The prognostic value of perioperative neutrophil-lymphocyte ratio (NLR) as a predictor of outcomes after pediatric cardiac surgery: A systematic review and meta-analysis.

Abstract

<h4>Background</h4>The neutrophil-lymphocyte ratio (NLR) has been suggested as a valuable indicator of poor outcomes in patients undergoing cardiac surgery. However, its prognostic role in pediatric patients undergoing open-heart surgery is unclear. This study aimed to evaluate the correlation between the perioperative NLR and clinical outcomes after pediatric open-heart surgery under cardiopulmonary bypass (CPB).<h4>Methods</h4>A literature search was conducted from their inception to July 19, 2024 in PubMed Central, ProQuest, Sage, ScienceDirect and Ovid. We included studies that investigated the perioperative value of NLR as a predictor of outcomes after pediatric cardiac surgery under CPB. A meta-analysis was performed according to preferred reporting items for systematic reviews and meta-analyses guidelines. The Newcastle-Ottawa scale was used to assess the study quality, while JAMOVI statistical software was used to perform the meta-analysis.<h4>Results</h4>A total of six studies were included based on our eligibility criteria; however, only four were included for meta-analysis. The results showed a significant correlation between postoperative NLR with hospital (r=0.34 [95% confidence interval [CI] 0.10-0.58]) and intensive care unit (r=0.25 [95% CI 0.04-0.46]) length of stay.<h4>Conclusion</h4>NLR has shown potential as a simple and affordable inflammatory marker in pediatric cardiac surgery under CPB. However, its moderate to weak correlation with clinical outcomes necessitates cautious interpretation. Further research in the form of impact studies is warranted to strengthen these findings.