Calculated Hematological Indices as Predictors of Cardiovascular Complications in Noncardiac Surgery (Pilot Study)
https://doi.org/10.21292/2078-5658-2022-19-2-14-22
Abstract
The objective: to study the prognostic significance of the ratio of the absolute number of neutrophils to lymphocytes (NLR) and platelets to lymphocytes (PLR) in assessing the risk of cardiovascular complications in non-cardiac surgical interventions.
Subjects and Methods. 85 patients aged 66 [61‒70] years who underwent elective vascular surgery were examined.
Results. Concomitant circulatory diseases were diagnosed in 98.8%. PLR < 91.2 with the sensitivity of 60% and the specificity of 67.8% was associated with diabetes mellitus (AUC – 0.686; 95% CI 0.576‒0.783, p = 0.0022). Cardiovascular complications were registered in 9.3% of patients. NLR was an independent predictor of cardiovascular complications: OR – 5.216; 95% CI 1.246‒21.826, p = 0.005. NLR > 2.1 discriminated cardiovascular complications with the sensitivity of 75% and specificity of 75% (AUC – 0.827; 95% CI 0.690–0.921; p = 0.004). PLR was also a predictor of cardiovascular complications: OR – 1.0111; 95% CI 1.0001–1.0223; p = 0.027. PLR > 105.5 allowed identifying patients with NT-proBNP > 650 pg/ml with the sensitivity of 75.0% and the specificity of 61.8% (AUC – 0.740; 95% CI 0.630‒0.832; p = 0.0308).
Conclusion. NLR and PLR can be used to identify patients with increased cardiac risk when undergoing vascular surgery. Further research in this field is advisable.
About the Authors
D. D. Sokolov
Yaroslavl State Medical University; Regional Clinical Hospital
Russian Federation
Russian Federation
Dmitry A. Sokolov, Associate Professor of Anesthesiology and Intensive Care Department
Phone: +7 (4852) 58-91-13
5, Revolyutsionnaya St., aroslavl, 150000
M. A. Kagramanyan
Yaroslavl State Medical University
Russian Federation
Russian Federation
Mariam A. Kagramanyan, Resident Physician of Anesthesiology and Intensive Care Department
Phone: +7 (4852) 58-91-13
5, Revolyutsionnaya St., aroslavl, 150000
I. A. Kozlov
M. F. Vladimirsky Moscow Regional Research and Clinical Institute
Russian Federation
Russian Federation
Igor A. Kozlov, Professor of Anesthesiology and Intensive Care Department
Phone: +7 (495) 631-04-55
61/2, Schepkina St., Moscow, 129110
References
1. Аmetov А.S., Solovieva O.L. Disturbances in the hemostasis system in diabetes mellitus and ways to correct them when prescribing combination therapy with Diabeton MB and metformin. Sakharny Diabet, 2007, vol. 10, no. 3, pp. 33-39. (In Russ.) https://doi.org/10.14341/2072-0351-5995.
2. Bondarenko I.Z., Shirshina I.А. Thrombogenesis mechanisms associated with diabetes mellitus: what determines the prognosis of interventional intervention? Sakharny Diabet, 2013, vol. 16, no. 3, pp. 58–63. (In Russ.) https://doi.org/10.14341/2072-0351-95.
3. Vitkovskiy Yu.А., Kuznik B.I., Solpov А.V. Pathogenetic significance of lymphocyte-to-platelet adherence. Meditsinskaya Immunologiya, 2006, vol. 8, no. 5-6, pp. 745-753. (In Russ.) https://doi.org/10.15789/1563-0625-2006-5-6-745-753.
4. Zabolotskikh I.B., Lebedinskiy K.M., Grigoriev E.V.et al. Perioperatsionnoe vedenie bolnykh s soputstvuyuschey ishemicheskoy boleznyu serdtsa. Klinicheskie rekomendatsii. V knige: Аnesteziologiya-reanimatologiya. Klinicheskie rekomendatsii. [Peri-operative management of the patients with concurrent ischemic heart disease. Guidelines. In: Anesthesiology and Intensive care. Guidelines]. I.B. Zabolotskikh, E.M. Shifman, eds., Moscow, GEOTAR-Media Publ., 2016, pp. 54-89.
5. Kornienko А.N., Dobrushina O.R., Zinina E.P. Prevention of cardiac complications of extracardiac surgery. Obschaya Reanimatologiya, 2011, vol. 7, no. 5, pp. 57-66. (In Russ.) https://doi.org/10/15360/18139779-2011-5-57.
