The prognostic value of elevated neutrophil–lymphocyte ratio for cardiac surgery-associated acute kidney injury: A systematic review and meta-analysis

Background

Patients undergoing cardiac surgery are at significant risk of developing postoperative acute kidney injury (AKI). Neutrophil–lymphocyte ratio (NLR) is a widely available inflammatory biomarker which may be of prognostic value in this setting.

Methods

We conducted a systematic review and meta-analysis of studies reporting associations between perioperative NLR with postoperative AKI. We searched Medline, Embase and the Cochrane Library, without language restriction, from inception to May 2022 for relevant studies. We meta-analysed the reported odds ratios (ORs) with 95% confidence intervals (CIs) for both elevated preoperative and postoperative NLR with risk of postoperative AKI and need for renal replacement therapy (RRT). We conducted a meta-regression to explore inter-study statistical heterogeneity.

Results

Twelve studies involving 10,724 participants undergoing cardiac surgery were included, with eight studies being deemed at high risk of bias using PROBAST modelling. We found statistically significant associations between elevated preoperative NLR and postoperative AKI (OR 1.45, 95% CI 1.18–1.77), as well as postoperative need for RRT (OR 2.37, 95% CI 1.50–3.72). Postoperative NLR measurements were not of prognostic significance.

Conclusions

Elevated preoperative NLR is a reliable inflammatory biomarker for predicting AKI following cardiac surgery.     

Resting and total energy expenditure in patients with ischemic heart disease.

Total energy expenditure (TEE) was measured by doubly labeled water in 13 preoperative patients undergoing elective coronary artery surgery and compared to resting energy expenditure (REE) measured by indirect calorimetry (IC) calculated from the Harris-Benedict (HB) formula or from formulas based on midarm circumference and arm muscle circumference. Mean REE measured by IC and calculated from the HB, midarm circumference, arm muscle circumference formulas were 62, 75, 62, and 69%, respectively, of TEE measured by doubly labeled water. REE measured by IC correlated significantly with that predicted by the HB (p = 0.006) but not the anthropometric formulas. The relationship between REE derived from anthropometric predictive formulas and REE measured by IC is altered in ischemic heart disease.     

Sudden coronary death in Glasgow: the severity and distribution of chronic coronary atherosclerotic stenoses.

A detailed analysis of the extent of coronary artery atherosclerosis was made in 92 white subjects (66 men and 26 women) who died suddenly from ischaemic heart disease. Stenoses resulting in loss of greater than or equal to 75% of luminal cross sectional area (significant stenosis) were found in 90 subjects and these were more extensive in the proximal coronary tree than in the distal. Thirty nine per cent had triple vessel disease, 37% had double vessel disease, and 23% had single vessel disease. In addition one man had an isolated significant stenosis affecting the left main coronary artery. The frequency of significant stenoses in the left main coronary artery was greater in men than in women. The arteries that were least affected were the distal branches of the right coronary artery. A notable feature was the widespread nature of the coronary atherosclerosis: only 26 of the total of 1840 segments of coronary artery examined in the 92 victims could be described as having a normal intima (less than or equal to 10% loss of the area within the internal elastic lamina).     

Treatment of myofascial trigger points in common shoulder disorders by physical therapy: A randomized controlled trial [ISRCTN75722066]

Background  

Shoulder disorders are a common health problem in western societies. Several treatment protocols have been developed for the clinical management of persons with shoulder pain. However available evidence does not support any protocol as being superior over others. Systematic reviews provide some evidence that certain physical therapy interventions (i.e. supervised exercises and mobilisation) are effective in particular shoulder disorders (i.e. rotator cuff disorders, mixed shoulder disorders and adhesive capsulitis), but there is an ongoing need for high quality trials of physical therapy interventions. Usually, physical therapy consists of active exercises intended to strengthen the shoulder muscles as stabilizers of the glenohumeral joint or perform mobilisations to improve restricted mobility of the glenohumeral or adjacent joints (shoulder girdle). It is generally accepted that a-traumatic shoulder problems are the result of impingement of the subacromial structures, such as the bursa or rotator cuff tendons. Myofascial trigger points (MTrPs) in shoulder muscles may also lead to a complex of symptoms that are often seen in patients diagnosed with subacromial impingement or rotator cuff tendinopathy. Little is known about the treatment of MTrPs in patients with shoulder disorders.     

Coping and recovery styles in the Vietnam era prisoner of war

Of the nearly 600 Vietnam War American prisoners of war (POWs), 332 were United States Air Force flyers who had suffered maltreatment, confinement, and boredom for months to years. We examined four coping styles of USAF POWs related to successful/unsuccessful coping and resistance stance during captivity and cognitive integration of the prisoner experience after repatriation. Findings indicate that no coping style is clearly associated with an increased risk of postrepatriation psychiatric morbidity. Postrepatriation MMPI scales indicate personality differences between individuals in the various coping groups.     

Recent advances in prophylaxis against deep vein thrombosis

The major development in DVT prophylaxis in recent years has been the introduction of low molecular weight heparins. Their main improvement compared with unfractionated heparin is in the convenience of a once daily dosage, but they have not yet convincingly been shown to be more effective or safer.22 23 A-V impulse boots may have an impact on knee and hip surgery but still face problems with patient acceptability. Probably the best way to ensure that more DVT are prevented is by clinicians maintaining a high level of awareness of the risk, and developing, and adhering to, local guidelines.