Platelet-leukocyte indices before heart surgery can predict VASOplegia

A persistent systemic inflammatory state is increasingly being attributed to interactions between platelets and leucocytes. Extending from the foregoing, there is a rising interest in determining the prognostic value of various novel platelet-leucocyte indices (PLIs), such as the platelet-lymphocyte ratio (PLR), systemic immune-inflammation index (SII = platelet neutrophil/lymphocyte), and aggregate index of systemic inflammation (AISI = platelet monocyte neutrophil/lymphocyte), in a variety of clinical settings

In this setting, post-CPB vasoplegia syndrome (VS) is a unique hemodynamic consequence with a reported prevalence ranging from 9 to 40%. It is characterized by systemic hypotension, low vascular resistance, a normal to elevated cardiac index, and poor response to volume treatment. In order to assess the potential of new PLIs (PLR, SII, and AISI) and leucocyte indices (LIs, including NLR and systemic inflammatory response index [SIRI = monocyte neutrophil lymphocyte]) in predicting post-cardiotomy VS, authors recently performed the current retrospective investigation.

The goal of the retrospective research was to assess how well PLIs and LIs predicted VS outcomes for 1,045 adult patients having elective heart surgery at a tertiary care facility. A normal or high CI (>2.5 L/min/m2), a normal or lowered central filling pressure despite high-dose vasopressors, mean blood pressure 60 mmHg, and low systemic vascular resistance (SVRI 1,500 dynes.s/cm 5/m2) were used to identify VS. A total of 205 patients (19.61%) had VS after surgery. Age, diabetes, dialysis-dependent renal failure, preoperative congestive heart failure (CHF), EuroSCORE II, ejection fraction, NLR, PLR, SII, SIRI, AISI, CPB, and aortic cross clamp (ACC) duration, packed red blood cell (PRBC) transfusion, and time-weighted average blood glucose all predicted VS on univariate analysis. Following the multivariate analysis, the EuroSCORE II (OR: 3.236; 95% CI: 2.345-4.468; P 0.001), CHF (OR: 1.04; 95% CI: 1.02-1.06; P = 0.011), SII (OR: 1.09; 95% CI: 1.02-1.18; P = 0.001), AISI (OR: 1.11; 95% CI: 1.05-1.17; P 0.00 The SII and AISI VS predicted cut-offs were 1,045 1045 /mm3 and 137532 /mm3, respectively. The postoperative vasoactive-inotropic score, lactate, the length of mechanical ventilation, and the length of the ICU stay all had positive correlations with AISI (R = 0.718, 0.655, 0.837, and 0.757, respectively).

The interplay between the endothelium and the corpuscular lineages as the agents of a continuing inflammatory process continues to hold people's attention. The neutrophil nitric oxide synthase may have pathogenic repercussions relevant to the establishment of post-cardiotomy VS before neutrophil activation and neutrophil-endothelial interactions in inflammatory situations. Along with the fact that platelets are now understood to be the main contributors to systemic inflammation, the problem is further complicated by increased platelet-leucocyte cross-talk in proinflammatory situations. Furthermore, as shown in the index analysis, perioperative variables such impaired glucose homeostasis and blood transfusion are also anticipated to stimulate leucocytes and platelet-leucocyte interactions, increasing the risk of VS.

This research is the first to examine how well LIs and PLIs predict the occurrence of vasoplegia in a sample of cardiac surgery patients. The VS risk stratification and clinical decision-making may be aided by the cost-effective, easily accessible hematological VS risk prediction. The adult cardiac surgical population may be stratified before to surgery in terms of their risk of developing post-cardiotomy VS, according to preoperative PLIs. The aforementioned prudent risk classification highlights the inflammatory relationship of this unique hemodynamic illness.

Key findings –

• VS predictive cut-offs of SII and AISI were 1,045 1045×109 /mm3 and 137532×109/mm3, respectively.

• AISI positively correlated with the postoperative vasoactive-inotropic score (R = 0.718), lactate (R = 0.655), mechanical ventilation duration (R = 0.837), and ICU stay.

References –

Magoon R, Kashav RC, Shri I, Dey S, Walian A, Kohli JK. VASOplegia is Predicted by Preoperative Platelet-LEucocyte conGlomerate Indices in Cardiac Surgery (VASOPLEGICS): A retrospective single-center study. Ann Card Anaesth 2022;25:414-21