6. Lunkov V.D., Maevskaya M.V., Tsvetaeva E.K. et al. Neutrophil to lymphocyte ratio as a predictor of adverse outcome in patients with decompensated liver cirrhosis. Rossiyskiy Journal Gastroenterologii, Gepatologii, Koloproktologii, 2019, vol. 29, no. 1, pp. 47-61. (In Russ.) https://doi.org/10.22416/1382-4376-2019-29-1-47-61.
7. Moroz V.V., Dobrushina O.R., Strelnikova E.P. et al. Predictors of cardiac complications of abdominal and pelvic operations in elderly and senile patients. Obschaya Reanimatologiya, 2011, vol. 7, no. 5, pp. 26. (In Russ.) https://doi.org/10.15360/1813-9779-2011-5-26.
8. Pismenny D.S., Savelieva O.E., Zavyalova M.V. et al. Assosiation of the proinflammatory status and distant metastases in non-small cell lung cancer. Sovremennye Problemy Nauki i Obrazovaniya, 2020, no. 6. (In Russ.) https://doi.org/10.17513/spno.30317. URL: https://science-education.ru/ru/article/view?id=30317 (Accessed: 18.11.2021).
9. Polyantsev А.А., Frolov D.V., Linchenko D.V. et al. Hemostatic disorders in diabetes patients. Vestnik Volgogradskogo Gosudarstvennogo Meditsinskogo Universiteta, 2017, vol. 3, no. 63, pp. 16-22. (In Russ.)
10. Sumin А.N. Topical issues of risk assessment and management of cardiac complications in noncardiac surgery. Ratsionalnaya Farmakoterapiya v Kardiologii, 2020, vol. 16, no. 5, pp. 749‒758. (In Russ.) https://doi.org/10.20996/1819-6446-2020-10-08.
11. Trotsyuk D.V., Medvedev D.S., Zaripova Z.А. et al. Risks of perioperative complications in patients of older age groups: causes, mechanisms and prognostic possibilities. RMJ, Meditsinskoe Obozrenie, 2021, vol. 5, no. 3, pp. 150-155. (In Russ.) https://doi.org/10.32364/2587-6821-2021-5-3-150-155.
12. Khoronenko V.E., Osipova N.А., Lagutin M.B. et al. Diagnosis and prevention of the degree of risk of peri-operative cardiovascular complications of geriatric patients undergoing cancer surgery. Anesteziologiya i Reanimatologiya, 2009, vol. 4, pp. 22–27. (In Russ.) PMID: 19827200.
13. Chaulin А.M., Grigorieva Yu.V., Pavlova T.V. et al. Diagnostic significance of complete blood count in cardiovascular patients. Rossiysky Kardiologicheskiy Journal, 2020, vol. 25, no. 12, pp. 172–177. (In Russ.) https://doi.org/10.15829/1560-4071-2020-3923.
14. Ackland G.L., Abbott T.E.F., Cain D. et al. Preoperative systemic inflammation and perioperative myocardial injury: prospective observational multicentre cohort study of patients undergoing non-cardiac surgery. British J. Anaesth., 2019, vol. 122, no. 2, pp. 180–187. https://doi.org/10.1016/j.bja.2018.09.002.
15. Balta S., Ozturk C. The platelet-lymphocyte ratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets, 2015, vol. 26, no. 7, pp. 680–681. https://doi.org/10.3109/09537104.2014.979340.
16. Bhutta H., Agha R., Wong J. et al. Neutrophil-lymphocyte ratio predicts medium-term survival following elective major vascular surgery: a cross-sectional study. Vasc. Endovasc. Surg., 2011, vol. 45, no. 3, pp. 227–231. https://doi.org/10.1177/1538574410396590.
17. Cantor H., Simpson E. Regulation of the immune response by subclasses of T lymphocytes. I. Interactions between pre-killer T cells and regulatory T cells obtained from peripheral lymphoid tissues of mice. Eur. J. Immunol., 1975, vol. 5, no. 5, pp. 330–336 https://doi.org/10.1002/eji.1830050508.
18. Duceppe E., Parlow J., MacDonald P. et al. Canadian cardiovascular society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery. Can. J. Cardiol., 2017, vol. 33, no. 1, pp. 17–32. https://doi.org/10.1016/j.cjca.2016.09.008.
19. Duffy B.K., Gurm H.S., Rajagopal V. et al. Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am. J. Cardiol., 2006, vol. 97, no. 7, pp. 993–996. https://doi.org/10.1016/j.amjcard.2005.10.034.
20. Durmus G., Belen E., Can M.M. Increased neutrophil to lymphocyte ratio predicts myocardial injury in patients undergoing non-cardiac surgery. Heart Lung, 2018, vol. 47, no. 3, pp. 243–247. https://doi.org/10.1016/j.hrtlng.2018.01.005.
