The Neutrophil to Lymphocyte Ratio and Serum Albumin as Predictors of Acute Kidney Injury After Coronary Artery Bypass Grafting

Abstract Postoperative acute kidney injury (AKI) is a highly prevalent and serious complication after cardiac surgery. The aim of this study is to identify the predictors of AKI and the cut-off values after isolated off-pump coronary artery bypass grafting (OPCAB). A total of 329 adult patients, who underwent isolated OPCAB between December 2008 and February 2021, were retrospectively analyzed. The patients were divided into three groups: non-AKI, early AKI and late AKI groups. The early AKI group or the late AKI group were defined as ‘having AKI that occurred before or after 48 hours postoperatively’, respectively. Multivariate logistic regression analysis was performed to identify the predictors of AKI. Receiver operating characteristic (ROC) curve analysis was used to evaluate the cutoff value, the sensitivity, and the specificity of the predictors. On the multivariate analysis, the emergency surgery, the preoperative serum albumin, and the postoperative day 1 neutrophil to lymphocyte ratio (NL ratio) were identified as the independent predictors of AKI. However, neither albumin nor the NL ratio predicted late AKI. The present study showed the preoperative albumin and the postoperative day 1 NL ratio were the robust and independent predictors of postoperative early AKI in isolated OPCAB.

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Analysis of Pre-and Post-operative Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Acute Kidney Injury After Coronary Artery Bypass Grafting Surgery

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v27i1.1626 ◽

2020 ◽

Vol 27 (1) ◽

Author(s):

Lonasis Cabuslay ◽

Lopa AT ◽

Wibawa SY ◽

Rauf DE

Keyword(s):

Acute Kidney Injury ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Kidney Injury ◽

High Morbidity ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Lymphocyte Ratio

Acute Kidney Injury (AKI) remains a common complication of post-operative Coronary Artery Bypass Grafting (CABG)related to high morbidity and mortality. Systemic inflammation has been known as a part of the pathogenesis of acute kidneyinjury. This study aimed to analyze the Neutrophil Lymphocyte (N/L) ratio and Platelet Lymphocyte (P/L) ratio in post-operativeAKI. This research was a retrospective study involving 76 patients who underwent CABG surgery in Dr. Wahidin SudirohusodoCentral Hospital, Makassar, between January 2015 and May 2019. The diagnosis of AKI was based on Kidney Disease ImprovingGlobal Outcomes (KDIGO) 2012 criteria. The N/L ratio and P/L ratio were calculated respectively as a neutrophil count ratio tolymphocyte count and platelet count to lymphocyte count. Twenty-five (32.9%) patients developed AKI in the first 48 hours ofthe post-operative period. There was no difference in pre-operative N/L ratio and the P/L ratio between AKI and non-AKIgroups (p > 0.05). Both ratios increased after surgery and were significantly different between the two groups with higher meanratio in non-AKI (16.93±9.16 vs. 21.86±11.13, p=0.040 and 239,24±184,36 vs. 314,49±143,73, p=0.011). Both pre-operativeand post-operative N/L ratio and P/L ratio could not distinguish AKI after CABG.

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Faculty Opinions recommendation of Prevention of acute kidney injury by erythropoietin in patients undergoing coronary artery bypass grafting: a pilot study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1162244.622723 ◽

2009 ◽

Author(s):

Robert Anderson

Keyword(s):

Acute Kidney Injury ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Pilot Study ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Kidney Injury ◽

Bypass Grafting ◽

Artery Bypass Grafting

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Faculty Opinions recommendation of Preoperative anemia in patients undergoing coronary artery bypass grafting predicts acute kidney injury.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.3713962.3438062 ◽

2010 ◽

Author(s):

John Augoustides ◽

Tygh Wyckoff

Keyword(s):

Acute Kidney Injury ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Kidney Injury ◽

Bypass Grafting ◽

Preoperative Anemia ◽

Artery Bypass Grafting

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Association between preoperative level of hemoglobin A1c and the incidence of acute kindey injury after coronary artery bypass grafting surgery: a cohort study

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-021-00161-7 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Ghada Mohamed Samir ◽

Omar Mohamed Ali Mohamed Omar ◽

Madiha Metwally Zidan ◽

Hazem Abd El Rahman Fawzy ◽

Marwa Mamdouh Mohamed El Far

Keyword(s):

Acute Kidney Injury ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Hemoglobin A1c ◽

Artery Bypass ◽

Kidney Injury ◽

P Value ◽

Bypass Grafting ◽

Artery Bypass Grafting

Abstract Background The development of acute kidney injury (AKI) is an important indicator of clinical outcomes after cardiac surgery. Elevated preoperative hemoglobin A1c level may be associated with acute kidney injury in patients undergoing coronary artery bypass grafting. This study will investigate the association of preoperative HbA1c levels with AKI after isolated coronary artery bypass grafting (CABG). Results Forty patients undergoing elective CABG were enrolled in this cohort study. Patients are divided into 2 equal groups who underwent isolated coronary artery bypass grafting (CABG): patients with preoperative HbA1c 5.7–6.4% (group A) (prediabetics) and patients with preoperative HbA1c > or = 6.5% (group B) (diabetics). Acute kidney injury according to the Kidney Disease: Improving Global Outcomes criteria developed in 11 patients (27.5%). There was a significant difference between the two groups as regards postoperative urinary NGAL, creatinine level on the 1st day, creatinine level on the 2nd day, urine output on the 1st day, and urine output on the 2nd day (p value was 0.001, 0.002, 0.006, 0.0002, and 0.012 respectively). Postoperative ICU stay duration was statistically significant in the diabetic group (P value 0.009). The need for renal replacement therapy was higher in the diabetic group, but it was not statistically significant between the two groups. Roc analysis shows AUC 0.922 with a significant p value (< 0.0001) and cut of value (≥ 7) with sensitivity 81.82 and specificity 93.10. Conclusion This study revealed that elevated preoperative HbA1c level above 7% showed an increase in incidence of post CABG acute kidney injury along with increase length of postoperative ICU stay.

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