The Prognostic Significance of Neutrophil to Lymphocyte Ratio (NLR), Monocyte to Lymphocyte Ratio (MLR) and Platelet to Lymphocyte Ratio (PLR) on Long-Term Survival in Off-Pump Coronary Artery Bypass Grafting (OPCAB) Procedures

Abstract

Background: Cardiovascular diseases, apart from commonly known risk factors, are related to inflammation. There are several simple novel markers proposed to present the relation between inflammatory reactions activation and atherosclerotic changes. They are easily available from whole blood count and include neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), and platelets to lymphocyte ratio (PLR). The RDW results were excluded from the analysis.

Method and results: The study based on retrospective single-centre analysis of 682 consecutive patients (131 (19%) females and 551 (81%) males) with median age of 66 years (60-71) who underwent off-pump coronary artery bypass grafting (OPCAB) procedure. During the median 5.3 +/- 1.9 years follow-up, there was a 87% cumulative survival rate. The laboratory parameters including preoperative MLR > 0.2 (HR 2.46, 95% CI 1.33-4.55, p = 0.004) and postoperative NLR > 3.5 (HR 1.75, 95% CI 1.09-2.79, p = 0.019) were found significant for long-term mortality prediction in multivariable analysis.

Conclusion: Hematological indices NLR and MLR can be regarded as significant predictors of all-cause long-term mortality after OPCAB revascularization. Multivariable analysis revealed preoperative values of MLR > 0.2 and postoperative values of NLR > 3.5 as simple, reliable factors which may be applied into clinical practice for meticulous postoperative monitoring of patients in higher risk of worse prognosis.

Keywords: monocyte to lymphocyte ratio; neutrophil to lymphocyte ratio; off-pump coronary artery bypass grafting; platelets to lymphocyte ratio.

Figure 1

Receiver characteristics operator for long-term mortality basing on preoperative indices (NLR, MLR and PLR (a–c)). Abbreviations: AUC—area under the curve, M/L—monocyte/Lymphocyte, N/L—neutrophil/lymphocyte, P/L—platelets/lymphocyte.

Figure 2

Receiver characteristics operator for long-term mortality basing on postoperative indices (NLR, MLR and PLR (a–c)). Abbreviations: AUC—area under the curve, M/L—monocyte/lymphocyte, N/L—neutrophil/lymphocyte, P/L—platelets/lymphocyte.

Figure 3

Receiver characteristics operator for long-term mortality basing on a preoperative multifactoral model. Abbreviations: AUC—area under the curve.

Figure 4

Receiver characteristics operator for long-term mortality based on postoperative multifactoral model. Abbreviations: AUC—area under the curve.