21. Grewal J., McKelvie R.S., Persson H. et al. Usefulness of N-terminal pro-brain natriuretic Peptide and brain natriuretic peptide to predict cardiovascular outcomes in patients with heart failure and preserved left ventricular ejection fraction. Am. J. Cardiol., 2008, vol. 102, no. 6, pp. 733–737. https://doi.org/10.1016/j.amjcard.2008.04.048.
22. Gupta P.K., Gupta H., Sundaram A. et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation, 2011, vol. 124, no. 4, pp. 381–387. https://doi.org/0.1161/CIRCULATIONAHA.110.015701.PMID:21730309.
23. Horne B.D., Anderson J.L., John J.M. et al. Which white blood cell subtypes predict increased cardiovascular risk? J. Am. Col. Cardiol., 2005, no. 45, pp. 1638–1643. https://doi.org/10.1016/j.jacc.2005.02.054.
24. Imtiaz F., Shafique K., Mirza S.S. et al. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int. Arch. Med., 2012, vol. 5, no. 1, pp. 2. https://doi.org/10.1186/1755-7682-5-2.
25. Lareyre F., Carboni J., Chikande J. et al. Association of Platelet to lymphocyte ratio and risk of 30-daypostoperative complications in patients undergoing abdominal aorticsurgical repair. Vasc. Endovascular. Surg., 2019, vol. 53, no. 1, pp. 5–11. https://doi.org/10.1177/1538574418789046.
26. Larmann J., Handke J., Scholz A.S. et al. Preoperative neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are associated with major adverse cardiovascular and cerebrovascular events in coronary heart disease patients undergoing non-cardiac surgery. BMC Cardiovascular Disorders, 2020, vol. 20, pp. 230–239. https://doi.org/10.1186/s12872-020-01500-6.
27. Lee L.K.K., Tsai P.N.W., Ip K.Y. et al. Pre-operative cardiac optimisation: a directed review. Anaesthesia, 2019, vol. 74, no. 1, pp. 67–79. https://doi.org/10.1111/anae.14511.
28. Lee T.H., Marcantonio E.R., Mangione C.M. et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation, 1999, vol. 100, no. 10, pp. 1043–1049. https://doi.org/10.1161/01.cir.100.10.1043.
29. Li N. Platelet-lymphocyte cross-talk. J. Leukoc. Biol., 2008, vol. 83, no. 5, pp. 1069–1078. https://doi.org/10.1189/jlb.0907615.
30. Nording H.M., Seizer P., Langer H.F. Platelets in inflammation and atherogenesis. Front Immunol., 2015, vol. 6, pp. 98. https://doi.org/10.3389/fimmu.2015.00098.
31. Ommen S.R., Gibbons R.J., Hodge D.O. et al. Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. Am. J. Cardiol., 1997, vol. 79, no. 6, pp. 812–814. https://doi.org/10.1016/s0002-9149(96)00878-8.
32. Papa A., Emdin M., Passino C. et al. Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin. Chim. Acta., 2008, vol. 395, no. 1–2, pp. 27–31. https://doi.org/10.1016/j.cca.2008.04.019.
33. Puelacher C., Bollen Pinto B., Mills N.L. et al. Expert consensus on peri-operative myocardial injury screening in noncardiac surgery: A literature review. Eur. J. Anaesthesiol., 2021, vol. 38, no. 6, pp. 600–608. https://doi.org/10.1097/EJA.0000000000001486.PMID:33653981.
34. Saienko Ya.A., Zak K.P., Popova V.V. Leukocyte composition and immunophenotype of the blood lymphocytes in women with type 2 diabetes mellitus and obesity. Intern. J. Endocrinol., 2016, vol. 12, no. 5.77, pp. 13–19. https://doi.org/10.22141/2224-0721.5.77.2016.78748.
35. Smith R.A., Bosonnet L., Raraty M. et al. Preoperative platelet –lymphocyte ratio is an independent significant prognostic marker in resected pancreatic ductal adenocarcinoma. Am. J. Surg., 2009, vol. 197, no. 4, pp. 466–472. https://doi.org/10.1016/j.amjsurg.2007.12.05.7.
36. Smith R.A., Ghaneh P., Sutton R. et al. Prognosis of resected ampullary adenocarcinoma by preoperative serum CA19-9 levels and platelet – lymphocyte ratio. J. Gastrointest. Surg., 2008, vol. 12, no. 8, pp. 1422–1428. https://doi.org/10.1007/s11605-008-0554-3.
Review
For citations:
Sokolov D.D., Kagramanyan M.A., Kozlov I.A. Calculated Hematological Indices as Predictors of Cardiovascular Complications in Noncardiac Surgery (Pilot Study). Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2022;19(2):14-22. (In Russ.) https://doi.org/10.21292/2078-5658-2022-19-2-14-22
Email this article 