Predicting postoperative ischemic stroke problems in patients following coronary bypass surgery using neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and red blood cell distribution width values.

Introduction: Coronary artery bypass grafting (CABG) plays an important role in the revascularization of ischemic heart disease. However, stroke is a rare but extremely serious complication after CABG. Aim: We investigated the relationship between platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio, red blood cell distribution width (RDW) values, and postoperative ischemic stroke by examining the preoperative complete blood count (CBC) parameters in patients who underwent CABG. Material and methods: A total of 1240 patients who underwent CABG between September 2016 and June 2019 were included in this retrospective observational study. The diagnosis of ischemic stroke was made in the postoperative period by neurology consultation and radiological imaging. The CBC data used as preoperative values for each case were obtained the day before surgery. Results: Ischemic stroke was observed in 40 patients. In patients with stroke, the mean age was higher, the hemoglobin (HB) value and lymphocyte count were lower (p < 0.001), and there were also higher neutrophil to lymphocyte ratio (NLR), PLR, and RDW values (p < 0.001), number of mechanical ventilator days, length of stay in the hospital, and length of stay in the ICU (p < 0.001). Statin and acetylsalicylic acid use were statistically significantly higher in patients without ischemic stroke after CABG (p < 0.001); the use of other antiaggregants was found to be higher in stroke patients (p < 0.05). However, age, operation time, PLR, NLR, and RDW values were determined as independent risk factors for ischemic stroke. Conclusions: In patients undergoing CABG, high preoperative PLR, NLR, and RDW values can be used as useful and independent risk factors for the prediction of postoperative ischemic stroke.

The predictive power of C-reactive protein- lymphocyte ratio for in-hospital mortality after colorectal cancer surgery.

BACKGROUND: The relation between immunity, inflammation, and tumor development and progression has been emphasized in colorectal cancer widely and the prognosis is linked to the inflammatory reaction of the host as well as the biological behavior of the tumor. AIM: In this study, we aimed to find out the predictive power of C-reactive protein- lymphocyte ratio (CLR) for in-hospital mortality after colorectal surgery. METHODS AND RESULTS: A series of 388 CRC patients were enrolled in the present retrospective study which was conducted in a tertiary state Hospital in Ankara, Turkey. In-hospital mortality was the main outcome to evaluate the predictive power of inflammatory markers, while the other outcomes that would be evaluated as separate variables were LOS in hospital and LOS in ICU. In this study, there were 260 males and 128 females, and the mean age was 60.9. The in-hospital mortality rate was 3.4% (n = 13) and age, APACHE II score and Charlson comorbidity index score were related to in-hospital mortality statistically. The mean LOS in the hospital was 13.9 days and LOS in ICU was 4.5 days. The CRP levels and the CLR levels were higher both in the preoperative and postoperative periods in the mortality (+) group and the difference was significant statistically (P = .008/ .002 and .004/ <.001, respectively). CLR in the postoperative period had the best predictive power with AUC: 0.876. CONCLUSION: In conclusion, within the context of our study there appears to be a relationship between CLR, as measured on day 2 postoperatively, and in-hospital mortality. It is observed to be more effective than NLR, ALC, and CRP.

A Randomized Clinical Trial on the Effect of Hypnosis on Anxiety and Pain in Rigid Cystoscopy Patients.

