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Increased neutrophil-to-lymphocyte ratio is associated with higher incidence of acute kidney injury and worse survival after transcatheter aortic valve implantation
, 1, 2, 1, 1, 1, 1, 3, 2, 1
Affiliations- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
- I Department of Cardiology, Poznan University of Medical Sciences, Poznan
- Student Scientific Group, English Division, Poznan University of Medical Sciences, Poznan
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Abstract
Background: Although considered a minimally invasive procedure, transcatheter aortic valve implantation (TAVI) generates an inflammatory response which is related to post-procedural complications including acute kidney injury (AKI). The aim of the present study was to analyse the association between simple, easily available post-operative morphological parameters of inflammatory status such as neutrophil-to-lymphocyte ratio (NLR) and AKI as well as post-discharge survival.
Methods: The study group was comprised of 203 consecutive patients (102 females and 101 males, mean age 78 ± 6.9 years) who underwent TAVI between January 2013 and March 2017. Demographic and clinical data were collected. Baseline and subsequent post-procedural blood samples (8, 24, 48, 72 at discharge) were taken. Blood morphology (including NLR) and creatinine concentration were assessed. Long-term survival was also analyzed.
Results: Seventy-four (36.5%) patients developed AKI. Baseline morphological parameters did not differ between subject with and without AKI. Those reflecting post-procedural inflammatory response, including leucocytes, neutrophils and NLR increased significantly following TAVI in both subgroups and the rise was more pronounced in AKI patients (p < 0.001). A comparison of Kaplan-Meier curves for patients with the lowest (NLR 1; below 25th percentile) and highest NLR (NLR 3; above 75th) revealed a significant difference in the log-rank test (p = 0.049). Estimated probability of 1-, 2- and 5-year survival were 100% vs. 79%, 94% vs. 77% and 75% vs. 46%, respectively in subgroup NLR 1 and NLR 3.
Conclusions: Inflammatory response after TAVI, estimated by means of NLR, is more pronounced in patients with AKI. A higher value of NLR is associated with a lower probability of long-term survival after TAVI.
Abstract
Background: Although considered a minimally invasive procedure, transcatheter aortic valve implantation (TAVI) generates an inflammatory response which is related to post-procedural complications including acute kidney injury (AKI). The aim of the present study was to analyse the association between simple, easily available post-operative morphological parameters of inflammatory status such as neutrophil-to-lymphocyte ratio (NLR) and AKI as well as post-discharge survival.
Methods: The study group was comprised of 203 consecutive patients (102 females and 101 males, mean age 78 ± 6.9 years) who underwent TAVI between January 2013 and March 2017. Demographic and clinical data were collected. Baseline and subsequent post-procedural blood samples (8, 24, 48, 72 at discharge) were taken. Blood morphology (including NLR) and creatinine concentration were assessed. Long-term survival was also analyzed.
Results: Seventy-four (36.5%) patients developed AKI. Baseline morphological parameters did not differ between subject with and without AKI. Those reflecting post-procedural inflammatory response, including leucocytes, neutrophils and NLR increased significantly following TAVI in both subgroups and the rise was more pronounced in AKI patients (p < 0.001). A comparison of Kaplan-Meier curves for patients with the lowest (NLR 1; below 25th percentile) and highest NLR (NLR 3; above 75th) revealed a significant difference in the log-rank test (p = 0.049). Estimated probability of 1-, 2- and 5-year survival were 100% vs. 79%, 94% vs. 77% and 75% vs. 46%, respectively in subgroup NLR 1 and NLR 3.
Conclusions: Inflammatory response after TAVI, estimated by means of NLR, is more pronounced in patients with AKI. A higher value of NLR is associated with a lower probability of long-term survival after TAVI.
Keywords
transcatheter aortic valve implantation, inflammatory response, acute kidney injury, survival
About this articleTitle
Increased neutrophil-to-lymphocyte ratio is associated with higher incidence of acute kidney injury and worse survival after transcatheter aortic valve implantation
Journal
Issue
Article type
Original Article
Published online
2021-11-15
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1480
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458
DOI
10.5603/CJ.a2021.0149
Pubmed
Keywords
transcatheter aortic valve implantation
inflammatory response
acute kidney injury
survival
Authors
Anna Olasińska-Wiśniewska
Bartłomiej Perek
Marek Grygier
Tomasz Urbanowicz
Marcin Misterski
Mateusz Puślecki
Sebastian Stefaniak
Konrad Stelmark
Maciej Lesiak
Marek Jemielity
References (27)- Scherner M, Wahlers T. Acute kidney injury after transcatheter aortic valve implantation. J Thorac Dis. 2015; 7(9): 1527–1535.
- Ma M, Gao WD, Gu YF, et al. Clinical effects of acute kidney injury after transcatheter aortic valve implantation: a systematic review and meta-analysis. Intern Emerg Med. 2019; 14(1): 161–175.
- Sinning JM, Ghanem A, Steinhäuser H, et al. Renal function as predictor of mortality in patients after percutaneous transcatheter aortic valve implantation. JACC Cardiovasc Interv. 2010; 3(11): 1141–1149.
