Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting
Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting
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DOI：
10.1016/j.ahj.2007.06.043
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发表时间：
2007-11-01
影响因子：
4.8
通讯作者：
Hillis, Graham S.
中科院分区：
文献类型：
--
作者：
Gibson, Patrick H.;Croal, Bernard L.;Hillis, Graham S.
背景：术前白色血细胞计数升高与冠状动脉旁路移植术（CABG）后不良结局相关。然而，白细胞亚型，特别是嗜中性粒细胞-淋巴细胞（N/L）比值，可能传达上级预后信息。我们假设，N/L比将预测接受手术revascular.Methods基线临床资料的患者的结果，前瞻性地获得了1938例接受冠状动脉搭桥术。术前检测白细胞分类，术后随访3.6年。结果术前N/L比值是一个强有力的单变量死亡预测因子（危险比[HR] 1。13个/单位，P< .001）。在包括所有研究变量的后向条件模型中，它仍然是一个强预测因子（HR 1.09/单位，P =.004）。在另一个模型中，包括欧洲心脏手术风险评估系统，N/L比值仍然是一个独立的预测因子（HR 1.08/单位，P = 0.008）。同样，它也是心血管死亡率的独立预测因子，并可预测白色血细胞计数正常的亚组患者的死亡。这种过度危险集中在N/L比值在上四分位数（>3.36）的患者中。这种预后效用独立于其他公认的风险因素。
Background An elevated preoperative white blood cell count has been associated with a worse outcome after coronary artery bypass grafting (CABG). Leukocyte subtypes, and particularly the neutrophil-lymphocyte (N/L) ratio, may however, convey superior prognostic information. We hypothesized that the N/L ratio would predict the outcome of patients undergoing surgical revascularization.Methods Baseline clinical details were obtained prospectively in 1938 patients undergoing CABG. The differential leukocyte was measured before surgery, and patients were followed-up 3.6 years later. The primary end point was all-cause mortality.Results The preoperative N/L ratio was a powerful univariable predictor of mortality (hazard ratio [HR] 1. 13 per unit, P< .001). In a backward conditional model, including all study variables, it remained a strong predictor (HR 1.09 per unit, P =.004). In a further model, including the European system for cardiac operative risk evaluation, the N/L ratio remained an independent predictor (HR 1.08 per unit, P = .008). Likewise, it was an independent predictor of cardiovascular mortality and predicted death in the subgroup-of patients with a normal white blood cell count. This excess hazard was concentrated in patients with an N/L ratio in the upper quartile (>3.36).Conclusion An elevated N/L ratio is associated with a poorer survival after CABG. This prognostic utility is independent of other recognized risk factors.