Introduction: Cystoscopy is one of the most common procedures in outpatient urology. Although flexible cystoscopes are more tolerable, rigid cystoscopes have still been used in many clinics because of their lower costs, better visual performance, and easier handling. It can be difficult to achieve optimal relief of pain and anxiety during rigid cystoscopy. The aim of the present prospective randomized study was to evaluate the efficacy of hypnosis as an adjunct to routine local anesthesia in reducing pain and anxiety in rigid cystoscopy patients. Materials and Methods: Ninety male patients undergoing rigid cystoscopy for the first time were randomized into two groups: (1) Hypnosis Group (Group H) patients underwent cystoscopy with hypnotic communication as an adjuvant approach for periprocedural analgesia and anxiety, (2) Standard Care Group (Group SC) patients underwent cystoscopy with routine local anesthesia and lubrication as control group. The data were collected using visual analog scale (VAS) for pain, State-Trait Anxiety Inventory (STAI) for anxiety and hemodynamic parameters. Furthermore, a VAS was also completed by the urologist to assess his satisfaction. Results: Baseline characteristics, STAI, hemodynamic parameters, and recovery duration were statistically similar between the two groups. The procedure duration was shorter in Group H (p = 0.018). The postprocedural STAI and VAS scores of patients in Group H were significantly lower than those of Group SC (p = 0.006; p = 0.02, respectively). Heart rate and mean arterial pressure after positioning of the patient (p = 0.000; p = 0.004, respectively) and insertion of the cystoscope (p = 0.000; p = 0.000) were statistically lower in Group H, whereas baseline, postprocedural, and predischarge hemodynamic measurements were similar. Urologists were also more satisfied in Group H (p = 0.000). Conclusion: Hypnosis as an adjunct therapy to local anesthesia during rigid cystoscopy significantly reduces pain and anxiety, provides more stable hemodynamic conditions, shortens procedure duration, and thus appears attractive for pain and anxiety management.

Correction to: Does the preoperative platelet-tolymphocyte ratio and neutrophil-tolymphocyte ratio predict morbidity after gastrectomy for gastric cancer?

In the original publication of this article [1] there are two garbled codes in the second sentence, the fourth paragraph of the Background section. The correct sentence should be: Tumor growth leads to the increased production of inflammatory cytokines and growth factors (mainly IL-1, IL-3, IL-6, IL-11, IL-23, and TNF-), and this perpetual process ensures immortality. These promoting factors are also important for angiogenesis and hematopoiesis, which explains the increase in blood cell types in cancerous diseases. The original publication has been corrected.

Does the preoperative platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio predict morbidity after gastrectomy for gastric cancer?

BACKGROUND: Gastric cancer is the 2nd most common cause of cancer-related deaths, and the morbidity rate after surgery is reported to be as high as 46%. The estimation of possible complications, morbidity, and mortality and the ability to specify patients at high risk have become substantial for an intimate follow-up and for proper management in the intensive care unit. This study aimed to determine the prognostic value of the preoperative platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) and their relations with clinical outcomes and complications after gastrectomy for gastric cancer. METHODS: This single-center, retrospective cohort study evaluated the data of 292 patients who underwent gastrectomy with curative intent between January 2015 and June 2018 in a tertiary state hospital in Ankara, Turkey. A receiver operating characteristic curve was generated to evaluate the ability of laboratory values to predict clinically relevant postoperative complications. The area under the curve was computed to compare the predictive power of the NLR and PLR. Then, the cutoff points were selected as the stratifying values for the PLR and NLR. RESULTS: The area under the curve values of the PLR (0.60, 95% CI 0.542-0.657) and NLR (0.556, 95% CI 0.497-0.614) were larger than those of the other preoperative laboratory values. For the PLR, the diagnostic sensitivity and specificity were 50.00 and 72.22%, respectively, whereas for the NLR, the diagnostic sensitivity and specificity were 37.50 and 80.16%, respectively. The PLR was related to morbidity, whereas the relation of the NLR with mortality was more prominent. This study demonstrated that the PLR and NLR may predict mortality and morbidity via the Clavien-Dindo classification in gastric cancer patients. The variable was grade ≥ 3 in the Clavien-Dindo classification, including complications requiring surgical or endoscopic interventions, life-threatening complications, and death. Both the PLR and NLR differed significantly according to Clavien-Dindo grade ≥ 3. In this analysis, the PLR was related to morbidity, while the NLR relation with mortality was more intense. CONCLUSION: Based on the results of the study, the PLR and NLR could be used as independent predictive factors for mortality and morbidity in patients with gastric cancer.

