariate regression analysis, the preoperative platelet to lymphocyte ratio was determined as an independent risk factor for occurrence of atrial fibrillation in the early postoperative period, reoperation for sternum dehiscence, occurrence of a neurologic event, prolonged stay in the hospital and mortality.<br /><strong>Conclusion:</strong> In this study, elevated levels of platelet to lymphocyte ratio were associated with mortality and morbidity after coronary artery bypass grafting operation.

scholarly journals Outcome Prediction in Patients with Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation—A Retrospective International Multicenter Study

Membranes ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 170
Author(s):  
Alexander Supady ◽  
Jeff DellaVolpe ◽  
Fabio Silvio Taccone ◽  
Dominik Scharpf ◽  
Matthias Ulmer ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
The United States ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Survival Prediction ◽  
Study Cohort ◽  
Additional Tool ◽  
Saps Ii ◽  
Membrane Oxygenation ◽  
International Multicenter

The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19 acute respiratory distress syndrome (ARDS) is still under debate and conclusive data from large cohorts are scarce. Furthermore, criteria for the selection of patients that benefit most from this highly invasive and resource-demanding therapy are yet to be defined. In this study, we assess survival in an international multicenter cohort of COVID-19 patients treated with V-V ECMO and evaluate the performance of several clinical scores to predict 30-day survival. Methods: This is an investigator-initiated retrospective non-interventional international multicenter registry study (NCT04405973, first registered 28 May 2020). In 127 patients treated with V-V ECMO at 15 centers in Germany, Switzerland, Italy, Belgium, and the United States, we calculated the Sequential Organ Failure Assessment (SOFA) Score, Simplified Acute Physiology Score II (SAPS II), Acute Physiology And Chronic Health Evaluation II (APACHE II) Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score, Predicting Death for Severe ARDS on V‑V ECMO (PRESERVE) Score, and 30-day survival. Results: In our study cohort which enrolled 127 patients, overall 30-day survival was 54%. Median SOFA, SAPS II, APACHE II, RESP, and PRESERVE were 9, 36, 17, 1, and 4, respectively. The prognostic accuracy for all these scores (area under the receiver operating characteristic—AUROC) ranged between 0.548 and 0.605. Conclusions: The use of scores for the prediction of mortality cannot be recommended for treatment decisions in severe COVID-19 ARDS undergoing V-V ECMO; nevertheless, scoring results below or above a specific cut-off value may be considered as an additional tool in the evaluation of prognosis. Survival rates in this cohort of COVID-19 patients treated with V‑V ECMO were slightly lower than those reported in non-COVID-19 ARDS patients treated with V-V ECMO.

scholarly journals Cross-Reactivity of Drug-Dependent Antibodies in Patients with Immune Thrombocytopenia Induced By Beta-Lactam Antibiotics

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2350-2350
Author(s):  
Matthew John Slaught ◽  
Daniel W. Bougie ◽  
Richard H. Aster
Keyword(s):  
Bacterial Infections ◽  
Immune Thrombocytopenia ◽  
Conflicts Of Interest ◽  
Cross Reactivity ◽  
Beta Lactam ◽  
Cross Reactions ◽  
Beta Lactam Antibiotics ◽  
Wide Range ◽  
Group 2 ◽  
Group 1

More than 50 beta lactam (BL) antibiotics are now in active use for treatment of a wide range of bacterial infections. BL antibiotics are among the most common drugs capable of inducing antibodies (DDAbs) that cause drug-induced immune thrombocytopenia (DITP). Most DDAbs are highly specific for the sensitizing drug but beta lactams all have a common core structure and many similarities among side groups that are added to augment potency and modify specificity, raising the possibility that a DDAb specific for one BL may cross-react with another. We studied DDAbs from 33 patients with DITP induced by 9 commonly used BL drugs to determine whether patterns of cross-reactivity exist that might influence the choice of an alternative antibiotic in a patient with BL-induced DITP. DDAbs were demonstrated in a flow cytometric assay considered to be "positive" when immunoglobulins in patient serum but not normal serum react with normal platelets in the presence, but not in the absence of drug (Blood 2018;131:1486). DDAbs detected in the 33 patients were specific for 9 different BL drugs that were divided into two groups, "penicillins" (Group 1) and cephalosporins (Group 2) on the basis of structural similarities (Figure 1). In Group 1 were 19 DDAbs specific for amoxicillin (2), nafcillin (4) and piperacillin (13). Structurally similar ampicillin and penicillin were also tested with these abs. In Group 2 were 14 DDAbs specific for cefadroxil (1), cefepime (2), ceftazidime (2), ceftizoxime (1), ceftriaxone (7) and cephalexin 1). Cross-reactions identified within these groups of DDAbs are shown in Tables 1 and 2. Cross-reactions, many quite strong (S) were observed among DDAbs specific for drugs in both structural groups (Tables 1 and 2). Particularly noteworthy were cross-reactions of the 19 Group 1 DDAbs with ampicillin (6) and penicillin (6) (Table 1) and of the 14 Group 2 DDAbs with cefepime (6), ceftizoxazole (6) and ceftriaxone (3) (Table 2). The findings show that platelet-specific DDAbs induced by beta lactam antibiotics, in contrast with those induced by medications like quinine, sulfamethoxazole and vancomycin, commonly cross-react with other antibiotics of this class. In patients with immune thrombocytopenia induced by a beta lactam antibiotic, it may be prudent to avoid switching to another beta lactam or, if this is necessary, to monitor platelet counts carefully. Disclosures No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document