Monitoring inflammatory biomarkers and their prognostic value in the management of patients undergoing open heart surgery

During open heart surgery, the contact of blood with the artificial surfaces of the cardiopulmonary bypass (CPB) circuit activates both cellular and humoral immune responses, which may lead to a systemic inflammatory response and, in severe cases, multi-organ dysfunction syndrome. This study aimed to monitor perioperative changes in systemic inflammatory parameters—C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammatory index (SII)—to assess their prognostic value concerning organ dysfunction. Furthermore, we investigated the effect of anti-inflammatory treatment on changes in immune cell counts. We conducted a prospective clinical study at the Emergency Cardiovascular Diseases and Transplantation Institute in Târgu Mureș. A total of 64 adult patients undergoing open heart surgery during November 1, 2022, and March 31, 2023, were included in our study. Inflammatory and vital parameters were monitored at predetermined intervals, and a subgroup of patients was randomly assigned to receive a single dose of 0.3 mg/kg Dexamethasone to mitigate CPB-induced inflammation. The study comprised 41 men and 23 women, with a mean age of 65 years, who underwent various open-heart surgical procedures. Preoperative values (NLR = 2.76; PLR = 128.67; summarized by SII = 647.85×10³/μL) following surgery (SII = 2717.99 ×10³/μL) increased significantly (p < 0.01); however, this increase was not associated with the type or duration of the procedure. Complications were notably more severe among patients with elevated NLR values. Among patients who received anti-inflammatory treatment (Dexamethasone), we observed significantly higher SII (3117.98 ± 2288.7 ×10³/μL) and NLR (19.3 ± 10.1) (p < 0.05) values. NLR, PLR, and SII are sensitive indicators of the inflammatory response that are cost-effective and suitable as prognostic markers for clinical practice. These parameters facilitate rapid and efficient assessment and follow-up of patients’ conditions.