Clinical Value of Neutrophil Lymphocyte Ratio as a Prognostic Biomarker in Congenital Heart Surgery

Background: Congenital heart disease (CHD) is the most common birth defect and a leading cause of infant mortality. The neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation, is emerging as a simple, cost-effective prognostic tool in cardiac surgery. Aim:To assess the prognostic value of preoperative and postoperative NLR in predicting complications and mortality in pediatric CHD surgeries, and compare outcomes between cyanotic and acyanotic patients. Methods:This retrospective cohort study included 50 pediatric CHD patients (1 month–8 years) undergoing surgery at Benha University Hospital and Bahteim Hospital. Patients were divided into cyanotic (n = 10) and acyanotic (n = 40) groups. Preoperative labs, including NLR, were recorded. Postoperative data included complications, ICU/hospital stay, and 30-day mortality. Results: Postoperative NLR was significantly higher in patients with complications in both groups (p = 0.001 acyanotic; p = 0.018 cyanotic). In acyanotic cases, post-NLR correlated with ICU stay (r = 0.489, p = 0.003) and predicted complications (AUC = 1, p = 0.011). In cyanotic patients, post-NLR correlated with longer hospital stay (r = 0.798, p = 0.008), and predicted complications and mortality (AUC = 0.917, p = 0.007). Preoperative NLR had no significant predictive value. Conclusion: Postoperative NLR is a valuable prognostic marker for complications and mortality, especially in cyanotic CHD, and may aid in early risk stratification.