Download Is preoperative eosinopenia an independent predictor of early

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)