Prognostic value of the preoperative neutrophil-lymphocyte ratio in patients undergoing the bidirectional Glenn procedure.
INTRODUCTION
The neutrophil-lymphocyte ratio (NLR) has been associated with worse outcomes in patients undergoing coronary artery bypass graft surgery. Little is known about this association in the pediatric population who require surgery for congenital heart defects, especially in patients with a single ventricle (SV).


OBJECTIVE
To analyze the association of the preoperative NLR with outcomes in patients undergoing the bidirectional Glenn procedure.


METHODS
This study involved a retrospective cohort analysis of 141 consecutive patients with SV undergoing the bidirectional Glenn procedure between January 2011 and December 2017 in two centers. The preoperative NLR was included in the last hemogram test before surgery. According to the NLR level, the patients were divided into group I (NLR < 1), group II (NLR between 1 and 2), and group III (NLR > 2). The primary endpoint was total hospital length of stay (LOS), and secondary endpoints were mechanical ventilation (MV) time, intensive care unit (ICU) LOS, ventricular dysfunction, complications, and middle-term mortality.


RESULTS
The average follow-up duration was 48 months. There were 61, 47, and 33 patients in groups I, II, and III, respectively. Patients in group III exhibited an increased risk of prolonged total hospital LOS (P = .00). An increase in MV time (P = .03) and ICU LOS (P = .02) was also observed in this group, and these patients experienced greater mortality in 24 months following the surgery (P = .03). There was no association between the NLR and ventricular dysfunction (P = .26) and complications (P = .46).


CONCLUSION
A high preoperative NLR was associated with worse outcomes in patients with SV physiology undergoing the bidirectional Glenn procedure.
['Manuel|Valdano|V|http://orcid.org/0000-0001-5740-7707', 'Miana|Leonardo A|LA|http://orcid.org/0000-0001-5806-6780', 'Guerreiro|Gustavo P|GP|', 'Tenório|Davi F|DF|http://orcid.org/0000-0003-2059-7548', 'Turquetto|Aida|A|', 'Penha|Juliano G|JG|', 'Massoti|Maria R|MR|', 'Tanamati|Carla|C|', 'Junior|António P F|APF|', 'Caneo|Luiz F|LF|', 'Jatene|Fábio B|FB|', 'Jatene|Marcelo B|MB|']
D000328:Adult D000368:Aged D006348:Cardiac Surgical Procedures D015331:Cohort Studies D005260:Female D005500:Follow-Up Studies D006330:Heart Defects, Congenital D006352:Heart Ventricles D006801:Humans D007958:Leukocyte Count D018655:Lymphocyte Count D008297:Male D008875:Middle Aged D009504:Neutrophils D011183:Postoperative Complications D057234:Preoperative Period D011379:Prognosis D012121:Respiration, Artificial D012189:Retrospective Studies D013997:Time Factors
neutrophil-lymphocyte ratio bidirectional Glenn procedure congenital heart disease single-ventricle physiology