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Neutrophil–lymphocyte ratio as predictor of mortality and morbidity in cardiovascular surgery: a systematic review
Author(s) -
Tan Tze Ping,
Arekapudi Anil,
Metha Jigesh,
Prasad Arun,
Venkatraghavan Lashmi
Publication year - 2015
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13036
Subject(s) - medicine , perioperative , hazard ratio , prospective cohort study , meta analysis , population , vascular surgery , confidence interval , neutrophil to lymphocyte ratio , surgery , cardiac surgery , lymphocyte , environmental health
Background Neutrophil–lymphocyte ratio ( NLR ) is an emerging biomarker of inflammation and predicts poorer outcome in cancer surgery. The prognostic value of NLR in cardiovascular surgery is unclear. Methods Systematic review and meta‐analysis of studies of in cardiovascular surgical patients were conducted to assess the role of perioperative NLR in predicting post‐operative mortality and morbidity. Electronic searches were conducted on O vid M edline, EMBASE , C ochrane C entral R egister of C ontrolled T rials and C ochrane D atabase of S ystemic R eviews for all prospective clinical studies reporting on NLR and post‐operative morbidity and mortality in cardiovascular surgical patient population. Our primary end point was all‐cause post‐operative mortality and the secondary end point was post‐operative morbidity. Mortality outcome from prospective studies were pooled for a meta‐analysis using a random‐effect model. Results Of the 999 citations identified, five studies with 3487 patients met the inclusion criteria. In a pooled analysis of three prospective studies of 3108 patients, a preoperative increase in NLR (>3.3 in cardiac surgery, >5 in vascular surgery) was associated with increased mortality at a mean follow‐up of 34.8 months (hazard ratio 1.85, 95% confidence interval 1.46–2.36; P < 0.00001). Raised NLR value was also associated with increased cardiac mortality, amputation in vascular operations and raised risk of post‐operative re‐intubation. Conclusions Elevated NLR were associated with increased long‐term mortality and morbidity after major cardiac and vascular surgery. NLR may guide perioperative management and risk‐stratification of patients.