Risk stratification with longitudinal neutrophil to lymphocyte ratio assessment after left ventricular assist device implantation
Risk stratification with longitudinal neutrophil to lymphocyte ratio assessment after left ventricular assist device implantation
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左心室辅助装置植入后纵向中性粒细胞与淋巴细胞比率评估的风险分层
DOI：
10.1177/0391398818784276
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
A. Tatooles
中科院分区：
文献类型：
--
作者：
G. Bhat;G. Yost;Kamel Ibrahim;P. Pappas;A. Tatooles
引言：炎症过程是心血管疾病（包括晚期心力衰竭）的特征性风险因素。先前的研究在风险分析中使用了个体白色细胞亚型，最近的一项研究关注了嗜中性粒细胞与淋巴细胞比率在评价左心室辅助装置植入后的阴性结局中的有效性。为了研究左心室辅助装置与白色细胞计数之间的相互作用，我们评估了左心室辅助装置植入后中性粒细胞与淋巴细胞比率的纵向变化。方法：本回顾性研究纳入了2012年至2013年期间接受左心室辅助装置植入术的100例患者。在左心室辅助装置植入前、术后前30天每天和术后前两次门诊访视时计算嗜中性粒细胞/淋巴细胞比值。收集所有患者的术前人口统计学和临床数据。结果：左心室辅助装置植入前即刻的平均嗜中性粒细胞/淋巴细胞比值为5.2 ± 4.9。手术后，嗜中性粒细胞/淋巴细胞比率逐渐下降，从术后第1天的峰值29.2下降到第二次门诊访视时的4.1（p < 0.001）。术后第10天嗜中性粒细胞/淋巴细胞比率没有改善与住院时间延长、右心衰竭和生存率恶化的趋势相关。结论：我们的研究结果表明，左心室辅助装置的植入，一个已知的影响显着的炎症反应。使用嗜中性粒细胞与淋巴细胞的比率，可以有效且容易地随时间监测这种应答的幅度。一般来说，嗜中性粒细胞与淋巴细胞的比率恢复到术前水平需要大约30天。几个月后，嗜中性粒细胞与淋巴细胞的比率改善到低于术前水平。这种降低可能反映了左心室辅助装置植入后各种心力衰竭介导的炎症过程的逆转。
Introduction: Inflammatory processes are well-characterized risk factors in cardiovascular disease including advanced heart failure. Previous studies have utilized individual white cell subtypes in risk analysis, and a recent study has focused on the efficacy of the neutrophil-to-lymphocyte ratio in evaluating negative outcomes following left ventricular assist device implantation. To investigate the interaction between the left ventricular assist device and white cell counts, we assessed longitudinal changes in neutrophil-to-lymphocyte ratio following left ventricular assist device implantation. Methods: This retrospective study included 100 patients who underwent left ventricular assist device implantation between 2012 and 2013. The neutrophil-to-lymphocyte ratio was calculated prior to left ventricular assist device implantation, daily for the first 30 postoperative days, and at the first two postoperative outpatient visits. Preoperative demographic and clinical data were collected for all patients. Results: The mean neutrophil-to-lymphocyte ratio immediately before left ventricular assist device implantation was 5.2 ± 4.9. After surgery, the neutrophil-to-lymphocyte ratio decreased asymptotically, from a peak of 29.2 on postoperative day 1 to 4.1 at the second outpatient visit (p < 0.001). Lack of improvement in the neutrophil-to-lymphocyte ratio at postoperative day 10 was associated with increased length of stay, right heart failure, and a trend toward worsened survival. Conclusion: Our results indicate a significant inflammatory response to implantation of the left ventricular assist device, a known effect. The magnitude of this response may be effectively and easily monitored over time using the neutrophil-to-lymphocyte ratio. In general, approximately 30 days is required for the neutrophil-to-lymphocyte ratio to return to preoperative levels. After several months, the neutrophil-to-lymphocyte ratio improves to below preoperative levels. It is possible that this reduction reflects the reversal of various heart failure–mediated inflammatory processes following left ventricular assist device implantation.
影响因子：
5
作者：
Topkara VK;Evans S;Zhang W;Epelman S;Staloch L;Barger PM;Mann DL
通讯作者：
Mann DL