Perioperative Inflammatory Biomarkers and Early Postoperative Prognosis in Elderly Patients Undergoing Cardiac Surgery.

OBJECTIVES

To evaluate the prognostic value of perioperative inflammatory biomarkers-specifically the systemic immune-inflammation index, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR)-for predicting early postoperative prognosis in elderly patients undergoing elective open cardiac surgery.

DESIGN

Retrospective observational cohort study.

SETTING

Single tertiary university hospital.

PARTICIPANTS

A total of 432 patients aged ≥65 years who underwent elective open cardiac surgery between August 2018 and October 2023 were analyzed. Patients with prior thoracic surgery, advanced renal disease, or incomplete preoperative data were excluded from the analysis.

INTERVENTIONS: No interventional procedures were performed. All patients were managed according to institutional perioperative protocols. Clinical variables and laboratory biomarkers were retrospectively analyzed.

MEASUREMENTS AND MAIN

RESULTS

Postoperative prognosis was classified as poor or good based on the occurrence of major early postoperative cardiac complications. Poor postoperative prognosis occurred in 98 patients (22.7%). Patients with poor postoperative prognosis exhibited higher preoperative NLR and PLR values, along with higher EuroSCOREs, longer intensive care unit and hospital stays, and increased short-term mortality (all p < 0.05). Among the inflammatory biomarkers assessed, PLR and NLR showed similar predictive performance for poor postoperative prognosis, whereas systemic immune-inflammation index demonstrated limited prognostic value in this cohort. Despite statistical significance, the moderate discriminative ability suggests limited utility for individual risk prediction.

CONCLUSION

Preoperative PLR and NLR are simple and accessible biomarkers associated with poor early postoperative prognosis in elderly cardiac surgery patients, although their predictive performance is moderate. Postoperative indices, particularly at 72 hours, show stronger associations with adverse outcomes. These markers may offer incremental value when integrated into multimodal perioperative risk assessment.