Predictive Value of Postoperative Neutrophil-Lymphocyte Ratio for Major Adverse Cardiac Events Following Off-Pump CABG with Preoperative Dexamethasone: A Retrospective Analysis from a Randomized Controlled Trial
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Abstract
Introduction:The neutrophil-lymphocyte ratio (NLR) is a known predictor of major adverse cardiac events (MACE) after coronary artery bypass grafting (CABG). However, its prognostic value in patients receiving preoperative dexamethasone remains uncertain. This study aimed to determine the optimal cut-off value of 24-hour postoperative NLR for predicting MACE in off-pump CABG (OPCAB) patients who received preoperative dexamethasone. Methods: This study is a single-center retrospective secondary analysis of data derived from a previously conducted randomized controlled trial (RCT). For this current observational study, a specific cohort of 60 OPCAB patients was retrospectively selected from the parent RCT, focusing on those who had received preoperative dexamethasone. This cohort comprised 12 patients who developed MACE and 48 who did not. The primary outcome for this analysis was the occurrence of MACE postoperatively, and the NLR was measured within the first 24 hours after surgery. Results: Patients who developed MACE had significantly higher postoperative NLRs. Receiver operating characteristic analysis showed an area under the curve (AUC) of 72.9%. A cut-off value of 16.24 for NLR provided a sensitivity of 91.7%, specificity of 58%, positive predictive value of 35.5%, negative predictive value of 96.9%, and a risk ratio of 10.29 (95% CI: 1.42–74.79). No significant adverse effects related to dexamethasone were noted. Conclusion: An NLR cut-off of 16.24 may serve as a reliable early predictor of MACE in OPCAB patients receiving preoperative dexamethasone, indicating that NLR retains prognostic value even with anti-inflammatory premedication.
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