Prognostic value of preoperative inflammatory and renal markers (SII, NLR, creatinine) on postoperative hospital stay and clinical outcomes in patients undergoing isolated coronary artery bypass graft surgery: a comprehensive analysis.
Sanrı U & Aslan M • Cardiovascular journal of Africa • 2026
Preoperative serum creatinine and advanced age are strong, independent predictors of prolonged hospital stay after isolated CABG, while NLR and SII are associated with longer stays but serve better as supportive prognostic indicators.
Key Findings
Results
Preoperative serum creatinine was significantly elevated in patients with prolonged hospital stay and was the strongest predictor of extended LOS after isolated CABG.
Serum creatinine was 1.28 ± 0.26 mg/dL in Group 2 (LOS > 7 days) versus 0.98 ± 0.19 mg/dL in Group 1 (LOS ≤ 7 days), p < 0.05
ROC analysis identified creatinine as the strongest predictor with AUC of 0.826 and a cut-off value of > 1.1 mg/dL
In multivariate logistic regression adjusted for CPB time, cross-clamp time, DM, HT, and number of grafts, elevated creatinine remained an independent risk factor (p = 0.042)
Study population: 120 patients undergoing elective isolated CABG at a single centre between January 2023 and December 2025
Results
Advanced age was an independent risk factor for prolonged hospital stay after isolated CABG.
Group 2 patients (LOS > 7 days, n = 32) were significantly older than Group 1 patients (LOS ≤ 7 days, n = 88)
Advanced age remained a strong independent risk factor in the expanded multivariate analysis adjusting for operative and clinical variables (p < 0.001)
Group 2 also had higher rates of male sex, diabetes mellitus, and hypertension compared to Group 1
Results
Preoperative NLR was significantly elevated in the prolonged hospital stay group but did not retain independent statistical significance in multivariate analysis.
NLR was 3.77 ± 1.39 in Group 2 versus 2.92 ± 0.96 in Group 1 (p < 0.05)
ROC analysis showed NLR was the second strongest predictor with AUC of 0.749
NLR did not retain independent statistical significance after adjustment for operative and clinical confounders including CPB time, cross-clamp time, DM, HT, and number of grafts
Authors concluded NLR serves better as a supportive prognostic indicator rather than an independent predictor
Results
Preoperative SII was significantly elevated in the prolonged hospital stay group but did not retain independent statistical significance in multivariate analysis.
SII was 911 ± 410 in Group 2 versus 738 ± 306 in Group 1 (p < 0.05)
Like NLR, SII did not retain independent statistical significance in the expanded multivariate logistic regression analysis
Authors concluded SII serves better as a supportive prognostic indicator in routine preoperative risk stratification
Results
Operative times were significantly longer in patients with prolonged hospital stay.
Group 2 patients (LOS > 7 days) had significantly longer operative times compared to Group 1 (LOS ≤ 7 days)
CPB time and cross-clamp time were included as confounders in the multivariate regression model
The study was a single-centre, retrospective cohort design with 120 patients categorised into Group 1 (n = 88, LOS ≤ 7 days) and Group 2 (n = 32, LOS > 7 days)
What This Means
This research suggests that two simple preoperative measurements — kidney function (measured by serum creatinine) and patient age — can predict which patients will need more than one week to recover in hospital after coronary artery bypass graft (CABG) heart surgery. The study followed 120 patients who had elective CABG surgery and found that those who stayed longer than 7 days in hospital tended to be older, have higher creatinine levels (above 1.1 mg/dL), and have more pre-existing conditions like diabetes and high blood pressure. A creatinine level above 1.1 mg/dL before surgery was particularly useful for identifying high-risk patients.
The study also examined two inflammation-related blood markers — the neutrophil-to-lymphocyte ratio (NLR) and the systemic immune-inflammation index (SII) — which were both elevated in patients with longer hospital stays. However, when other factors like age, kidney function, and surgical time were taken into account together, NLR and SII were no longer independently predictive. This suggests they may provide additional supporting information rather than serving as standalone predictors.
This research matters because identifying patients at risk for prolonged recovery before surgery allows medical teams to better plan care, allocate hospital resources, and potentially intervene early to reduce complications. The findings suggest that routinely available and inexpensive preoperative tests — particularly creatinine and patient age — may be sufficient to flag high-risk CABG patients, while inflammation markers like NLR and SII could complement but not replace these assessments in standard preoperative evaluation.
Sanrı U, Aslan M. (2026). Prognostic value of preoperative inflammatory and renal markers (SII, NLR, creatinine) on postoperative hospital stay and clinical outcomes in patients undergoing isolated coronary artery bypass graft surgery: a comprehensive analysis.. Cardiovascular journal of Africa. https://doi.org/10.5830/CVJA-2026-034