Neutrophil-to-lymphocyte ratio is prognostic factor of prolonged pleural effusion after pediatric cardiac surgery

Kazuki Yakuwa; Kagami Miyaji; Tadashi Kitamura; Takashi Miyamoto; Minoru Ono; Yukihiro Kaneko

doi:10.1177/20480040211009438

Neutrophil-to-lymphocyte ratio is prognostic factor of prolonged pleural effusion after pediatric cardiac surgery

JRSM Cardiovasc Dis. 2021 Apr 19:10:20480040211009438. doi: 10.1177/20480040211009438. eCollection 2021 Jan-Dec.

Authors

Kazuki Yakuwa^{1

2}, Kagami Miyaji², Tadashi Kitamura², Takashi Miyamoto², Minoru Ono³, Yukihiro Kaneko¹

Affiliations

¹ Division of Cardiovascular Surgery, National Center for Child Health and Development, Tokyo, Japan.
² Department of Cardiovascular Surgery, Kitasato School of Medicine, Sagamihara, Japan.
³ Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Abstract

Objectives: Postoperative pleural effusion (PE) is common after pediatric cardiac surgery, and if prolonged can lead to the deterioration of the general condition due to malnutrition and result in death. This study aims at identifying the prognostic factors of prolonged PE after pediatric cardiac surgery.Design and settings: Patients were divided into the effective (with chest tube removal within 10 days after medical therapy) and ineffective (with chest tube in place for more than 10 days) groups. The factors were compared between the two groups retrospectively.

Participants: Participants included patients who had prolonged PE after cardiac surgery in national center for child and health development between October 2014 and October 2017.

Main outcome measures: Baseline characteristics and procedure details were compared between the two groups to determine the predictor of prolonged PE. White blood cell count, platelet count, neutrophil-to-lymphocyte ratio, hemoglobin level, serum total protein level, serum albumin level, blood fibrinogen level, serum creatinine level, etc. were examined.

Results: Twenty patients were included. Between the two groups, no significant differences in baseline characteristics, such as age, weight, and sex were found, and significant differences were observed only in the NLR change ratio (effective group, 5.1 [4.1-8.0] versus ineffective group, 11.9 [9.9-14.1]; P = 0.01).

Conclusions: NLR change ratio is a potential prognostic factor of prolonged PE, including chylothorax, after pediatric cardiac surgery.

Keywords: Pediatric and congenital heart disease' including cardiovascular surgery; cardiovascular surgery; neutrophil-to-lymphocyte ratio; perioperative management; postoperative persistent pleural effusion.