Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-28T02:57:03.601Z Has data issue: false hasContentIssue false
  • English
  • Français

The role of the neutrophil–lymphocyte ratio for pre-operative risk stratification of acute kidney injury after tetralogy of Fallot repair

Part of: Tetralogy of Fallot (TOF) Basic Science Surgery

Published online by Cambridge University Press:  21 May 2021

Valdano Manuel Open the ORCID record for Valdano Manuel [Opens in a new window] ,
Leonardo A. Miana Open the ORCID record for Leonardo A. Miana [Opens in a new window] ,
Aida Turquetto ,
Gustavo Pampolha Guerreiro ,
Natália Fernandes  and
Marcelo Biscegli Jatene
Valdano Manuel*
Affiliation:
Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
Leonardo A. Miana
Affiliation:
Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Aida Turquetto
Affiliation:
Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Gustavo Pampolha Guerreiro
Affiliation:
Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Natália Fernandes
Affiliation:
Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Marcelo Biscegli Jatene
Affiliation:
Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
*
Author for correspondence: Valdano Manuel, Division of Cardiovascular Surgery, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéias de Carvalho Aguiar, 44–Pinheiros, São Paulo, Brazil. Tel: +55 11949768625. E-mail: valdanympub@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Acute kidney injury is a risk factor for chronic kidney disease and mortality after congenital heart surgery under cardiopulmonary bypass. The neutrophil–lymphocyte ratio is an inexpensive and easy to measure biomarker for predicting outcomes in children with congenital heart disease undergoing surgical correction.

Objective:

To identify children at high risk of acute kidney injury after tetralogy of Fallot repair using the neutrophil–lymphocyte ratio.

Methods:

This single-centre retrospective analysis included consecutive patients aged < 18 years who underwent tetralogy of Fallot repair between January 2014 and December 2018. The pre-operative neutrophil–lymphocyte ratio was measured using the last pre-operative complete blood count test. We used the Acute Kidney Injury Network definition.

Results:

A total of 116 patients were included, of whom 39 (33.6%) presented with acute kidney injury: 20 (51.3%) had grade I acute kidney injury, nine had grade II acute kidney injury (23.1%), and 10 (25.6%) had grade III acute kidney injury. A high pre-operative neutrophil–lymphocyte ratio was associated with grade III acute kidney injury in the post-operative period (p = 0.04). Patients with acute kidney injury had longer mechanical ventilation time (p = 0.023), intensive care unit stay (p < 0.001), and hospital length of stay (p = 0.002).

Conclusion:

Our results suggest that the pre-operative neutrophil–lymphocyte ratio can be used to identify patients at risk of developing grade III acute kidney injury after tetralogy of Fallot repair.

Keywords

Congenital heart diseaseinflammationcyanotic congenital heart diseaseneutrophil–lymphocyte ratiotetralogy of Fallot
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 6 , June 2021 , pp. 1009 - 1014
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Meeting presented at 26º Congresso Brasileiro de Cardiologia e Cirurgia Cardiovascular Pediátrica, 11 December, 2020.

