Stability across time of the neutrophil-lymphocyte and lymphocyte-neutrophil ratios and associations with outcomes in cardiac surgery patients

Abstract Background Elevated white blood cell counts and leukocyte ratios are recognized markers of systemic inflammation associated with poor surgical outcomes. We analyzed the temporal stability and prognostic value of the preoperative Neutrophil-to-Lymphocyte ratio (NLR) and Lymphocyte-to-Neutrophil ratio (LNR) in patients undergoing coronary artery bypass grafts and/or valve surgery. Methods We retrospectively reviewed 558 patients who underwent elective cardiac surgery between July 2014 and December 2016, excluding patients with immunosuppressed status. The stability of NLR and LNR was evaluated using interclass correlation coefficients. The patients were dichotomized into two groups, high NLR and low NLR, based on the median value of preoperative NLR in our cohort. A logistic regression model compared preoperative NLR and LNR values to clinical outcomes, including a composite of perioperative events and mid-term mortality. Results We identified that NLR reliability over time was good (ICC = .592; R-squared = .351), and LNR reliability over time was excellent (ICC = .761; R-squared = .601). Furthermore, an increased duration between collection dates was not significantly correlated with increased variability in NLR (Pearson Correlation Coefficient: −.111, p = .117). On multivariate model, neither high NLR (OR = .879, p = .168) nor low LNR (OR = 3.30, p = .214) was significantly associated with a composite of perioperative events, but increased LNR was associated with lower mid-term mortality (HR .001, p = .026). Conclusions Both NLR and LNR were stable over time, up to 100 days, but LNR values were more consistent compared to NLR. High LNR was significantly associated with decreased risk of mid-term mortality, and LNR showed a stronger relationship with mid-term mortality than its NLR counterpart. Both of these findings indicate that LNR may be a more useful and valuable clinical marker.

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Does heparin coating improve biocompatibility? A study on complement, blood cells and postoperative morbidity during cardiac surgery

Perfusion ◽

10.1177/026765919701200607 ◽

1997 ◽

Vol 12 (6) ◽

pp. 385-391 ◽

Cited By ~ 22

Author(s):

Ali Belboul ◽

Najib Al-Khaja

Keyword(s):

Cardiac Surgery ◽

Postoperative Morbidity ◽

Artery Bypass ◽

Classical Pathway ◽

Serum Pool ◽

Heparin Coating ◽

Cell Counts ◽

Significant Difference ◽

White Blood Cell Counts ◽

Coated Surfaces

To evaluate whether the effect of heparin coating the extracorporeal circuit resulted in differences in patient outcome and haemostatic alteration, 24 patients undergoing elective, isolated coronary artery bypass were randomized prospectively to cardiopulmonary bypass (CPB) with heparin-coated circuits (group H, n = 12) or uncoated circuits (group C, n = 12). The technique of CPB, heparinization and its reversal were the same in both groups. We studied complement status (C3d, C3, C3d/C3, C4 and C-function), white blood cell counts with differentiation and the postoperative morbidity. The results confirmed that CPB activates complement and increases neutrophils in both the H and C groups. A significantly lower level of Ieucocytosis was seen in group H compared to the C group ( p < 0.05). The complement function via the classical pathway (C-function), expressed as a percentage of the function of a reference serum pool (the values of normal sera were 75-125%), was significantly reduced in both heparin-coated and uncoated circuits ( p < 0.05). There was no significant intergroup difference regarding C3, C3d/C3, C4 and C-function during the study period. A lower frequency of postoperative morbidity was present in the H group. We conclude that heparin-coated surfaces elicit less leucocytosis and decrease postoperative morbidity in patients undergoing cardiac surgery but do not cause a significant difference regarding activation of the complement system as reported by many other investigators.

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Three Manual Noncommercial Methods to Prepare Equine Platelet-Rich Plasma

Animals ◽

10.3390/ani11061478 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1478

Author(s):

Lorenzo G. T. M. Segabinazzi ◽

Giorgia Podico ◽

Michael F. Rosser ◽

Som G. Nanjappa ◽

Marco A. Alvarenga ◽

...

