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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 4, July/August 2015
AFRICA
159
Comparison of neutrophil:lymphocyte ratios following
coronary artery bypass surgery with or without
cardiopulmonary bypass
Mustafa Aldemir, Elif Do
ğ
an Bakı, Fahri Adalı, Görkem Çar
ş
anba, Evren Tecer, Hanife Uzel Ta
ş
Abstract
Objective:
Coronary artery bypass graft (CABG) surgery
may induce postoperative systemic changes in leukocyte
counts, including leukocytosis, neutrophilia or lymphopenia.
This retrospective clinical study investigated whether off-
pump coronary artery bypass (OPCAB) surgery working on
the beating heart without extracorporeal circulation could
favourably affect leukocyte counts, including neutrophil-to-
lymphocyte (N:L) ratio, after CABG.
Methods:
In this study, 30 patients who underwent isolated
CABG with cardiopulmonary bypass (CPB), and another
30 patients who underwent the same operation without CPB
between May 2010 and May 2013, were screened from the
computerised database of our hospital. Pre-operative, and
first and fifth postoperative day differential counts of leuko-
cytes with the N:L ratio of peripheral blood were obtained.
Results:
A significant increase in total leukocyte and neutro-
phil counts and N:L ratio, and a decrease in lymphocyte
counts were observed at all time points after surgery in both
groups. N:L ratio was significantly higher in the CPB group
compared with the OPCAB group on the first postoperative
day (20.73
±
13.85 vs 10.19
±
4.55,
p
<
0.001), but this differ-
ence disappeared on the fifth postoperative day.
Conclusion:
CPB results in transient but significant changes in
leukocyte counts in the peripheral blood stream in terms of
N:L ratio compared with the off-pump technique of CABG.
Keywords:
myocardial revascularisation, cardiopulmonary
bypass, off-pump technique, neutrophil:lymphocyte ratio
Submitted 24/3/14, accepted 27/1/15
Previously published online 23/4/15
Cardiovasc J Afr
2015;
26
: 159–164
www.cvja.co.zaDOI: 10.5830/CVJA-2015-015
Coronary artery bypass grafting (CABG) is the most common
procedure in cardiovascular surgery. However the procedure
itself is associated with significant morbidity and mortality rates.
It is well known that large changes in immune reactivity
occur during or after cardiac surgical operations.
1
Surgical
trauma has a well-known effect on increased immune mediator
levels.
2
Production of reactive oxygen species, decreased barrier
function, induction of hypoperfusion, and tissue destruction are
examples of adverse outcomes resulting from severe activation
of the native immunity.
3
Cardiopulmonary bypass circuit devices
play a key role at that point, with contact activation of both
cellular and humoral components of the blood accepted as
major liability issues. T and B cells of the adaptive immune
system are affected mostly in the early postoperative period with
some delay in the course of surgery.
4
In open-heart surgery, risk stratification has mostly been
done using the European System for Cardiac Operative Risk
Evaluation (EuroSCORE).
5
However there are some concerns
about overestimation/underestimation with the EuroSCORE,
which is why more reliable predictors are needed.
There are many studies in the literature about the relationship
between inflammation and adverse cardiovascular outcomes.
6
In this era, some biomarkers of inflammation have been
investigated, such as total white blood cell count (WCC), a
predictor of mortality after coronary artery bypass grafting.
7
However subtypes of WCC or ratios between them have been
shown to be more valuable in the prediction of outcomes.
8
One
of these is the neutrophil:lymphocyte ratio, a potentially useful
biopredictor of inflammation in cardiovascular disease.
9
It is
inexpensive, readily available and easily calculable.
In screening the literature, there are some studies on its
prognostic value after cardiac operations,
10
but there are no
published studies on the relationship between cardiopulmonary
bypass and the neutrophil:lymphocyte (N:L) ratio. Therefore,
the current study was conducted to investigate the N:L ratio as
a measure of systemic inflammation and its relationship, if any,
with cardiopulmonary bypass.
Methods
This retrospective clinical study was performed on 60 patients who
underwent isolated CABG surgery at our institution, Department
of Cardiovascular Surgery, Kocatepe University, Afyonkarahisar,
Turkey, between May 2010 and May 2013. This clinical
retrospective study was approved by the local ethics committee of
the Faculty of Medicine, Afyon Kocatepe University.
All patients had coronary artery disease with varying degrees
of stenosis of the left anterior descending coronary artery.
Patients with left main or left main equivalent coronary artery
disease were also included in the study. The data of the 60 cases
Department of Cardiovascular Surgery, Faculty of
Medicine, Afyon Kocatepe University, Turkey
Mustafa Aldemir, MD,
draldemir@yahoo.comFahri Adalı, MD
Görkem Çar
ş
anba, MD
Evren Tecer, MD
Department of Anaesthesiology, Faculty of Medicine, Afyon
Kocatepe University, Turkey
Elif Do
ğ
an Bakı, MD
Department of Public Health, Faculty of Medicine, Afyon
Kocatepe University, Turkey
Hanife Uzel Ta
ş
, MD