{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:38:54Z","timestamp":1790887134520,"version":"4.1.0"},"reference-count":37,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T00:00:00Z","timestamp":1749600000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>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\u2013Lymphocyte Ratio (NLR), Monocyte\u2013Lymphocyte Ratio (MLR), and Platelet\u2013Lymphocyte Ratio (PLR), to identify patients at risk of developing surgically treated postpericardiotomy syndrome (PPS). Methods: A total of 150 patients were retrospectively analyzed. In total, 75 patients who developed postpericardiotomy syndrome requiring surgical drainage constituted the postpericardiotomy group, whereas 75 age- and surgically matched non-PPS patients served as the control group. Blood samples were collected at four time points: preoperative (T1), 24 h postoperative (T2), 7 days postoperative (T3), and 24 h before secondary intervention in the PPS 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 the SIRI, MLR, and CRP levels were observed in patients who developed PPS and required surgical intervention. MLR on postoperative day 7 had the highest sensitivity (84%) with a cut-off of 0.575, whereas SIRI demonstrated the highest specificity (81.3%) at a cut-off of 3.34. SII increased significantly only in the late stage, indicating disease progression. The NLR lacked predictive power across all time points. Conclusions: The SIRI and MLR are promising early-stage biomarkers for identifying patients at high risk of developing PPS. Their integration into routine postoperative follow-up could facilitate earlier diagnosis and reduce surgical burden. A multi-marker approach may enhance the diagnostic precision of PPS beyond that of traditional inflammatory measures.<\/jats:p>","DOI":"10.3390\/diagnostics15121488","type":"journal-article","created":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T11:18:40Z","timestamp":1749640720000},"page":"1488","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Predictive Role of Systemic Inflammatory Indices in Surgically Managed Postpericardiotomy Syndrome Following Cardiac Surgery"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9182-0690","authenticated-orcid":false,"given":"Murat","family":"Y\u00fccel","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2758-7644","authenticated-orcid":false,"given":"Emrah","family":"U\u011fuz","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t University, Ankara 06010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0744-0001","authenticated-orcid":false,"given":"Muhammet Fethi","family":"Sa\u011flam","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t University, Ankara 06010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kemal E\u015fref","family":"Erdo\u011fan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t University, Ankara 06010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mete","family":"H\u0131d\u0131ro\u011flu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Faculty of Medicine, Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t University, Ankara 06010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8575-2555","authenticated-orcid":false,"given":"Altay","family":"Alili","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u015eeref Alp","family":"K\u00fc\u00e7\u00fcker","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,11]]},"reference":[{"key":"ref_1","first-page":"589","article-title":"Considerations in Dressler Syndrome: A Comprehensive Review","volume":"4","author":"Ynostroza","year":"2024","journal-title":"Int. J. Med. Sci. Clin. Res. Stud."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1161\/01.CIR.6.3.321","article-title":"Results of the surgical treatment for mitral stenosis; analysis of one hundred consecutive cases","volume":"6","author":"Janton","year":"1952","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1161\/01.CIR.8.4.481","article-title":"Reactivation of rheumatic fever following mitral commissurotomy","volume":"8","author":"Soloff","year":"1953","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1080\/07853890.2020.1758339","article-title":"Postpericardiotomy syndrome after cardiac surgery","volume":"52","author":"Lehto","year":"2020","journal-title":"Ann. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1097\/MCP.0b013e32835311a2","article-title":"The post-pericardiotomy syndrome","volume":"18","author":"Imazio","year":"2012","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Honorato, P.F., De Lacerda, D.A., De Oliveira, A.V.L., Cunha, M.E.B., Santana, Y.T., Da Silva, B.V.P., De Maria, G.C., Montenegro, A.K.T., De Meneses Costa, M., and Lima, J.V.G. (2024, January 27). Post-myocardial infarction pericarditis: Dressler syndrome and its clinical implications. Proceedings of the III Seven International Medical and Nursing Congress, Online.","DOI":"10.56238\/IIICongressMedicalNursing-016"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2749","DOI":"10.1093\/eurheartj\/ehq319","article-title":"COlchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS): A multicentre, randomized, double-blind, placebo-controlled trial","volume":"31","author":"Imazio","year":"2010","journal-title":"Eur. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/0167-5273(83)90194-8","article-title":"Clinical features and long-term natural history of the postpericardiotomy syndrome","volume":"4","author":"Nishimura","year":"1983","journal-title":"Int. J. Cardiol."},{"key":"ref_9","first-page":"226","article-title":"The Postpericardiotomy Syndrome","volume":"5","author":"McGuinness","year":"1963","journal-title":"J. Occup. Environ. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e227772","DOI":"10.1136\/bcr-2018-227772","article-title":"Dressler\u2019s syndrome: Are we underdiagnosing what we think to be rare?","volume":"12","author":"Campos","year":"2019","journal-title":"BMJ Case Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1111\/eci.12764","article-title":"Determinants of the postpericardiotomy syndrome: A systematic review","volume":"47","author":"Nathoe","year":"2017","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Lai, R., and Xu, T. (2025). Update for diagnosis and treatment of syndrome after cardiac injury: A mini-review. Front. Cardiovasc. Med., 12.","DOI":"10.3389\/fcvm.2025.1526671"},{"key":"ref_13","first-page":"100068","article-title":"Post-cardiac injury syndrome: An evidence-based approach to diagnosis and treatment","volume":"12","author":"Malik","year":"2021","journal-title":"Am. Heart J. Plus"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2921","DOI":"10.1093\/eurheartj\/ehv318","article-title":"2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS)","volume":"36","author":"Adler","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.1161\/01.CIR.87.5.1738","article-title":"Cardiac tamponade. A clinical or an echocardiographic diagnosis?","volume":"87","author":"Fowler","year":"1993","journal-title":"Circulation"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1016\/j.jtcvs.2019.12.114","article-title":"Adverse events and survival with postpericardiotomy syndrome after surgical aortic valve replacement","volume":"160","author":"Lehto","year":"2020","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/0002-8703(88)90457-7","article-title":"The epidemiology of the postpericardiotomy syndrome: A common complication of cardiac surgery","volume":"116 Pt1","author":"Miller","year":"1988","journal-title":"Am. Heart J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"28","DOI":"10.3109\/07853890.2015.1122223","article-title":"Occurrence of postpericardiotomy syndrome admissions: A population-based registry study","volume":"48","author":"Lehto","year":"2016","journal-title":"Ann. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1186\/2042-6410-2-1","article-title":"Sex differences in autoimmune diseases","volume":"2","author":"Voskuhl","year":"2011","journal-title":"Biol. Sex. Differ."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/S0197-1859(82)80039-3","article-title":"Humoral immunity and heart disease: Postpericardiotomy syndrome","volume":"3","year":"1982","journal-title":"Clin. Immunol. Newsl."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"19","DOI":"10.21776\/ub.hsj.2024.005.03.4","article-title":"Inflammatory Cascade Unveiled: Exploring Complications and Therapeutic Strategies for Post-Myocardial Infarction Inflammation (A Literature Review)","volume":"5","author":"Bahar","year":"2024","journal-title":"Heart Sci. J."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ye, J.-J., Hu, X., Wang, Z., Li, R., Gan, L., Zhang, M., and Wang, T. (2023). The role of mtDAMPs in the trauma-induced systemic inflammatory response syndrome. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1164187"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.cellimm.2015.02.002","article-title":"Sex, the aging immune system, and chronic disease","volume":"294","year":"2015","journal-title":"Cell Immunol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1016\/j.jtcvs.2015.01.031","article-title":"Incidence and risk factors of postpericardiotomy syndrome requiring medical attention: The Finland postpericardiotomy syndrome study","volume":"149","author":"Lehto","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e010269","DOI":"10.1161\/JAHA.118.010269","article-title":"Occurrence of Postpericardiotomy Syndrome: Association With Operation Type and Postoperative Mortality After Open-Heart Operations","volume":"7","author":"Lehto","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_26","first-page":"423","article-title":"Association of anti-heart antibodies and circulating immune complexes in the post-pericardiotomy syndrome","volume":"57","author":"Wulfrank","year":"1984","journal-title":"Clin. Exp. Immunol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1007\/BF00796322","article-title":"Relationship between the degree of injury at operation and the change in antimyosin antibody titer in the postpericardiotomy syndrome","volume":"15","author":"Nomura","year":"1994","journal-title":"Pediatr. Cardiol."},{"key":"ref_28","first-page":"57","article-title":"Postpericardiotomy syndrome incidence, diagnostic and treatment strategies: Experience AT two collaborative centers","volume":"58","author":"Gabaldo","year":"2019","journal-title":"Acta Clin. Croat."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1053\/j.jvca.2008.08.004","article-title":"Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery","volume":"22","author":"Salis","year":"2008","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1016\/j.amjcard.2011.06.025","article-title":"Contemporary features, risk factors, and prognosis of the post-pericardiotomy syndrome","volume":"108","author":"Imazio","year":"2011","journal-title":"Am. J. Cardiol."},{"key":"ref_31","first-page":"320","article-title":"Aortic cross-clamp duration in cardiopulmonary bypass-oxidative stress relationship","volume":"8","author":"Onuk","year":"2019","journal-title":"Med. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/s11936-996-0009-7","article-title":"Post-myocardial infarction pericarditis","volume":"2","author":"Indik","year":"2000","journal-title":"Curr. Treat. Options Cardiovasc. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"131","DOI":"10.2147\/JIR.S283835","article-title":"The Associations of Two Novel Inflammation Indexes, SII and SIRI with the Risks for Cardiovascular Diseases and All-Cause Mortality: A Ten-Year Follow-Up Study in 85,154 Individuals","volume":"14","author":"Jin","year":"2021","journal-title":"J. Inflamm. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1007\/s10654-021-00752-6","article-title":"Systemic inflammation markers and cancer incidence in the UK Biobank","volume":"36","author":"Alcala","year":"2021","journal-title":"Eur. J. Epidemiol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Liu, Z., Li, Y., Wang, Y., Zhang, H., Lian, Y., and Cheng, X. (2022). The Neutrophil-to-Lymphocyte and Monocyte-to-Lymphocyte Ratios Are Independently Associated With the Severity of Autoimmune Encephalitis. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.911779"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Buonacera, A., Stancanelli, B., Colaci, M., and Malatino, L. (2022). Neutrophil to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23073636"},{"key":"ref_37","first-page":"279","article-title":"Behavior of inflammatory markers of myocardial injury in cardiac surgery: Laboratory correlation with the clinical picture of postpericardiotomy syndrome","volume":"81","author":"Saraiva","year":"2003","journal-title":"Arq. Bras. Cardiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/12\/1488\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:50:09Z","timestamp":1760032209000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/12\/1488"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,11]]},"references-count":37,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["diagnostics15121488"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15121488","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,11]]}}}