References

Mehta, RL, Kellum, JA, Shah, SV, et al. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: R31.10.1186/cc5713CrossRefGoogle ScholarPubMed
Greenberg, JH, Parsons, M, Zappitelli, M, et al. Cardiac biomarkers for risk stratification of acute kidney injury after pediatric cardiac surgery [published online ahead of print, 2020 Apr 10]. Ann Thorac Surg 2020. S0003-4975(20)30506-3.Google Scholar
Bucholz, EM, Whitlock, RP, Zappitelli, M, et al. Cardiac biomarkers and acute kidney injury after cardiac surgery. Pediatrics 2015; 135: e945–e956.10.1542/peds.2014-2949CrossRefGoogle ScholarPubMed
de Fontnouvelle, CA, Greenberg, JH, Thiessen-Philbrook, HR, et al. Interleukin-8 and tumor necrosis factor predict acute kidney injury after pediatric cardiac surgery. Ann Thorac Surg 2017; 104: 2072–2079.10.1016/j.athoracsur.2017.04.038CrossRefGoogle ScholarPubMed
Greenberg, JH, Zappitelli, M, Jia, Y, et al. Biomarkers of AKI progression after pediatric cardiac surgery. J Am Soc Nephrol 2018; 29: 1549–1556.10.1681/ASN.2017090989CrossRefGoogle ScholarPubMed
Greenberg, JH, Whitlock, R, Zhang, WR, et al. Interleukin-6 and interleukin-10 as acute kidney injury biomarkers in pediatric cardiac surgery. Pediatr Nephrol 2015; 30: 1519–1527.10.1007/s00467-015-3088-4CrossRefGoogle ScholarPubMed
Manuel, V, Miana, LA, Guerreiro, GP, et al. Prognostic value of the preoperative neutrophil–lymphocyte ratio in patients undergoing the bidirectional Glenn procedure. J Card Surg 2020; 35: 328–334.10.1111/jocs.14381CrossRefGoogle ScholarPubMed
Savluk, OF, Guzelmeric, F, Yavuz, Y, et al. Neutrophil–lymphocyte ratio as a mortality predictor for Norwood stage I operations. Gen Thorac Cardiovasc Surg 2019; 67: 669–676.10.1007/s11748-019-01081-yCrossRefGoogle ScholarPubMed
Savluk, OF, Guzelmeric, F, Yavuz, Y, et al. The neutrophil lymphocyte ratio as a successful extubation predictor of prolonged intubation in pediatric. Heart Surg 2017; 27: e9416.Google Scholar
Manuel, V, Miana, LA, Guerreiro, GP, et al. Preoperative neutrophil–lymphocyte ratio can predict outcomes for patients undergoing tetralogy of Fallot repair. Braz J Cardiovasc Surg. 2021. doi: 10.21470/1678-9741-2020-0408.CrossRefGoogle Scholar
Manuel, V, Miana, LA, Solla, DJF, et al. Preoperative level of neutrophil–lymphocyte ratio: comparison between cyanotic and acyanotic congenital heart disease. J Card Surg. 2021. doi: 10.1111/jocs.15413.CrossRefGoogle Scholar
Bu, X, Zhang, L, Chen, P, Wu, X. Relation of neutrophil-to-lymphocyte ratio to acute kidney injury in patients with sepsis and septic shock: a retrospective study. Int Immunopharmacol 2019; 70: 372–377.10.1016/j.intimp.2019.02.043CrossRefGoogle Scholar
Koo, CH, Eun Jung, D, Park, YS, et al. Neutrophil, lymphocyte, and platelet counts and acute kidney injury after cardiovascular surgery. J Cardiothorac Vasc Anesth 2018; 32: 212–222.10.1053/j.jvca.2017.08.033CrossRefGoogle ScholarPubMed
Gibson, PH, Croal, BL, Cuthbertson, BH, et al. Preoperative neutrophil–lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J 2007; 154: 995–1002.10.1016/j.ahj.2007.06.043CrossRefGoogle ScholarPubMed
Habib, M, Thawabi, M, Hawatmeh, A, et al. Value of neutrophil to lymphocyte ratio as a predictor of mortality in patients undergoing aortic valve replacement. Cardiovasc Diagn Ther 2018; 8: 164–172.10.21037/cdt.2018.03.01CrossRefGoogle ScholarPubMed
Suh, B, Shin, DW, Kwon, HM, et al. Elevated neutrophil to lymphocyte ratio and ischemic stroke risk in generally healthy adults. PLoS One 2017; 12: e0183706.10.1371/journal.pone.0183706CrossRefGoogle ScholarPubMed
Ronco, C, Bellomo, R, Kellum, JA. Acute kidney injury. Lancet 2019; 394: 1949–1964.10.1016/S0140-6736(19)32563-2CrossRefGoogle ScholarPubMed
Hoste, EA, Clermont, G, Kersten, A, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006; 10: R73.10.1186/cc4915CrossRefGoogle ScholarPubMed
Mishra, J, Dent, C, Tarabishi, R, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005; 365: 1231–1238.10.1016/S0140-6736(05)74811-XCrossRefGoogle ScholarPubMed
Praught, ML, Shlipak, MG. Are small changes in serum creatinine an important risk factor? Curr Opin Nephrol Hypertens 2005; 14: 265–270.10.1097/01.mnh.0000165894.90748.72CrossRefGoogle ScholarPubMed
Li, S, Krawczeski, CD, Zappitelli, M, et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med 2011; 39: 1493–1499.10.1097/CCM.0b013e31821201d3CrossRefGoogle ScholarPubMed
Pedersen, KR, Povlsen, JV, Christensen, S, et al. Risk factors for acute renal failure requiring dialysis after surgery for congenital heart disease in children. Acta Anaesthesiol Scand 2007; 51: 1344–1349.10.1111/j.1399-6576.2007.01379.xCrossRefGoogle ScholarPubMed
Yin, X, Xin, M, Ding, S, et al. Predictive role of perioperative neutrophil to lymphocyte ratio in pediatric congenital heart disease associated with pulmonary arterial hypertension. BMC Surg 2021; 21: 3.10.1186/s12893-020-01009-xCrossRefGoogle ScholarPubMed
Waikar, SS, Liu, KD, Chertow, GM. Diagnosis, epidemiology and outcomes of acute kidney injury. Clin J Am Soc Nephrol 2008; 3: 844–861.10.2215/CJN.05191107CrossRefGoogle ScholarPubMed
Qing, M, Schumacher, K, Heise, R, et al. Intramyocardial synthesis of pro- and anti-inflammatory cytokines in infants with congenital cardiac defects. J Am Coll Cardiol 2003; 41: 2266–2274.10.1016/S0735-1097(03)00477-7CrossRefGoogle ScholarPubMed
Chawla, LS, Amdur, RL, Amodeo, S, Kimmel, PL, Palant, CE. The severity of acute kidney injury predicts progression to chronic kidney disease. Kidney Int 2011; 79: 1361–1369.10.1038/ki.2011.42CrossRefGoogle ScholarPubMed