The relationship of lactic acid, neutrophil lymphocyte ratio and monocyte lymphocyte ratio with the outcomes of coronary arterial disease patients following coronary artery bypass surgery

Cynthia Citradinata , Nyoman Suci Widyastiti

Cynthia Citradinata
PPDS Department of Clinical Pathology, Faculty of Medicine, Diponegoro University/ dr.Kariadi hospital Semarang. Email: cynthiatjitra@gmail.com

Nyoman Suci Widyastiti
PPDS Department of Clinical Pathology, Faculty of Medicine, Diponegoro University/ dr.Kariadi hospital Semarang
Online First: August 01, 2019 | Cite this Article
Citradinata, C., Widyastiti, N. 2019. The relationship of lactic acid, neutrophil lymphocyte ratio and monocyte lymphocyte ratio with the outcomes of coronary arterial disease patients following coronary artery bypass surgery. Bali Medical Journal 8(2). DOI:10.15562/bmj.v8i2.1422

Background: Coronary artery bypass surgery (CABG) is a surgical procedure for coronary arterial disease (CAD). It has a risk of postoperative complication, extending from a long length of stay in the intensive care unit (ICU) to death. CABG needs a long duration of perioperative time, which decreases tissue oxygenation. It causes increased lactic acid production and initiates the secretion of inflammatory factors. Neutrophil/lymphocyte ratio (NLR) and monocyte/lymphocyte ratio (MLR) become inflammatory signs that are caused by the failure of heart microcirculation during the operative procedure. This study aimed to determine the relationship of lactic acid, NLR and MLR with the outcomes of CAD patients following CABG surgery.

Methods: This was a prospective study including 42 CAD patients who had undergone CABG procedure at Dr. Kariadi Hospital Semarang between December 2017 and July 2018. Lactic acid data were taken using the spectrophotometer method.  NLR and MLR were taken by the calculation index. The outcomes data were ICU length of stay (LoS), complications, and death, which were obtained from the medical record. The data were analyzed using bivariate analysis.

Results: There was a significant correlation between lactic acid with ICU LoS (p = 0.001), complication (p = 0.01), and mortality (p = 0.044). There was a significant correlation between NLR with ICU LoS (p = 0.003), complication (p = 0.009), and mortality (p = 0.014). There was a significant correlation between MLR with ICU LoS (p = 0.02), complication (p = 0.027), and mortality (p = 0.017).

Conclusion: There was a significant correlation between lactic acid, NLR dan MLR with the outcomes of CAD patients (ICU LoS, complication and mortality) that have undergone CABG procedure.


World Health Organization. Cardiovascular diseases. Available from: http://www.who.int/mediacentre/factsheets/fs317/en/2016 [Accessed June 2016].

World Health Organization. The Top 10 Causes of Death. Available from: http://www.who.int/mediacentre/factsheets/fs310/en/. [Accessed May 2014].

Libby P, Antman AM, Selwyn AP et al. Vascular disease. In: Longo DL, Fauci AS, Kasper DL et al. (eds.). Harrisons Principles of Internal Medicine. 18th ed. New York: The McGraw-Hill Companies; 2012.

Yerokun BA, Williams JB, Gaca J, Smith PK, Roe MT. Indications, algorithms, and outcomes for coronary artery bypass surgery in patients with acute coronary syndromes. Coron Artery Dis. 2016; 27(4): 319 – 26. DOI: 10.1097/MCA.0000000000000364.

Christian WH, Helge M, Jean-Pierre B, Frans van de Wer A. Acute Coronary Syndrome. In: Jhon C, Thomas F L, Patrick WS. (eds.). Cardiovascular Medicine. 2nd ed. West Sussex: Blackwell Publishing Ltd; 2009.

Hein OV, Birnbaum J, Wernecke K, England M, Konertz W, Spies C. Prolonged intensive care unit stay in cardiac surgery : risk factor and long-term survival. Ann Thorac Surg. 2006; 81(3): 880 – 5. DOI: 10.1016/j.athoracsur.2005.09.077.

