The Effect of Preoperative Neutrophil-Lymphocyte Ratio On Quality of Life After Coronary Artery Bypass Graft (CABG) Surgery

Fatmawati Kamal, Raihan Awg Isa, Zalizah Khalid, Ummi Mohlisi Mohd Asmawi

Abstract


Background: The ability to predict outcome in a patient is important in personalized medicine. Scoring systems, use clinical and laboratory parameters to prognosticate a patient. Inflammation and oxidative stress have been shown to play a role in the pathogenesis of cardiovascular diseases. Neutrophil-lymphocyte ratio (NLR) is one of the cheapest and most accessible inflammatory biomarker ever used. Studies have shown the ability of NLR to predict outcome in high risk vascular surgical patients and a variety of diseases such as cancer, non-alcoholic fatty liver, and Alzheimer disease. Increased NLR with a cut-off >2.5, is associated with unfavorable outcome in these conditions. A study in Korea showed a mean NLR of 1.65  in 12 610 healthy adults.

Aim: This study was done to look at the effect of NLR on the outcome of patients underwent coronary artery bypass graft (CABG) surgery. 

Methodology: This is a retrospective observational study done at the Faculty of Medicine, Universiti Teknologi MARA between June 2013 and December 2017. Historical data was collected from the Cardiothoracic Department database provided by the Record Office and approved by UiTM Research Ethics Committee in March 2017. The sample size was calculated to be 170. Data includes all patients who underwent CABG during that period and had neutrophil and lymphocyte counts available pre-operatively. NLR was calculated as a ratio of absolute count of neutrophils to absolute count of lymphocytes. NLR >2.5 was used as cut-off. The outcome parameters include mortality, and prolonged intensive care unit (ICU)  and hospital stay. 

Findings: A total of 260 CABG surgery were done between June 2013 and December 2017. Only about 137 patients fulfilled the inclusion and exclusion criteria, of which 79.6% were males and 20.4% were females. 35% of the patients had NLR >2.5. 37.4% (n=34) of patients with high NLR, had prolonged ICU and hospital stay. Mortality post-CABG was 6.6% (n=9), of which 5 patients had NLR >2.5, and 4 had both prolonged ICU and hospital stay. 

Implication: NLR is a useful, low cost and easily accessible inflammatory marker. NLR was found to be increased in patients who had prolonged intensive care unit (ICU) stay and hospital/ ward stay. Thus NLR can potentially be used to predict worse outcome.

Keywords: Neutrophil-lymphocyte ratio; coronary artery bypass graft (CABG); mortality; length of stay (maximum 4 keywords) 

eISSN: 2398-4287© 2019. The Authors. Published for AMER ABRA cE-Bsby e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, UniversitiTeknologi MARA, Malaysia.



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DOI: https://doi.org/10.21834/e-bpj.v4i10.1628

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