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Changes in neutrophil-to-lymphocyte ratios in postcardiac arrest patients treated with targeted temperature management [Anatol J Cardiol]
Anatol J Cardiol. 2017; 18(3): 215-222 | DOI: 10.14744/AnatolJCardiol.2017.7716

Changes in neutrophil-to-lymphocyte ratios in postcardiac arrest patients treated with targeted temperature management

Kazım Başer1, Hatice Duygu Baş1, Pavan Attaluri1, Terrance Rodrigues1, Jacob Nichols1, Kenneth Nugent2
1Department of Internal Medicine, Texas Tech University Health Sciences Center at Lubbock; TX-USA
2Department of Pulmonary and Critical Care, Texas Tech University Health Sciences Center at Lubbock; TX-USA

Objective: The prognostic value of changes in neutrophil-to-lymphocyte ratios (NLR) in cardiac arrest survivors receiving targeted temperature management (TTM) is unknown. The current study investigated NLR in postcardiac arrest (PCA) patients undergoing TTM.
Methods: This retrospective single-center study included 95 patients (59 males, age: 55.0±17.0 years) with in-hospital and out-of-hospital cardiac arrests who underwent TTM for PCA syndrome within 6 h of cardiac arrest. Hypothermia was maintained for 24 h at a target temperature of 33°C. NLR was calculated as the absolute neutrophil count divided by the absolute lymphocyte count.
Results: Of the 95 patients, 59 (62%) died during hospital stay. Fewer vasopressors were used in patients who survived. Out-of-hospital cardiac arrest was more frequent in decedents (p=0.005). Length of stay in the hospital and intensive care unit were significantly longer in patients who survived (p=0.0001 and p=0.001, respectively). NLR on admission and during rewarming did not differ between survivors and decedents. NLR during cooling was significantly higher in decedents (p=0.014). Delta NLR cut-off of 13.5 best separated survivors and decedents (AUC=0.68, 95% CI: 0.57–0.79, p=0.003 with a sensitivity and specificity of 64% and 67%, respectively). In multivariate logistic regression analysis, larger increase in NLR was significantly associated with decreased survival (OR: 0.96, 95% CI: 0.94–0.99, p=0.008).
Conclusion: Changes in NLR are an independent determinant of survival in patients with return of spontaneous circulation PCA treated with TTM. An NLR change can be used to predict survival in these patients.

Keywords: neutrophil-to-lymphocyte ratio, targeted temperature management, predictor of mortality

Kazım Başer, Hatice Duygu Baş, Pavan Attaluri, Terrance Rodrigues, Jacob Nichols, Kenneth Nugent. Changes in neutrophil-to-lymphocyte ratios in postcardiac arrest patients treated with targeted temperature management. Anatol J Cardiol. 2017; 18(3): 215-222

Corresponding Author: Kazım Başer, United States