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. 2022 Feb;36(1):68-78.
doi: 10.1007/s00540-021-03008-5. Epub 2021 Oct 8.

The lymphocyte/monocyte ratio and red blood cell transfusion during radical retropubic prostatectomy

Jun-Young Park  1 , Jihion Yu  1 , Bumjin Lim  2 , Jiwoong Lee  1 , Jai-Hyun Hwang  1 , Yongsoo Lee  3 , Young-Kug Kim  4
Affiliations

The lymphocyte/monocyte ratio and red blood cell transfusion during radical retropubic prostatectomy

Jun-Young Park et al. J Anesth. 2022 Feb.

Abstract

Purpose: Despite improvements of strategy in radical retropubic prostatectomy, blood loss is still a major concern. The lymphocyte/monocyte (LM) ratio is a prognostic indicator for various diseases. We identified the risk factors, including the LM ratio, for red blood cell (RBC) transfusion during radical retropubic prostatectomy.

Methods: This retrospective study assessed patients who underwent radical retropubic prostatectomy between March 2009 and December 2020. To determine the risk factors for RBC transfusion, a multivariate logistic regression analysis was conducted. A receiver operating characteristic (ROC) curve analysis was also performed. Postoperative outcomes, including acute kidney injury (AKI), hospitalization duration, and intensive care unit (ICU) admission, were also evaluated.

Results: Among 1302 patients, 158 patients (12.1%) received an intraoperative RBC transfusion. Multivariate logistic regression analysis demonstrated that the risk factors for RBC transfusion were the LM ratio, hemoglobin, 6% hydroxyethyl starch amount, and positive surgical margin. The area under the ROC curve of LM ratio was 0.706 (cut-off = 4.3). The LM ratio at ≤ 4.3 was significantly related to transfusion in multivariate-adjusted analysis (odds ratio = 4.598, P < 0.001). AKI and ICU admission were significantly higher, and the hospitalization duration was significantly longer in patients with RBC transfusion.

Conclusions: The LM ratio was a risk factor for RBC transfusion in radical retropubic prostatectomy. The optimal cut-off value of the LM ratio to predict transfusion was 4.3. RBC transfusion was associated with poor postoperative outcomes. Therefore, our results suggest that the LM ratio provide useful information on RBC transfusion in radical retropubic prostatectomy.

Keywords: Acute kidney injury; Hospitalization duration; Intensive care unit admission; Lymphocyte/monocyte ratio; Radical retropubic prostatectomy; Transfusion.

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Conflict of interest statement

The authors have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of the study protocol
Fig. 2
Fig. 2
Multivariate logistic regression analysis of factors associated with red blood cell transfusion during radical retropubic prostatectomy. OR, odds ratio; CI, confidence interval. ACEi, angiotensin converting enzyme inhibitor; ARB, angiotensin II receptor blocker; RDW, red cell distribution width; NL, neutrophil/lymphocyte; PL, platelet/lymphocyte; LM, lymphocyte/monocyte; GFR, glomerular filtration rate; aPTT, activated partial thromboplastin time
Fig. 3
Fig. 3
Predictive value of the LM ratio ≤ 4.3 for red blood cell transfusion during radical retropubic prostatectomy compared with the LM ratio > 4.3. The multivariate-adjusted odds ratio was determined using the variables shown in Table 3. LM, lymphocyte/monocyte; OR, odds ratio; CI, confidence interval
See this image and copyright information in PMC

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