Fatih BAYRAKTAR, Murat BAŞTOPÇU, Murat SARGIN, Murat ACAREL, Müge Taşdemir METE, Sevinç BAYER ERDOĞAN, Hüseyin KUPLAY, Serap Aykut AKA

Postkardiyotomi şok nedeniyle ekstrakorporeal membran oksijenasyon desteği altında erken böbrek hasarında nötrofil-lenfosit oranı

Amaç: Bu çalışmada postkardiyotomik şok nedeniyle ekstrakorporeal membran oksijenasyon desteği alan hastalarda nötrofil-lenfosit oranı ve böbrek hasarı arasındaki ilişki araştırıldı. Çalışma planı: Ocak 2007 - Temmuz 2018 tarihleri arasında merkezimizde postkardiyotomik şok nedeniyle ekstrakorporeal membran oksijenasyon desteği alan ve en az 48 saat hayatta kalan toplam 119 hasta (38 erkek, 81 kadın; ort. yaş 54.4±13.0 yıl; dağılım 24-74 yıl) retrospektif olarak incelendi. Hastaların ameliyat öncesi ve sonrası nötrofil-lenfosit oranları, demografik özellikleri, böbrek fonksiyon parametreleri ve ekstrakorporeal membran oksijenasyona ilişkin verileri kaydedildi. Böbrek hasarının gelişimi ve evreleri revize Akut Böbrek Hasarı Ağı ve Böbrek Hastalığında Küresel Sonuçların İyileştirilmesi kriterlerine göre belirlendi. Bulgular: Ameliyat öncesi nötrofil-lenfosit oranı ve böbrek hasarı arasında anlamlı bir ilişki saptanmadı (p>0.05). Ameliyat sonrası nötrofil-lenfosit oranı, böbrek hasarı gelişen hastalarda, böbrek hasarı olmayan hastalara kıyasla, daha yüksekti (sırasıyla 8.68 [0.84-42.00] ve 4.02 [1.04-21.21], p=0.004). Hastalar Akut Böbrek Hasarı Ağı (p=0.015) ve Böbrek Hastalığında Küresel Sonuçların İyileştirilmesi (p=0.006) kriterlerine göre böbrek hasarı evrelerine ayrıldıklarında, daha ciddi böbrek hasarı olan hastalarda nötrofil-lenfosit oranı daha yüksek bulundu. Alıcı işletim karakteristik analizi ile böbrek hasarı tespitinde nötrofil-lenfosit oranının kesim değeri 6.71 olarak saptandı. 6.71’in üzerinde bir değere sahip hastalarda, böbrek hasarı gelişiminin olasılık oranı 5.941 idi. Sonuç: Ameliyat öncesi değil fakat, ameliyat sonrası nötrofillenfosit oranı, postkardiyotomik şok nedeniyle ekstrakorporeal membran oksijenasyon desteği alan hastalarda böbrek hasarının varlığı ve derecesi ile ilişkilidir. Nötrofil-lenfosit oranı, bu hasta grubunda basit ve ucuz bir enflamasyon belirtecidir.

Neutrophil-to-lymphocyte ratio for early renal failure under extracorporeal membrane oxygenation support for postcardiotomy shock

Background: This study aims to investigate the relationship betweenthe neutrophil-to-lymphocyte ratio and renal injury in patients underextracorporeal membrane oxygenation support for postcardiotomy shock.Methods: Between January 2007 and July 2018, a total of 119patients (38 males, 81 females; mean age 54.4±13.0 years; range,24 to 74 years) who received extracorporeal membrane oxygenationsupport for postcardiotomy shock and survived at least 48 hours inour center were retrospectively analyzed. Pre- and postoperativeneutrophil-to-lymphocyte ratios, demographic characteristics, renalfunction parameters, and extracorporeal membrane oxygenationrelateddata of the patients were recorded. Occurrence and stages ofrenal injury was determined using the revised Acute Kidney InjuryNetwork and Kidney Disease Improving Global Outcomes criteria.Results: No significant relationship was found between preoperativeneutrophil-to-lymphocyte ratio and renal injury (p>0.05).Postoperative neutrophil-to-lymphocyte ratio was higher in patientswho developed renal injury, compared to patients without renalinjury (8.68 [0.84-42.00] vs. 4.02 [1.04-21.21], respectively, p=0.004).When patients were grouped for renal injury stage according to therevised Acute Kidney Injury Network (p=0.015) and Kidney DiseaseImproving Global Outcomes (p=0.006) criteria, the patients withmore severe renal injury had higher neutrophil-to-lymphocyte ratio.The receiver operating characteristics analysis revealed a cut-offvalue of 6.71 for the neutrophil-to-lymphocyte ratio for the detectionof renal injury. Patients with a value above 6.71 had an odds ratio of5.941 for occurrence of renal injury.Conclusion: Postoperative, but not preoperative neutrophil-tolymphocyteratio is associated with presence and severity of renalinjury in patients under extracorporeal membrane oxygenation supportfor postcardiotomy shock. Neutrophil-to-lymphocyte ratio is a simpleand inexpensive marker of inflammation in this patient population.

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