Prognostic Value of NLR, TLR, and ALC in Predicting ToF Primary Repair Outcome

Study Overview
=================
Brief Summary
-----------------
Tetralogy of Fallot (ToF) were cyanotic congenital heart disease with chronic hypoxia which increases the risk of exacerbated inflammatory response in ToF primary repair. Various studies have recently shown inflammatory biomarkers to predict morbidity and mortality in hypoxemic patients, but they are not readily available and expensive.This study aims to compare the prognostic value of neutrophil-lymphocyte ratio (NLR), absolute lymphocyte count (ALC), and thrombocyte-lymphocyte ratio (TLR) in predicting ToF primary repair outcomes. This was a retrospective observational study on ToF primary repair in National Cardiovascular Center Harapan Kita between Januari 2020 until December 2022. Preoperative NLR, ALC, and TLR were derived from blood test obtained <14 days before surgery. The primary endpoints were redo surgery, 30-day mortality, and complications. The secondary endpoints were hospital length of stay (HLOS) and postoperative LOS.

Detailed Description
-----------------
This was a retrospective observational study on tetralogy of Fallot (ToF) primary repair in National Cardiovascular Center Harapan Kita between Januari 2020 until December 2022. The preoperative demographic data included were patients' gender, age, weight, oxygen saturation, and associated diagnosis other than ToF. The preoperative data of complete blood count and differential count must be tested from the most recent peripheral blood samples taken no later than 14 days before the surgery. The data obtained were the number of days of the most recent blood test including the leukocyte count, percentage neutrophil, percentage and absolute lymphocyte count, thrombocyte count, as well as the derived variables such as neutrophil lymphocyte ratio (NLR) ratio and thrombocyte lymphocyte ratio (TLR). The intraoperative data included were the use of cardiopulmonary bypass (CPB), CPB time, aortic cross-clamp (AOX) time, and the total duration of surgery. Patients were evaluated and followed-up for any complications and postoperative mortality during the same hospital stay until discharge. Patients were then followed up for any cause of mortality within 30 days postoperative.

Official Title
-----------------
Prognostic Value of Neutrophil-Lymphocyte Ratio (NLR), Absolute Lymphocyte Count (ALC), and Thrombocyte-Lymphocyte Ratio (TLR) in Predicting the Outcomes of Tetralogy of Fallot Primary Repair

Conditions
-----------------
Congenital Heart Disease, Tetralogy of Fallot, Neutrophil-lymphocyte Ratio, Absolute Lymphocyte Count, Thrombocyte-lymphocyte Ratio, Outcome, TOF

Intervention / Treatment
-----------------
* Procedure: ToF primary repair


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: All patients with ToF and any other associated cardiac anomalies, who underwent ToF primary repair and had a complete blood cell count with differential count available preoperatively Exclusion Criteria: Surgery other than ToF primary repair Association with other procedures (except patent ductus arteriosus/PDA ligation, patent foramen ovale/PFO or atrial septal defect/ASD closure, or pulmonary arteries enlargement) Preoperative hemodynamic instability Suspected or confirmed infection with prior antibiotic administration during the same hospital admission Absence of complete blood count with differential count

Ages Eligible for Study
-----------------
Maximum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| ToF primary repair<br>Patients who underwent ToF primary repair from January 2020 until December 2022 | Procedure: ToF primary repair<br>* ToF primary repair for patients with ToF<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Patients Requiring Redo surgery | Redo surgery was defined as additional or corrective surgery after the initial primary ToF repair within the same hospital admission. | From the initial primary ToF until the discharge of the patients or until 2 weeks after the operation, whichever came first | 
| Mortality | Mortality intraoperative or postoperative | Until 30 days postoperative | 
| Complications (categorized as mild, moderate, severe) | Complication was defined as any adverse events that arised during the operation or postoperative until the discharge of the patient. | From the initial primary ToF until the discharge of the patients or until 2 weeks after the operation, whichever came first | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital Length of Stay | Hospital length of stay (HLOS) was defined as the duration of stay in the hospital from the initial admission to discharge. | From the initial primary ToF until the discharge of the patients or until 12 weeks after the operation, whichever came first | 
| Postoperative Length of Stay | Longer postoperative LOS was defined as hospitalization of more than 5 days from the period of surgery until postoperative discharge (based on our center). | From the initial primary ToF until the discharge of the patients or until 12 weeks after the operation, whichever came first | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Congenital Heart Disease, Tetralogy of Fallot, Neutrophil-lymphocyte ratio, Absolute lymphocyte count, Thrombocyte-lymphocyte ratio, Outcome