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Is preoperative eosinopenia an independent predictor of early mortality for coronary artery bypass surgery? Ozge Korkmaz1, Hakkı Kaya2, Sabahattin Göksel1, Ali Zorlu2, Muslim Gül3, Hasan Yücel2, Ilker Ince4, Mehmet Birhan Yılmaz2, Ocal Berkan1 1 Department of Cardiovascular Surgery , Cumhuriyet University School of Medicine, Sivas, Turkey 2 Department of Cardiology, Cumhuriyet University University School of Medicine, Sivas, Turkey 3 Department of Cardiovascular Surgery, Numune Training and Researche Hospital,Sivas, Turkey 4 Department of Cardiovascular Surgery, Tokat Gaziosmanpaşa University, Tokat, Turkey Introduction: Coronary artery bypass graft (CABG) surgery in one the most effective and widely used methods employed in the treatment of ischemic heart disease, but many factors to various degrees are directly associated with perioperative and postoperative problems. Various scoring systems are used to predict prognosis during surgery, and there are many ongoing studies investigating new markers. In this study, evaluate the relationship between preoperative eosinophil count and postoperative mortality in patients that underwent CABG operation. Method: The data of the patients, who were underwent isole cardiopulmonary bypass operation, were collected from patient charts, perfusion and intensive care unit follow-up cards,and a total 241 patients (157 males, 84 females), who underwent isolated on-pump CABG operation between 2011 and 2013 in different centers and for whom study data were available, were retrospectively reviewed. In all patients, age, gender, diabetes, hyperlipidemia, hypertension, smoking history, left ventricular ejection fraction (LVEF), preoperative and postoperative biochemical tests, hemogram parameters, thyroid hormones, and operative medications were evaluated. Results: The mean age of patients was 64±11 years, while 65% of the patients were male and 35% were female. After the follow-up period, 36 (15%) of the 241 patients experienced cardiovascular death. Patients were classified into two groups as those who survived versus those who died. Eosinophil levels were lower among the patients who died compared to the patients who survived (0.8 [0-3.8] vs. 1.7 [0-9.4] 1000 x cells/mm3, p<0.001). In the multivariate cox regression model with forward stepwise method; eosinophil (OR=0.548, 95% CI: 0.332-0.904, p=0.019), absence of HT (OR=4.740, 95% CI: 1.563-14.374, p=0.006), and the lack of preoperative RAAS inhibitor use (OR=3.086, 95% CI: 1.025-9.290, p=0.045) were associated with an increased risk of death. Optimal cut-off level of eosinophil for predicting mortality was determined as ≤ 1.6 1000 x cells/mm3, with a sensitivity of 85.7% and specificity of 51.0% (AUC: 0.703, 95% CI: 0.641 to 0.760). Discussion: The inflammation is a key process in the induction, development, and progression of atherosclerosis. Various studies showed that elevation of serum acute phase proteins with the progression of atherosclerosis and other conditions associated with atherosclerosis such as coronary artery disease and myocardial infarction, and white blood cell count and subunits reflected inflammation and had a prognostic value in cardiovascular disorders. Eosinopenia is used as a biomarker for infections, and recently, it was used as the predictor of mortality in pediatric and adult patients in the intensive care units.These patients is considered to be associated with an increase in glucocorticoid and epinephrine levels caused by acute stress. Acute phase reactants in addition to inflammatory cytokines such as tumor necrosis factor have been implicated in decreased eosinophil count. Eosinopenia can be linked to two basic factors; first is the stress related to the operation and associated release of stress hormones, particularly glucocorticoids and endogenous epinephrine, and second is insufficiency of the existing cardiac status that potentiate the effect of first factor and generate endogenous adrenergic response. Eosinophil levels can assist and facilitate risk stratification for patients with CABG. Table 1: Spearman correlation coefficients for Eosinophil Eosinophil Age (y) P value - 0.135 0.037 Aspartat aminotransferase (IU/L) 0.004 - 0.185 White blood cell (1000xcells/mm3) 0.001 - 0.208 Basophil (1000xcells/mm3) 0.001 0.543 < Platelet counts, x103 0.137 0.034 Triglyceride (mg/dl) 0.143 0.036 Table 2: Multivariate logistic regression analysis for in-hospital mortality Multivariate Variable p Absence of hypertension 0.006 4.740 1.563-14.374 Eosinophil counts 0.019 0.548 0.332-0.904 Pre-op RAAS inhibitors not usage 1.025-9.290 OR (95% CI) 0.045 3.086 All the variables from were examined and only those with P < 0.1 level (Presence of hypertension, Smoking, Pre-op Beta blocker usage, Pre-op RAAS inhibitors usage, LV Ejection fraction, Hemoglobin, Hematocrit, Platelet counts, White blood cell, Eosinophil, Basophil, Creatinine, CK-MB, and TG), and correlated with Eosinophil counts (age and aspartat aminotransferase) were enrolled into multivariate logistic regression model with forward stepwise method. CI: Confidence interval; OR: Odds ratio. Abbreviations in table 1. Figure 1: Optimal cut-off level of eosinophil for predicting mortality was determined as ≤ 1.6 1000 x cells/mm3, with a sensitivity of 85.7% and specificity of 51.0% (AUC: 0.703, 95% CI: 0.641 to 0.760)