Association between Postoperative Neutrophil/Lymphocyte Ratio, Neutrophil/Platelet Ratio with Mortality after Off-Pump Cardiac Surgery in Premature Newborns

Abstract

Objective:Each year nearly 15 million premature babies are born and their survival rates around the world vary dramatically. Neutrophil-lymphocyte ratio (NLR) is not only a novel marker of systemic inflamation but also a reliable predictor of poor prognosis, response to surgical or medical theraphy. Neutrophil-platelet ratio (NPR) is also gaining importance in some emerging studies as an effective screening tool for inflammatory process. The objective of the present study was to evaluate the association of postoperative NLR and NPR with clinical outcomes in prematures undergoing off-pump cardiac surgery, thereby providing an underlying predictor for clinical prognosis.

Methods:Records of 14 premature infants were retrospectively evaluated. These patients’ PDAs were closed surgically without cardiopulmonary bypass. The association of postoperative NLR and NPR with post-operative outcomes such as postoperative length of stay, hospital length of stay, postoperative mechanical ventilation time and hospital mortality was evaluated.

Results:This study was conducted with fourteen premature infants with a mean (±SD) gestational age of 25.7(±2.0) weeks and a mean weight of 1191(±553) g at the time of operation. A positive correlation was detected between postoperative NPR and both postoperative NLR (r=0.704,P=0.005) and mortality (r=0.598,P=0.024). However, there was no statistically significant relationship between both postoperative NLR, NPR and mean postoperative length of stay, mean hospital stay and mean postoperative mechanical ventilation time. Also there was no statistically significant relationship between NLR and mortality. However, when the patients were divided into 2 groups as alive and dead NLR and NPR were significantly higher in dead group compared to alive group.

Conclusions: There is a positive correlation between postoperative NPR and both postoperative NLR and mortality. Both NLR and NPR are easily obtained and inexpensive markers that can offer an additional means of risk stratification in this vulnerable premature population undergoing off-pump cardiac surgery.