Examination and Validation of Neutrophil-Lymphocyte Ratio as a Perioperative Risk Assessment Biomarker in Major Noncardiac Surgical Patients: An Observational Cross-sectional Study.

BACKGROUND AND AIMS: Neutrophil-lymphocyte ratio (NLR) can predict prognosis of disease in patients suffering from cerebrovascular accidents, ischemic heart disease, infectious diseases, sepsis, etc., that can cause increased postoperative morbidity and prolonged stay in hospital. So, NLR can be a potential preoperative risk assessment and stratification biomarker. Our study aims to estimate any correlation between preoperative NLR and coexisting medical and surgical disease and to validate NLR against American Society of Anesthesiologists Physical Status (ASA PS) Classification System, Revised Cardiac Risk Index (RCRI), Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score, and Gupta's postoperative respiratory failure risk in Indian patients.

MATERIALS AND

METHODS

This observational, cross-sectional study was conducted in the preanesthesia check-up clinic. Information regarding sociodemographic profile, primary surgical disease, hematological investigations, that is, complete blood count, neutrophil count, lymphocyte count, NLR, and coexistent medical disease was collected, and ASA PS, RCRI, ARISCAT score, and Gupta's postoperative respiratory failure risk were calculated for each study subject. Data were analyzed using standard statistical tests.

RESULTS

Age, congestive cardiac failure, smoking, malignancy, and beta blockers usage were associated with elevated NLR. NLR was found to have a significant relationship with anesthesia risk indices: ASA PS, RCRI, ARISCAT, and Gupta's postoperative respiratory failure risk.

CONCLUSION

Significant association has been observed between increased NLR and occurrence of systemic illness. NLR also has a significant association with ASA PS Classification System, RCRI, ARISCAT score, and Gupta's postoperative respiratory failure risk. So, NLR may serve as a valuable biomarker in preoperative risk stratification.