Predictive Role of Systemic Inflammatory Indices in Surgically Managed Dressler Syndrome Following Cardiac Surgery

Objective: This study aimed to evaluate the prognostic utility of systemic inflammatory markers, such as the Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), Neutrophil-Lymphocyte Ratio (NLR), Monocyte-Lymphocyte Ratio (MLR), and Platelet-Lymphocyte Ratio (PLR), to identify patients at risk of developing surgically treated Dressler syndrome. Methods: A total of 150 patients were retrospectively analyzed. 75 patients who developed Dressler syndrome requiring surgical drainage constituted the Dressler group, whereas 75 age-and surgically matched non-Dressler patients served as the control group. Blood samples were collected at four time points: preoperative (T1), 24 h postoperative (T2), postoperative day 7 (T3), and 24 h before secondary intervention in the Dressler group and the closest matched outpatient follow-up (T4) in the control group. Inflammatory marker values were compared within and between the groups at the four defined time points. Logistic regression and receiver operating characteristic (ROC) analyses were used to determine the diagnostic and predictive accuracy of each marker. Results: Significant increases in SIRI, MLR, and CRP levels were observed in patients who developed DS and required surgical intervention. MLR on postoperative day 7 showed the highest sensitivity (84%) with a cutoff of 0.575, whereas SIRI demonstrated the highest specificity (81.3%) at a cutoff of 3.34. The SII increased significantly only in the late stage, indicating disease progression. The NLR lacked predictive power across all time points. Conclusion: SIRI and MLR are promising early stage biomarkers for identifying patients at a high risk of developing DS. Their integration into routine postoperative follow-up could facilitate earlier diagnosis and reduce surgical burden. A multimarker approach may enhance the diagnostic precision of DS beyond that of traditional inflammatory measures.