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The role of the neutrophil–lymphocyte ratio for pre-operative risk stratification of acute kidney injury after tetralogy of Fallot repair

Part of: Surgery Tetralogy of Fallot (TOF) Basic Science

Published online by Cambridge University Press:  21 May 2021

Valdano Manuel Open the ORCID record for Valdano Manuel [Opens in a new window] ,
Leonardo A. Miana Open the ORCID record for Leonardo A. Miana [Opens in a new window] ,
Aida Turquetto ,
Gustavo Pampolha Guerreiro ,
Natália Fernandes  and
Marcelo Biscegli Jatene
Valdano Manuel*
Affiliation:
Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
Leonardo A. Miana
Affiliation:
Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Aida Turquetto
Affiliation:
Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Gustavo Pampolha Guerreiro
Affiliation:
Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Natália Fernandes
Affiliation:
Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Marcelo Biscegli Jatene
Affiliation:
Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
*
Author for correspondence: Valdano Manuel, Division of Cardiovascular Surgery, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéias de Carvalho Aguiar, 44–Pinheiros, São Paulo, Brazil. Tel: +55 11949768625. E-mail: valdanympub@gmail.com
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Abstract

Introduction:

Acute kidney injury is a risk factor for chronic kidney disease and mortality after congenital heart surgery under cardiopulmonary bypass. The neutrophil–lymphocyte ratio is an inexpensive and easy to measure biomarker for predicting outcomes in children with congenital heart disease undergoing surgical correction.

Objective:

To identify children at high risk of acute kidney injury after tetralogy of Fallot repair using the neutrophil–lymphocyte ratio.

Methods:

This single-centre retrospective analysis included consecutive patients aged < 18 years who underwent tetralogy of Fallot repair between January 2014 and December 2018. The pre-operative neutrophil–lymphocyte ratio was measured using the last pre-operative complete blood count test. We used the Acute Kidney Injury Network definition.

Results:

A total of 116 patients were included, of whom 39 (33.6%) presented with acute kidney injury: 20 (51.3%) had grade I acute kidney injury, nine had grade II acute kidney injury (23.1%), and 10 (25.6%) had grade III acute kidney injury. A high pre-operative neutrophil–lymphocyte ratio was associated with grade III acute kidney injury in the post-operative period (p = 0.04). Patients with acute kidney injury had longer mechanical ventilation time (p = 0.023), intensive care unit stay (p < 0.001), and hospital length of stay (p = 0.002).

Conclusion:

Our results suggest that the pre-operative neutrophil–lymphocyte ratio can be used to identify patients at risk of developing grade III acute kidney injury after tetralogy of Fallot repair.

Keywords

Congenital heart diseaseinflammationcyanotic congenital heart diseaseneutrophil–lymphocyte ratiotetralogy of Fallot
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 6 , June 2021 , pp. 1009 - 1014
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Meeting presented at 26º Congresso Brasileiro de Cardiologia e Cirurgia Cardiovascular Pediátrica, 11 December, 2020.

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