Keyword(s):

Blood Transfusion ◽

Platelet Rich Plasma ◽

Upright Position ◽

Platelet Counts ◽

Cell Counts ◽

Blood Cell Counts ◽

Platelet Concentration ◽

Manual Methods ◽

White Blood Cell Counts ◽

Over Time

In light of PRP’s increasing popularity in veterinary practice, this study aimed to compare three manual methods to prepare and cool equine PRP. The blood of 18 clinically healthy mares was collected via venipuncture in a blood transfusion bag (method 1), blood tubes (method 2), and a syringe (method 3). In method 1, samples were double centrifuged; method 2 involved one centrifugation, and in method 3 the syringe was kept in an upright position to sediment for 4 h. After processing with three methods, PRP and platelet-poor plasma (PPP) were extracted and assessed for red (RBC) and white blood cell counts (WBC), platelet counts, and viability. In a subset of mares (n = 6), samples were processed with the three methods, and PRP was evaluated at 6 and 24 h postcooling at 5 °C. Method 1 resulted in the highest and method 3 in the lowest platelet concentration (p < 0.05), and the latter also had greater contamination with WBC than the others (p < 0.001). Platelet viability was similar across treatments (p > 0.05). Cooling for 24 h did not affect platelet counts in all methods (p > 0.05); however, platelet viability was reduced after cooling PRP produced by method 3 (p = 0.04), and agglutination increased over time in all methods (p < 0.001). The three methods increased (1.8–5.6-fold) platelet concentration in PRP compared to whole blood without compromising platelet viability. In conclusion, all three methods concentrated platelets and while cooling affected their viability. It remains unknown whether the different methods and cooling would affect PRP’s clinical efficacy.

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Validity and Reliability of the Computer-Administered Routine Opioid Outcome Monitoring (ROOM) Tool

Pain Medicine ◽

10.1093/pm/pnaa297 ◽

2020 ◽

Vol 21 (12) ◽

pp. 3645-3654

Author(s):

Louisa Picco ◽

Melissa Middleton ◽

Raimondo Bruno ◽

Michala Kowalski ◽

Suzanne Nielsen

Keyword(s):

Alcohol Use ◽

Pearson Correlation ◽

Correlation Coefficients ◽

Opioid Use Disorder ◽

Opioid Use ◽

Chronic Noncancer Pain ◽

Retest Reliability ◽

Outcome Monitoring ◽

Test Retest Reliability ◽

Over Time

Abstract Objective The Routine Opioid Outcome Monitoring (ROOM) tool measures outcomes with opioids using an established framework which includes domains such as pain, mood, opioid use disorder, alcohol use, and constipation. This study aims to validate and establish the test-retest reliability of the computer-administered ROOM tool. Design and Setting Cross-sectional analysis of an online sample. Subjects Participants comprised those with chronic noncancer pain who regularly used prescription opioids. Methods Participants self-completed the online ROOM tool along with other validated measures (validation questionnaire), and those who were agreeable also completed the online test-retest questionnaire approximately two weeks later. Subcomponents of the ROOM tool (i.e., pain, mood, alcohol use, opioid use disorder, and constipation) were validated against longer measures of the same construct using Pearson correlation coefficients. Intraclass correlation coefficients were used to assess the stability of the ROOM tool over time. Results A total of 324 participants completed the validation questionnaire, of whom 260 also completed the test-retest questionnaire. The opioid use disorder domain showed good sensitivity (73.6) and specificity (75.8) against the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, any opioid use disorder. All ROOM components showed moderate correlation (r = 0.55–0.73) with their longer counterparts. Test-retest reliability was fair (0.58–0.75), indicating that responses were relatively stable over time. Reliability did vary, however, based on the components being measured and how certain tools were scored. Conclusion The computer-administered ROOM tool is a valid approach for brief monitoring of outcomes with prescribed opioids in primary care settings and appears to be acceptable to people who are using prescribed opioids for chronic pain.

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“In the tube” following sternotomy: A quasi-experimental study

European Journal of Cardiovascular Nursing ◽

10.1177/1474515120951981 ◽

2020 ◽

pp. 147451512095198

Author(s):

L Park ◽

C Coltman ◽

H Agren ◽

S Colwell ◽

KM King-Shier

Keyword(s):

