Relationship between white cell count, neuropsychologic outcome, and microemboli in 161 patients undergoing coronary artery bypass surgery.
OBJECTIVE
Neuropsychologic impairment remains a problem after coronary artery bypass grafting. Relatively few studies have examined the potential role of the perioperative inflammatory response. This study aimed to determine whether there was any association between perioperative white cell count, microemboli, and cognitive performance after surgical intervention.


METHODS
White cell count and differential were prospectively measured perioperatively in 161 patients undergoing coronary artery bypass grafting. A neuropsychologic test battery (9 tests) was administered preoperatively and 6 to 8 weeks postoperatively in all 161 patients. Cerebral microemboli during cardiopulmonary bypass were also recorded by means of a transcranial Doppler scan of the right middle cerebral artery.


RESULTS
There was no correlation between microemboli and white cell counts at any time point. There were weak but significant inverse correlations between both preoperative (r = -0.19, P = .02) and postoperative (r = -0.21, P < .01) white cell count and a measure of overall neuropsychologic test performance (total z change score). There was a weak but significant positive correlation between the neutrophil count 10 minutes after bypass and the intraoperative microemboli count (r = 0.23, P = .01).


CONCLUSIONS
The correlation between white cell count and neuropsychologic outcome suggests that an inflammatory response might have a role in determining cognitive outcome after coronary artery surgery with cardiopulmonary bypass. The positive correlation between the microemboli during cardiopulmonary bypass and the neutrophil count 10 minutes after bypass is compatible with microemboli contributing to the inflammatory response. The patients' preoperative inflammatory status might also be predictive of the response to surgical intervention.
Whitaker
Donald
D
University College London and University College London Hospitals, London, United Kingdom.
Stygall
Jan
J
Harrison
Michael
M
Newman
Stanton
S
D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004617:Embolism / Q000209:etiology*; D006801:Humans; D007958:Leukocyte Count; D009483:Neuropsychological Tests; D009504:Neutrophils