• Luke A Perry, Zhengyang Liu, Joel Loth, Jahan C Penny-Dimri, Mark Plummer, Reny Segal, and Julian Smith.
• Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Australia. Electronic address: Luke.Perry@mh.org.au.
• J. Cardiothorac. Vasc. Anesth. 2022 May 1; 36 (5): 1296-1303.

ObjectivesNeutrophil-lymphocyte ratio (NLR) is an inflammatory biomarker that has been evaluated across a variety of surgical disciplines and is widely predictive of poor postoperative outcome, but its value in cardiac surgery is unclear. The authors did this systematic review and meta-analysis to determine the impact of elevated perioperative NLR on survival after cardiac surgery.DesignSystematic review and meta-analysis of study-level data.SettingMultiple hospitals involved in an international pool of studies.ParticipantsAdults undergoing cardiac surgery.InterventionsNone.Measurements And Main ResultsThe authors searched multiple databases from inception until November 2020. They generated summary hazard ratios (HR) and odds ratios (OR) for the association of elevated preoperative NLR with long-term and short-term mortality following cardiac surgery. They separately reported on elevated postoperative NLR. Between-study heterogeneity was explored using metaregression. The authors included 12 studies involving 13,262 patients undergoing cardiac surgery. Elevated preoperative NLR was associated with worse long-term (>30 days) (hazard ratio [HR] 1.56; 95% CI [confidence interval], 1.18-2.06; 8 studies) and short-term (<30 days) mortality (OR 3.18; 95% CI, 1.90-5.30; 7 studies). One study reported the association of elevated postoperative NLR with long-term mortality (HR 8.58; 95% CI, 2.55-28.85). There was considerable between-study heterogeneity for the analysis of long-term mortality (I2 statistic 94.39%), which mostly was explained by study-level variables, such as the number of variables adjusted for by included studies and how many of these significantly increased the risk of long-term mortality, high risk of bias, and number of study centers, as well as participant level factors, such as average participant age and hypertension prevalence.ConclusionsPerioperative NLR is an independent predictor of short-term and long-term postoperative mortality following cardiac surgery. Further research is required to determine which patient-level factors modify the prognostic value of NLR and to evaluate its role in routine clinical practice.Copyright © 2021 Elsevier Inc. All rights reserved.

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