ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Pediatric Cardiology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1489242
This article is part of the Research TopicSurgical and Non-Surgical Intervention of Congenital Heart Disease Management in Developing and Developed CountriesView all 13 articles
Prognostic Value of Neutrophil-Lymphocyte Ratio, Absolute Lymphocyte Count, and Thrombocyte-Lymphocyte Ratio in Predicting the Outcomes of Tetralogy of Fallot Primary Repair
Provisionally accepted
- 1National Cardiovascular Center Harapan Kita (Indonesia), Jakarta, Jakarta, Indonesia
- 2Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
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Tetralogy of Fallot (ToF) is a chronic hypoxic condition that increases the risk of inflammatory responses during surgery. However, many inflammatory biomarkers used to predict surgical outcomes are costly and not widely accessible. This single-center, retrospective observational study aimed to compare the prognostic value of neutrophil-lymphocyte ratio (NLR), absolute lymphocyte count (ALC), and thrombocyte-lymphocyte ratio (TLR) in predicting outcomes of ToF primary repair. Between January 2020 and December 2022, 501 patients underwent ToF primary repair. Our findings revealed low postoperative reoperation (6.5%) and 30-day mortality (4.7%) rates, but prolonged LOS (92.2%) and a high complication rate (84%), with grade IVa (27.9%) and grade I (26.4%) complications being the most common. Elevated NLR (r=0.132, p=0.014), female gender (r=0.117, p=0.027), associated diagnoses (r=0.104, p=0.047), and prolonged surgical duration (r=0.176, p=0.001) were linked to higher complication burdens, though the correlations were weak. Among the three indexes, preoperative NLR demonstrated the strongest predictive value for complications, despite its low sensitivity and specificity. Given its accessibility and cost-effectiveness, NLR may serve as a useful tool for identifying high-risk patients and improving postoperative monitoring. Future multicenter prospective studies are necessary to validate the prognostic value of preoperative NLR under standardized conditions, across a broader patient population, and with more comprehensive confounding variables adjustments, ultimately improving ToF surgical outcomes (Clinical Trial NCT05976204).
Keywords: Absolute lymphocyte count, complications, Mortality, Neutrophil-lymphocyte ratio, Tetralogy of Fallot, thrombocyte-lymphocyte ratio
Received: 31 Aug 2024; Accepted: 22 May 2025.
Copyright: © 2025 Siagian and Christianto. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sisca Natalia Siagian, National Cardiovascular Center Harapan Kita (Indonesia), Jakarta, 11420, Jakarta, Indonesia
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