Relation Between Insulinoresistance and Neutrophile to Lymphocyte Ratio in Cardiac Surgery.

The University Hospital of Besançon is conducting a public interest research project called CRYSTAL, who studies the relationship between the Neutrophil to Lymphocyte ratio (NLR) and insulin resistance in post-operative cardiac surgery. This study could make it possible to determine, thanks to an easily measurable marker in the blood upon leaving the cardiac surgery operating room, which patients are at risk of developing insulin resistance and who would deserve close monitoring of glycemia following cardiac surgery. Coronary artery bypass graft (CABG) and valve replacement surgeries under extracorporeal circulation (ECB) are considered high-risk procedures, particularly due to the inflammation generated by ECB. This inflammation is the cause of metabolic disturbances including insulin resistance, which causes stress hyperglycemia and glycemic variability that alters the prognosis. Insulin treatment is effective but requires enhanced monitoring and intensive care. Beyond discharge from intensive care, some patients still have insulin resistance that can persist for several days, and whose management cannot be optimally carried out in a conventional hospitalization department. The persistence of insulin resistance is explained by the intensity of the postoperative inflammatory reaction. The NLR is a simple and reliable indicator to quantify this inflammation. The hypothesis of this study is therefore that the NLR could predict the onset of prolonged postoperative insulin resistance and identify patients likely to benefit from enhanced glycemic monitoring.