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Title: Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting
Authors: Gibson, Patrick H.
Croal, Bernard L.
Small, Gary R.
Ifezulike, Ada I.
Gibson, George
Jeffrey, Robert R.
Buchan, Keith G.
El-Shafei, Hussein
Hillis, Graham S.
Cuthbertson, Brian
University of Aberdeen, School of Medicine & Dentistry, Division of Applied Medicine
University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Keywords: Coronary Artery Bypass
Myocardial Ischemia
Issue Date: Nov-2007
Publisher: Elsevier
Citation: Gibson, P.H, Croal, B.L., Cuthbertson, B.H, Small, G.R., Ifezulike, A.I., Gibson, G., Buchan, K.G., El-Shafei, H., and Hillis, G.S. (2007). Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. American Heart Journal [Online], 154(5), pp.995-1002. Available from: [Accessed 10 April 2008]
Abstract: Background: An elevated preoperative white blood cell count has been associated with a worse outcome after coronary artery bypass grafting (CABG). Leukocyte subtypes, and particularly the neutrophil-lymphocyte (N/L) ratio, may however, convey superior prognostic information. We hypothesized that the N/L ratio would predict the outcome of patients undergoing surgical revascularization. Methods: Baseline clinical details were obtained prospectively in 1938 patients undergoing CABG. The differential leukocyte was measured before surgery, and patients were followed-up 3.6 years later. The primary end point was all-cause mortality. Results: The preoperative N/L ratio was a powerful univariable predictor of mortality (hazard ratio [HR] 1.13 per unit, P < .001). In a backward conditional model, including all study variables, it remained a strong predictor (HR 1.09 per unit, P = .004). In a further model, including the European system for cardiac operative risk evaluation, the N/L ratio remained an independent predictor (HR 1.08 per unit, P = .008). Likewise, it was an independent predictor of cardiovascular mortality and predicted death in the subgroup of patients with a normal white blood cell count. This excess hazard was concentrated in patients with an N/L ratio in the upper quartile (>3.36). Conclusion: An elevated N/L ratio is associated with a poorer survival after CABG. This prognostic utility is independent of other recognized risk factors.
ISSN: 1097-6744
Appears in Collections:Applied Health Sciences research
Applied Medicine research
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