Pre-operative neutrophil–lymphocyte ratio predicts low cardiac output in children after cardiac surgery

Iliopoulos, Ilias; Alder, Matthew N.; Cooper, David S.; Villarreal, Enrique G.; Loomba, Rohit; Sahay, Rashmi D.; Fei, Lin; Steele, Paul E.; Flores, Saul

doi:10.1017/s1047951120000487

Cited by 34Congenital Heart Disease StudiesInflammatory Biomarkers in Disease PrognosisCardiac and Coronary Surgery Techniques

Pre-operative neutrophil–lymphocyte ratio predicts low cardiac output in children after cardiac surgery

Iliopoulos, Ilias, Alder, Matthew N., Cooper, David S., Villarreal, Enrique G., Loomba, Rohit, Sahay, Rashmi D., Fei, Lin, Steele, Paul E. +1 more·2020·Cardiology in the Young

DOI 10.1017/s1047951120000487

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Abstract

Neutrophil–lymphocyte ratio has been associated with clinical outcomes in several groups of cardiac patients, including patients with coronary artery disease, cardiac failure, and cardiac transplant recipients. We hypothesised that pre- and/or post-operative haematological cell counts are associated with clinical outcomes in children undergoing cardiac surgery for CHD. We performed a post hoc analysis of data collected as part of a prospective observational cohort study (n = 83, data available n = 47) of children evaluated for glucocorticoid receptor levels after cardiac surgery (July 2015–January 2016). The association of neutrophil–lymphocyte ratio with low cardiac output syndrome, time to inotrope free, and vasoactive-inotropic score was examined using proportional odds analysis, cox regression, and linear regression models, respectively. A majority (80%) of patients were infants (median/interquartile range 4.1/0.2–7.6 months) with conotruncal (36%) and left-sided obstructed lesions (28%). Two patients required mechanical circulatory support and three died. Higher pre-operative neutrophil–lymphocyte ratio was associated with higher cumulative odds of severe/moderate versus mild low cardiac output on post-operative day 1 (odds ratio 2.86; 95% confidence interval 1.18–6.93; p = 0.02). Pre-operative neutrophil–lymphocyte ratio was not significantly associated with time to inotrope free or vasoactive-inotrope score. Post-operative neutrophil–lymphocyte ratio was also not associated with outcomes. In children after congenital heart surgery, higher pre-operative neutrophil–lymphocyte ratio was associated with a higher chance of low cardiac output in the early post-operative period. Pre-operative neutrophil–lymphocyte ratio maybe a useful prognostic marker in children undergoing congenital heart surgery.

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LCOS definitions differ among studies, varying from temporary use of a single vasoactive agent to counteract "stunning" to the requirement of mechanical support.
“Several therapies have been evaluated for their effect on LCOS and compared in meta-analyses, however LCOS definitions differ among studies varying from the temporary use of a single vasoactive agent to counteract “stunning” to the requirement of mechanical support (15, 16).”
From Definitions of low cardiac output syndrome after cardiac surgery and their effect on the incidence of intraoperative LCOS: A literature review and cohort study (2022) · cites this paper as [15]

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Reply to Letter: Predictive value of preoperative neutrophil–lymphocyte ratio predicts low cardiac output in children after cardiac surgery
Villarreal, E. G., Loomba, R. S., & Flores, S. (2020) · Cardiology in the Young · doi:10.1017/s1047951120001559
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Predictive value of pre-operative neutrophil–lymphocyte ratio for children undergoing congenital heart surgery
Manuel, V., Miana, L. A., & Jatene, M. B. (2020) · Cardiology in the Young · doi:10.1017/s1047951120000840 · Cited by 4 · see citing works
The Association Between Neutrophil-Lymphocyte Ratio and Poor Outcomes Following Infant Cardiac SurgeryPreprint
Gao, P., Liu, J., Wang, X., Zhang, P., Jin, Y., Bai, L., & Li, Y. (2021) · Research Square · doi:10.21203/rs.3.rs-948260/v1 · Cited by 1 · see citing works
Neutrophil–Lymphocyte Ratio in Congenital Heart Surgery: What Is Known and What Is New?
Manuel, V., Miana, L. A., & Jatene, M. B. (2022) · World Journal for Pediatric and Congenital Heart Surgery · doi:10.1177/21501351211064143 · Cited by 14 · see citing works

Authors: Iliopoulos, I., Alder, M. N., Cooper, D. S., Villarreal, E. G., Loomba, R., Sahay, R. D., Fei, L., Steele, P. E., & Flores, S.
Affiliations: Cincinnati Children's Hospital Medical Center (US)
Baylor College of Medicine (US)
Advocate Children's Hospital (US)
Corresponding author: Villarreal, Enrique G.
ORCID: Iliopoulos, Ilias
Alder, Matthew N.
Cooper, David S.
Villarreal, Enrique G.
Loomba, Rohit
Sahay, Rashmi D.
Fei, Lin
Steele, Paul E.
Venue: Cardiology in the Young
Publisher: Cambridge University Press (CUP)
Published: 2020-03-05
Volume: 30
Issue: 4
Pages: 521-525
ISSN: 1047-9511 (ISSN-L)
1467-1107
DOI: 10.1017/s1047951120000487
OpenAlex: W3009979413
Cited by: 34
References: 36
Citations by year: 2026: 5 · 2025: 5 · 2024: 3 · 2023: 4 · 2022: 6 · 2021: 9 · 2020: 2
FWCI: 3.77
Type: journal article
Language: en
Open access: closed
Licence: www.cambridge.org/core/terms (unspecified)
Locations: Cardiology in the Young (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
Keywords: neutrophil-to-lymphocyte ratio, low cardiac output syndrome, congenital heart disease, pediatric cardiac surgery, prognostic factors, inotrope requirement, vasoactive-inotropic score, infants
MeSH terms: Adolescent, Cardiac Output, Cardiac Output, Low, Child, Child, Preschool, Female, Follow-Up Studies, Cardiac Surgical Procedures, Humans, Infant, Leukocyte Count, Lymphocytes, Male, Neutrophils, Postoperative Period, Prognosis, Prospective Studies, Preoperative Period

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Pre-operative neutrophil–lymphocyte ratio predicts low cardiac output in children after cardiac surgery

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