Anderson LW, Holmberg MJ, Doherty M, Khabbaz K, Lerner A, Berg KM, Donnino MW. Postoperative Lactate Levels and Hospital Length of Stay After Cardiac Surgery. J Cardiothorac Vasc Anesth. 2015; 29(6): 1454 – 60. DOI: 10.1053/j.jvca.2015.06.007.

Ranucci M, Isgro G, Romitti F, Mele S, Biagioli B, Giomarelli P. Anaerobic metabolism during cardiopulmonary bypass: predictive value of carbon dioxide derived parameters. Ann Thorac Surg. 2006; 81(6): 2189 – 95. DOI: 10.1016/j.athoracsur.2006.01.025.

Dragu R, Khoury S, Zuckerman R, Suleiman M, Mutlak D, Agmon Y et al. Predictive value of white blood cell subtypes for long-term outcome following myocardial infarction. Atherosclerosis. 2008; 196(1): 405 – 12. DOI: 10.1016/j.atherosclerosis.2006.11.022.

Gibson PH, Croal BL, Cuthbertson BH, Small GR, Ifezulike AI, Gibson G et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J. 2007; 154(5): 995-1002. DOI: 10.1016/j.ahj.2007.06.043.

Ji H, Li Y, Fan Z, Zuo B, Jian X, Li L et al. Monocyte/lymphocyte ratio predicts the severity of coronary artery disease: a syntax score assessment. BMC Cardiovasc Disord. 2017; 17(1): 90. DOI: 10.1186/s12872-017-0507-4.

Abraham BP, Prodhan P, Jaquiss RD, Bhutta AT, Gossett JM, Imamura M et al. Cardiopulmonary bypass flow rate: a risk factor for hyperlactatemia after surgical repair of secundum atrial septal defect in children. J Thorac Cardiovasc Surg. 2010; 139(1): 170 – 3. DOI: 10.1016/j.jtcvs.2009.04.060.

Xiang F, Chen R, Cao X, Shen B, Liu Z, Tan X et al. Monocyte/lymphocyte ratio as a better predictor of cardiovascular and all-cause mortality in hemodialysis patients: A prospective cohort study. Hemodial Int. 2018; 22(1): 82 – 92. DOI: 10.1111/hdi.12549.

Lee JS, Kim NY, Na SH, Youn YH, Shin CS. Reference values of neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, and mean platelet volume in healthy adults in South Korea. Medicine (Baltimore). 2018; 97(26): e11138. DOI: 10.1097/MD.0000000000011138.

Kounis NG, Soufras GD, Tsigkas G, Hahalis G. White blood cell counts, leukocyte ratios, and eosinophils as inflammatory markers in patients with coronary artery disease. Clin Appl Thromb Hemost. 2015; 21(2): 139 – 43. DOI: 10.1177/1076029614531449.

Almashrafi A , Elmontsri M, Aylin P. Systematic review of factors influencing length of stay in ICU after adult cardiac surgery. BMC Health Serv Res. 2016; 16: 318. DOI: 10.1186/s12913-016-1591-3.

El-Chami MF, Sawaya FJ, Kilgo P, Stein W 4th, Halkos M, Thourani V et al. Ventricular arrhythmia after cardiac surgery: incidence, predictors, and outcomes. J Am Coll Cardiol. 2012; 60(25): 2664 – 71. DOI: 10.1016/j.jacc.2012.08.1011.

Santos CA, Oliveira MA, Brandi AC, Botelho PH, Brandi Jde C, Santos MA et al. Risk factors for mortality of patients undergoing coronary artery bypass graft surgery. Rev Bras Cir Cardiovasc. 2014; 29(4): 513 – 20. DOI: 10.5935/1678-9741.20140073.

No Supplementary Material available for this article.
Article Views      : 0
PDF Downloads : 0