The predictive power of SAPS-3 and SOFA scores and their relations with patient outcomes in the Surgical Intensive Care Unit.

OBJECTIVES: Individual risk of surgical patients is more often underestimated and there is not an absolute criterion demonstrating which patient deserves intensive care. Since a nominative assessment of these patients to quantify the intensity of critical illness is not appropriate, prognostic scores are used to assess the mortality rate and prognosis for critical patients including surgical ones. This study aimed to test the calibration power of SAPS-3 score and SOFA score of surgical patients undergoing gastrointestinal surgery, and identify any relation with patient outcomes in the department of surgical ICU. MATERIAL AND METHODS: This retrospective observational study was conducted during the period between August 2017 and December 2017. It was performed at a Gastroenterological Surgical ICU, a tertiary care hospital in Ankara, Türkiye. To calculate SAPS-3 and SOFA score, physiological data and laboratory analysis on the day of ICU admission were used. Records were reviewed from hospitalization to medical discharge or hospital mortality. Statistical analysis included Mann Whitney U-test and ROC-curves to predict 30-day mortality. RESULTS: A total of 233 patients admitted to the Gastroenterological Surgical ICU were included into the study and the main reason for ICU admission was surgical problems. Mortality rate was 2.6 % (6 patients). Average SAPS -3 score was 32.5 and SOFA score was 30.1. A significant correlation was observed with the SAPS-3 score, but not with the SOFA score statistically in mortality as a dependent factor. The discriminative power, assessed using the AUC and the probability of death estimation, was satisfactory with the SAPS-3 scores (AUC 0.754) while it was lower with the SOFA score (AUC 0.631). CONCLUSION: We found that SAPS-3 score was significantly correlated not only with mortality rate, but also with LOS in the ICU. Nonetheless, SOFA score was not related to mortality, but related to LOS in the ICU. Prognostic score systems are used to estimate mortality but they may be used to identify LOS in the ICU and postoperative complications. It can be concluded that SAPS-3 and SOFA scores may be used to prognosticate postoperative ICU requirement.

Does lactate clearance prognosticates outcomes in ECMO therapy: a retrospective observational study.

BACKGROUND: ECMO support is a final treatment modality for patients in the refractory cardiogenic arrest and postcardiotomy cardiogenic shock with an utmost importance. Eventhough it is linked to high mortality, its usage gains popularity worldwide. We assessed the fluctuation of lactate levels and the clearance of lactate during the ECMO therapy and its prognostic role on mortality. METHODS: Data were gathered on all patients receiving ECMO therapy longer than 48 h between January 2015 and December 2017 retrospectively. Blood lactate had been recorded before ECMO implantation and at specific time points during ECMO support as a routine procedure. In this study, the Lactate clearance at specific time points (Lactate clearance-1) and the duration that lactate cleared more than 10% of the initial lactate level (Lactate clearance-2) was measured. Statistical analysis included Mann Whitney U-test and ROC-curves to predict 30-day mortality. RESULTS: Fourty-eight patients underwent ECMO therapy for refractory cardiogenic shock resulting in 70.8% mortality. The lactate levels before and after ECMO therapy as well as the dynamic changes were significantly correlated with mortality variable. With AUC calculation, LC-2 has a strong discrimination (AUC = 0.97) on 30-day survivors and nonsurvivors. LAE-LBE (AUC = 0.785), L48-LBE (AUC = 0.706) showed moderate predictive power on 30-day mortality. CONCLUSIONS: Changes in lactate levels after ECMO implantation is an important tool to assess effective circulatory support and it is found superior to single lactate measurements as a prognostic sign of mortality in our study. Based on our results, an early insertion of ECMO before lactate gets high was suggested. Serial changes on lactate levels and calculation of its clearance may be superior to single lactate on both effective circulatory support and as prognostic prediction. LC-2 showed a strong discrimination on 30-day mortality.