The Relationship Between Acute Renal Failure After Transcatheter Aortic Valve Replacement And Preprocedural Neutrophil To Lymphocyte Ratio

Objective: Transcatheter aortic valve replacement (TAVR) is a less invasive alternative to open-heart surgery forpatients with severe symptomatic aortic stenosis who has a high risk for surgery. Acute kidney injury (AKI) is not a rarecomplication after TAVR and has been associated with poorer outcomes and survival. This study aims to analyze therelation between serum Neutrophil-lymphocyte ratio (NLR) and AKI in Post-TAVR patients.Methods: 148 patients who have been performed TAVR at our institution between 2010 and 2018, analyzedretrospectively. We divided the patients into two groups. Group 1 (n=116): The patients who did not develop AKI afterTAVR procedure (control group) and Group 2 (n=32): The patients who developed AKI after TAVR. The independentrelation between possible independent predictors of AKI in post-TAVI patients was analyzed by regression analysis.Results: 32 patients (22%) suffered from AKI after TAVR during hospitalization. NLR was significantly associated withthe development of AKI (3.22 ±0.62 vs. 2.42 ± 0.45, p

Transkateter Aort Kapak Replasmanı Sonrası Gelişen Akut Böbrek hasarı ile İşlem Öncesi Nötrofil Lenfosit Oranı Arasındaki İlişki

Giriş: Transkateter aort kapak replasmanı (TAVR), cerrahi aort kapak replasmanına alternatif olarak, ciddi aort stenozu olan yüksekcerrahi riskli hastalar için günümüzde kabul görmüş ve gelişen bir tedavi seçeneğidir. Akut böbrek hasarı (ABH), TAVR sonrası sık görülen bir komplikasyon olup daha kötü sonuçlarla ve sağ kalımla ilişkilidir. Bu çalışmanın amacı TAVR yapılan hastalarda, işlem öncesi serum nötrofil lenfosit oranı (NLR) ile işlem sonrası gelişen ABH arasındaki ilişkiyi araştırmaktır. Yöntemler: Kurumumuzda 2010- 2018 tarihleri arasında TAVR uygulanan 148 hastanın retrospektif analizi yapılmıştır. Hastalar iki gruba ayrılmıştır. Grup 1 (n = 116): TAVR uygulanan ancak ABH gelişmeyen kontrol grubu hastalar; Grup 2 (n = 32): TAVR sonrası ABH gelişen hastalar. Veriler akut böbrek hasarının olası bağımsız belirteçlerini tespit etmek için regresyon analizi yöntemi ile analiz edilmiştir. Bulgular: Bu çalışmada 32 hasta da (%22) TAVR sonrası ABH gelişmiştir. Nötrofil lenfosit Oranı, ABH gelişimi ile anlamlı olarak ilişkili (3.22 ±0.62 vs. 2.42 ± 0.45, p

PDF

___

1. Lindman BR, Clavel M-A, Mathieu P, et al. Calcific aortic stenosis. Nat Rev Dis Prim. 2016; 2: 16006.

2. Eveborn GW, Schirmer H, Heggelund G, et al. The evolving epidemiology of valvular aortic stenosis. the Tromsø Study. Heart. 2013 Mar 15; 99: 396–400.

3. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Jun 10; 63: e57-185.

4. Bagur R, Webb JG, Nietlispach F, et al. Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J. 2010 Apr 1; 31: 865–74.

5. Najjar M, Salna M, George I. Acute kidney injury after aortic valve replacement: Incidence, risk factors and outcomes. Expert Review of Cardiovascular Therapy. 2015.

6. Papa A, Emdin M, Passino C, et al. Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta. 2008 Sep; 395: 27–31.

7. Park B-J, Shim J-Y, Lee H-R, et al. Relationship of neutrophil-lymphocyte ratio with arterial stiffness and coronary calcium score. Clin Chim Acta. 2011 May 12; 412: 925–9.

8. Zazula AD, Précoma-Neto D, Gomes AM, et al. An assessment of neutrophils/lymphocytes ratio in patients suspected of acute coronary syndrome. Arq Bras Cardiol. 2008 Jan; 90: 31–6.

9. Duffy BK, Gurm HS, Rajagopal V, et al. Usefulness of an Elevated Neutrophil to Lymphocyte Ratio in Predicting Long-Term Mortality After Percutaneous Coronary Intervention. Am J Cardiol. 2006 Apr 1; 97: 993– 6.

10. Gibson PH, Cuthbertson BH, Croal BL, et al. Usefulness of Neutrophil/Lymphocyte Ratio As Predictor of New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting. Am J Cardiol. 2010 Jan 15; 105: 186–91.

11. Rudiger A, Burckhardt OA, Harpes P, et al. The relative lymphocyte count on hospital admission is a risk factor for long-term mortality in patients with acute heart failure. Am J Emerg Med. 2006 Jul; 24: 451–4.

12. Gibson PH, Croal BL, Cuthbertson BH, et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J. 2007 Nov; 154: 995–1002.

13. Bhat T, Teli S, Rijal J, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther. 2013 Jan 10; 11: 55–9.

14. Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document†. Eur Heart J. 2012 Oct; 33: 2403–18.

15. Roques F, Michel P, Goldstone AR, et al. The logistic EuroSCORE. Eur Heart J. 2003 May 1; 24: 882–3.

16. Park JJ, Jang HJ, Oh IY, et al. Prognostic value of neutrophil to lymphocyte ratio in patients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol. 2013;

17. Bhat T, Teli S, Rijal J, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: A review. Expert Review of Cardiovascular Therapy. 2013.

18. Onuk T, Güngör B, Karataş B, et al. Increased neutrophil to lymphocyte ratio is associated with in-hospital mortality in patients with aortic dissection. Clin Lab. 2015; 61.

19. Yin Y, Wang J, Wang X, et al. Prognostic value of the neutrophil to lymphocyte ratio in lung cancer: A meta-analysis. Clinics. 2015;

20. Turkmen K, Guney I, Yerlikaya FH, et al. The relationship between neutrophil-to-lymphocyte ratio and inflammation in end-stage renal disease patients. Ren Fail. 2012; 34: 155–9.

21. Erdem E. Neutrophil lymphocyte ratio in aute renal failure. Indian J Nephrol. 2015; 25: 126–7.

22. Mozos I, Malainer C, Horbańczuk J, et al. Inflammatory Markers for Arterial Stiffness in Cardiovascular Diseases. Front Immunol. 2017 Aug 31; 8: 1058.

23. Li J, Chen Q, Luo X, et al. Neutrophil-toLymphocyte Ratio Positively Correlates to Age in Healthy Population. J Clin Lab Anal. 2015 Nov; 29: 437–43.

24. Nam S-H, Kang S-G, Song S-W. The Neutrophil-Lymphocyte Ratio Is Associated with Coronary Artery Calcification in Asymptomatic Korean Males: A Cross-Sectional Study. Biomed Res Int. 2017 Feb 9; 2017: 1–8.

25. Candela P, Evola S, Lunetta M, et al. The spectrum of risk factors for contrast induced nephropathy in patients undergoing coronary angiography or intervention. J Indian Coll Cardiol. 2014 Sep 1; 4: 157–61.

26. Gürsoy OM, Karakoyun S, Kalçık M, et al. Usefulness of Novel Hematologic Inflammatory Parameters to Predict Prosthetic Mitral Valve Thrombosis. Am J Cardiol. 2014 Mar; 113: 860– 4.

27. Ram P, Mezue K, Pressman G, et al. Acute kidney injury post-transcatheter aortic valve replacement. Clin Cardiol. 2017 Dec 1; 40: 1357– 62.