- 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; 31(7): 865–874.
- Elhmidi Y, Bleiziffer S, Piazza N, et al. Incidence and predictors of acute kidney injury in patients undergoing transcatheter aortic valve implantation. Am Heart J. 2011; 161(4): 735–739.
- Navaratnarajah A, Bhan A, Alcock E, et al. Systemic inflammation and oxidative stress contribute to acute kidney injury after transcatheter aortic valve implantation. Cardiol J. 2020 [Epub ahead of print].
- Komosa A, Perek B, Rzymski P, et al. Transcatheter aortic valve replacement is associated with less oxidative stress and faster recovery of antioxidant capacity than surgical aortic valve replacement. J Clin Med. 2019; 8(9).
- Ackland GL, Abbott TEF, Cain D, et al. Preoperative systemic inflammation and perioperative myocardial injury: prospective observational multicentre cohort study of patients undergoing non-cardiac surgery. Br J Anaesth. 2019; 122(2): 180–187.
- Généreux P, Piazza N, Alu MC, et al. VARC-3 WRITING COMMITTEE. Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research. Eur Heart J. 2021; 42(19): 1825–1857.
- Olasinska-Wisniewska A, Grygier M, Lesiak M, et al. Short- and mid-term outcome of transcatheter aortic valve implantation in patients with advanced age. Cardiol J. 2017; 24(4): 358–363.
- Baştuğ S, Çöteli C, Çelik MC, et al. Baseline Anemia Is an Independent Predictor of Long-Term Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation. Angiology. 2021 [Epub ahead of print]: 33197211029801.
- Gharaie Fathabad S, Kurzhagen JT, Sadasivam M, et al. T Lymphocytes in Acute Kidney Injury and Repair. Semin Nephrol. 2020; 40(2): 114–125.
- Angkananard T, Anothaisintawee T, McEvoy M, et al. Neutrophil lymphocyte ratio and cardiovascular disease risk: a systematic review and meta-analysis. Biomed Res Int. 2018; 2018: 2703518.
- Urbanowicz TK, Olasińska-Wiśniewska A, Michalak M, et al. Neutrophil to lymphocyte ratio as noninvasive predictor of pulmonary vascular resistance increase in congestive heart failure patients: Single-center preliminary report. Adv Clin Exp Med. 2020; 29(11): 1313–1317.
- Azab B, Zaher M, Weiserbs KF, et al. Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction. Am J Cardiol. 2010; 106(4): 470–476.
- Bi JB, Zhang J, Ren YF, et al. Neutrophil-to-lymphocyte ratio predicts acute kidney injury occurrence after gastrointestinal and hepatobiliary surgery. World J Gastrointest Surg. 2020; 12(7): 326–335.
- Urbanowicz TK, Michalak M, Gąsecka A, et al. A risk score for predicting long-term mortality following off-pump coronary artery bypass grafting. J Clin Med. 2021; 10(14).
- Schofield ZV, Woodruff TM, Halai R, et al. Neutrophils: a key component of ischemia-reperfusion injury. Shock. 2013; 40(6): 463–470.
- Bolisetty S, Agarwal A. Neutrophils in acute kidney injury: not neutral any more. Kidney Int. 2009; 75(7): 674–676.
- Awad AS, Rouse M, Huang L, et al. Compartmentalization of neutrophils in the kidney and lung following acute ischemic kidney injury. Kidney Int. 2009; 75(7): 689–698.
- Dinerman JL, Mehta JL, Saldeen TG, et al. Increased neutrophil elastase release in unstable angina pectoris and acute myocardial infarction. J Am Coll Cardiol. 1990; 15(7): 1559–1563.
- Durmus E, Kivrak T, Gerin F, et al. Neutrophil-to-Lymphocyte ratio and platelet-to-lymphocyte ratio are predictors of heart failure. Arq Bras Cardiol. 2015; 105(6): 606–613.
- Cho JH, Cho HJ, Lee HY, et al. Neutrophil-Lymphocyte ratio in patients with acute heart failure predicts in-hospital and long-term mortality. J Clin Med. 2020; 9(2).
- Inaba A, Tuong ZK, Riding AM, et al. B lymphocyte-derived CCL7 augments neutrophil and monocyte recruitment, exacerbating acute kidney injury. J Immunol. 2020; 205(5): 1376–1384.
- DeSart K, O'Malley K, Schmit B, et al. Systemic inflammation as a predictor of clinical outcomes after lower extremity angioplasty/stenting. J Vasc Surg. 2016; 64(3): 766–778.e5.
- Gomes WJ, Buffolo E. Coronary stenting and inflammation: implications for further surgical and medical treatment. Ann Thorac Surg. 2006; 81(5): 1918–1925.
- Wasser K, Schnaudigel S, Wohlfahrt J, et al. Inflammation and in-stent restenosis: the role of serum markers and stent characteristics in carotid artery stenting. PLoS One. 2011; 6(7): e22683.