Cardiac Surgery ◽

Artery Bypass ◽

Univariate Analysis ◽

Bypass Graft ◽

Median Sternotomy ◽

Length Of Hospital Stay ◽

Arm Movement ◽

Quasi Experimental ◽

Oriented Movement ◽

Over Time

Background: Traditionally, physical movement has been limited for cardiac surgery patients, up to 12-weeks post-operatively. Patients are asked to use “standard sternal precautions,” restricting their arm movement, and thereby limiting stress on the healing sternum. Aim: To compare return to function, pain/discomfort, wound healing, use of pain medication and antibiotics, and post-operative length of hospital stay in cardiac surgery patients having median sternotomy who used standard sternal precautions or Keep Your Move in the Tube movement protocols post-operatively. Methods: A quasi-experimental design was used (100 standard sternal precautions and 100 Keep Your Move in the Tube patients). Patients were followed in person or by telephone over a period of 12-weeks postoperatively. Outcomes were measured at day 7, as well as weeks 4, 8, and 12 weeks. Results: The majority of participants (77% in each group) were male and had coronary artery bypass graft surgery (66% standard sternal precautions and 72% Keep Your Move in the Tube). Univariate analysis revealed the standard sternal precautions group had lesser ability to return to functional activities than the Keep Your Move in the Tube group ( p<0.0001) over time. This difference was minimized however, by week 12. Multivariate analysis revealed that increasing age, body mass index, and female sex were associated with greater functional impairment over time, but no difference between standard sternal precautions and Keep Your Move in the Tube groups. Conclusions: Keep Your Move in the Tube, a novel patient-oriented movement protocol, has potential for cardiac surgery patients to be more confident and comfortable in their recovery.

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Plasma endotoxin concentrations during cardiac surgery may be related to atherosclerosis

Perfusion ◽

10.1177/026765910001500503 ◽

2000 ◽

Vol 15 (5) ◽

pp. 421-426 ◽

Cited By ~ 8

Author(s):

Vibeke Videm ◽

Jan L Svennevig ◽

Erik Fosse ◽

Brit Mohr ◽

Ansgar O Aasen

Keyword(s):

Cardiac Surgery ◽

Postoperative Complications ◽

Valve Replacement ◽

Artery Bypass ◽

Elective Cardiac Surgery ◽

Plasma Endotoxin ◽

Systemic Endotoxemia ◽

Risk Patients ◽

The Relationship ◽

Cardiac Operations

Systemic endotoxemia develops during cardiopulmonary bypass, probably due to intestinal ischaemia. Differences in endotoxaemia among various cardiac operations and the relationship between endotoxemia and postoperative complications were studied in high-risk patients. Blood samples were obtained at termination of bypass in 136 adults undergoing elective cardiac surgery. Postoperative complications were registered prospectively. Plasma endotoxin was quantified by a kinetic limulus amebocyte lysate assay. Mean endotoxin concentrations were significantly lower in patients undergoing isolated valve replacement (89 ng/l) than in patients undergoing coronary artery bypass grafting alone (234 ng/l), or combined with valve replacement (278 ng/l) or carotid artery surgery (321 ng/l) ( p < 0.05). In multivariate linear regression, only the number of grafts (0, 1-3, 4-5) was significantly correlated to endotoxin concentrations ( p < 0.0005). Endotoxin concentrations were related to development of gastrointestinal dysfunction ( p = 0.03), but not to mortality ( p = 0.24) or other complications ( p = 0.62).

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Association between Relative Amounts of White Blood Cell Counts: a Case of Distribution Dependent Correlations

Nutrition and Food Processing ◽

10.31579/2637-8914/028 ◽

2020 ◽

Vol 3 (2) ◽

pp. 01-06

Author(s):

Arne Høstmark

Keyword(s):

White Blood Cells ◽

Negative Relationship ◽

Correlation Coefficients ◽

Computer Experiments ◽

Positive Association ◽

Negative Association ◽

Random Numbers ◽

Cell Counts ◽

White Blood Cell Counts ◽

Theoretical Considerations

We previously observed a positive association between relative amounts of particular body fatty acids, provided they had low-numbers relative to sum of the remaining ones. Additionally, theoretical considerations and computer experiments suggested that, with two high-number variables relative to one with much lower numbers, we should expect a negative relationship between relative amounts of the high-number variables. Moreover, the correlation outcomes with true values could be well reproduced using random numbers, provided that the numbers had the true ranges (distributions). This finding led to the concept of Distribution Dependent Correlations. Since counts of segmented neutrophil leukocytes (N) and lymphocytes (L) are normally much higher than sum of the remaining (R) white blood cells (WBC), it was suggested that %N might possibly be negatively associated with %L. In the present work, random numbers were sampled in lieu of reported WBC subgroup values, but using the measured mean ± SD values. The results demonstrate that relative amounts of random number “N” and “L” were indeed inversely related in both sexes: Spearman’s rho = -0.9, p <0.001, n = 200, as observed using within-person data, and between-person data as well. Furthermore, an alteration in distributions (variability) of the WBC subgroup changed the correlation outcome, as evaluated by scatterplots and correlation coefficients. Decreasing (increasing) values of %R improved (made poorer) the negative association between %N and %L. Thus, the observed negative association between %N and %L seems to be a case of Distribution Dependent Correlations. Hypothetically, by directing WBC subgroup counts to particular places on the scale, a powerful tool is available to govern the associations between relative amounts of WBC subgroups.

