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

Simple Summary Inflammatory processes are involved in the development and progression of coronary artery disease. Environmental factors, including hyperglycaemia, hyperlipidaemia, or smoking, promote endothelial disfunction. This process generates inflammation, which further exaggerates vascular wall injury. Immune cells migrate to the endothelium after its damage and promote platelets activation. Cardiac surgery activates inflammatory response. The knowledge on the intensity of immune cells activation may enable assessment of long-term consequences, including increased morbidity and mortality. The off-pump coronary artery bypass grafting technique allows to minimize systemic inflammatory reaction; however, some extent of the response still exists and may influence surgical results. The assessment of inflammatory response has undeniable value in coronary artery disease management. Several markers have been proposed; however, indices widely available from whole blood count are most valuable in daily practice. We evaluated and proposed the use of neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), and platelets to lymphocyte ratio (PLR) in the prognosis of the long-term outcomes after off-pump coronary artery bypass grafting. Patients who present with abnormally increased values of pre-operative and post-operative NLR, MLR, and PLR should undergo meticulous follow-up controls, as they are burdened with a higher risk of death. 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.