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Co-culture with leukemia cells decreases proliferation and increases chemoprotective capacity of normal mesenchymal stromal cells

10.21203/rs.3.rs-16127/v1 ◽

2020 ◽

Author(s):

Ruixia Hou ◽

Wanfang Yang ◽

Yaofang Zhang ◽

Xiuhua Chen ◽

Fanggang Ren ◽

...

Keyword(s):

Mesenchymal Stromal Cells ◽

Stromal Cells ◽

Healthy Donor ◽

Pearson Correlation ◽

Correlation Coefficients ◽

Cell Types ◽

Leukemia Cells ◽

Cell Counts ◽

Functional Components

Abstract Background Bone marrow mesenchymal stromal cells (BM-MSCs) are essential structural and functional components of the BM microenvironment and play an important role in acute myeloid leukemia (AML) pathogenesis. BM-MSCs isolated from AML patients (AML-MSCs) show distinct signatures from normal BM-MSCs. However, the exact abnormalities of AML-MSCs and the origin of these abnormalities are still unknown.Methods In this study, we evaluated the proliferative activity of AML-MSCs, and the influence of leukemia cells (LCs) on BM-MSCs. These two cell types were co-cultured using an in vitro co-culture system, and the biological functions of AML-MSCs, healthy donor derived MSCs (HD-MSCs), and LC-treated HD-MSCs (LCtrHD-MSCs) were compared by flow cytometry, and CCK-8 and chemotaxis assays. Student t-test (between two groups) and one-way ANOVA (more than 2 groups) were used to compare differences. Pearson correlation coefficients were used to assess correlations between two factors.Results AML-MSCs display a significant proliferative deficiency, which correlates with primary leukemic blast cell counts but not with patients’ age. Inhibition of BM-MSC proliferation could be induced by leukemia cells through direct contact. Co-cultured leukemia cells also increase expression of several inflammatory cytokines, and chemokines in BM-MSCs. Furthermore, LCtrHD-MSCs reduced apoptosis, and increased migration and chemoresistance in co-cultured AML cells, comparable with AML-MSCs.Conclusions Our results showed that leukemia cells can induce healthy donor derived BM-MSCs to exhibit AML-MSC-like characteristics and indicated that AML-MSC abnormalities may be partly induced by leukemia cells.

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Non-home discharge after cardiac surgery in Australia and New Zealand: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2021-049187 ◽

2021 ◽

Vol 11 (12) ◽

pp. e049187

Author(s):

Mahesh Ramanan ◽

Aashish Kumar ◽

Chris Anstey ◽

Kiran Shekar

Keyword(s):

Cardiac Surgery ◽

New Zealand ◽

Artery Bypass ◽

Care Facility ◽

Cross Sectional Study ◽

Adult Patients ◽

Sectional Study ◽

Cross Sectional ◽

Home Discharge ◽

Over Time

ObjectiveTo determine the proportion of patients surviving their cardiac surgery who experienced non-home discharge (NHD) over a 16-year period in Australia and New Zealand (ANZ).DesignRetrospective, multicentre, cross-sectional study over the time period 01 January 2004 to 31 December 2019.SettingAdult patients who underwent cardiac surgery from the Australia New Zealand Intensive Care Society Adult Patient Database (APD).ParticipantsAdult patients (age 18 and above) who underwent index coronary artery bypass grafting, cardiac valve surgery or combined valve/coronary surgery.ExposureThe primary exposure variable was the calendar year during the which the index surgery was performed.OutcomeThe primary outcome was NHD after the index surgery. NHD included discharge to locations such as nursing home, chronic care facility, rehabilitation and palliative care.ResultsWe analysed 252 924 index cardiac surgical admissions from 101 discrete sites with a median age of 68 years (IQR 60–76), of which 74.2% (187 662 out of 252 920) were males. Of these, 4302 (1.7%) patients died in hospital and 213 011 (84.2%) were discharged home, 18 010 (7.1%) were transferred to another hospital and 17 601 (7%) experienced NHD. In Australia, 14 457 (6.4%) of patients progressed to NHD, compared with 3144 (11.7%) in New Zealand. The rate of NHD increased significantly over time (adjusted OR per year=1.06, 95% CI, 1.06 to 1.07, p<0.001). Increasing age, female sex, non-elective surgery, surgery type and Acute Physiology and Chronic Health Evaluation III Score were all associated with significant increase in NHD.ConclusionsThere was significant increase in NHD after cardiac surgery over time in ANZ. This has significant clinical relevance for informed consent discussions between healthcare providers and patients, and for healthcare services planning.

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Haematological profile in foals during the first year of life

Veterinary Record ◽

10.1136/vr.104461 ◽

2019 ◽

Vol 184 (16) ◽

pp. 503-503 ◽

Cited By ~ 2

Author(s):

Babak Faramarzi ◽

Lon Rich

Keyword(s):

Venous Blood ◽

Reference Intervals ◽

First Year ◽

Cell Counts ◽

Haematological Values ◽

Haematological Profile ◽

White Blood Cell Counts ◽

First Year Of Life ◽

Changes Over Time ◽

Over Time

Foals’ haematological values change constantly during their first year of life. The use of updated age-based reference intervals (RIs) is imperative for providing accurate diagnosis and optimum care for sick foals. The authors' objective was to provide updated RIs for 13 haematological values in 2, 7, 14, 30, 90, 180 and 365-day-old foals and to investigate the changes over time in each measured value. Venous blood was collected at those ages from clinically healthy foals. Thirteen haematological values were analysed. The 95% RIs were reported using a bootstrapping method. Differences over time were examined using Friedman test. RIs for each of the measured values were calculated. Results showed noticeable trends in changes over time in several values. Nevertheless, white blood cell counts significantly increased between day 2 and day 90 (P=0.011) while lymphocyte counts increased from day 2 up to day 180 (P=0.033). The mean corpuscular haemoglobin and mean corpuscular volume (P=0.011) significantly decreased between day 2 and day 90. Normal haematological values in foals not only differ from those in adult horses but also change throughout the first year of life; thus, it is critical that clinicians use age-based RIs when treating sick foals.

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Psychological functioning in parents of children undergoing elective cardiac surgery

Cardiology in the Young ◽

10.1017/s1047951104002045 ◽

2004 ◽

Vol 14 (2) ◽

pp. 131-139 ◽

Cited By ~ 42

Author(s):

Jo Wray ◽

Tom Sensky

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Surgical Procedures ◽

Congenital Heart ◽

Individual Characteristics ◽

Hospital Treatment ◽

Healthy Children ◽

Elective Cardiac Surgery ◽

Over Time

Purpose: To assess levels of distress, the marital relationship, and styles of coping of parents of children with congenital heart disease, to evaluate any change in these parameters following elective cardiac surgery for their child, and to compare these parents with parents of children undergoing another form of hospital treatment, and with parents of healthy children.Design:A prospective study in which parents were assessed the day before the surgical procedure being undergone by their child, and 12 months afterwards.Participants:We assessed three groups of parents of 75 children, aged from birth to 16.9 years. The first was a group whose children were undergoing surgery because of congenital heart disease, the second was a group whose children were undergoing transplantation of bone marrow, and the third was a group whose children were healthy. Measures used for assessment included the General Health Questionnaire, the Dyadic adjustment scale, and the Utrecht coping list.Results:Parents in both groups of children undergoing surgery had significantly higher rates of distress prior to the surgical procedures than did the parents of the healthy children, but within those whose children were undergoing cardiac surgery, there were no differences between parents of children with cyanotic and acyanotic lesions. Following treatment, there was a significant reduction in the levels of distress in both groups whose children had undergone surgery. There were few differences between any of the groups on the other parameters, and the evaluated indexes showed stability over time.Conclusion:Despite elevated levels of psychological distress prior to surgical procedures, which had fallen after one year, the stability of other parameters of parental functioning over time suggests that the surgical interventions are of less significance than either factors attributable to the presence of chronic illness, or the individual characteristics of the parents.

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