The role of the modified Glasgow prognostic score in predicting postoperative mortality following open-heart surgery

The Modified Glasgow Prognostic Score is an inflammation-based index utilizing C-reactive protein and albumin levels. It has been investigated in various diseases such as cancer, heart failure, and myocardial infarction. Open heart surgery, particularly with cardiopulmonary bypass, induces an acute-phase inflammatory response that is associated with postoperative complications and mortality. This study aimed to evaluate the prognostic value of preoperative and early postoperative Modified Glasgow Prognostic Score in predicting early outcomes in patients undergoing open heart surgery, with the goal of improving patient stratification and surgical decision-making. A retrospective review of medical records was conducted for 456 patients who underwent open heart surgery between January 1, 2022, and October 1, 2024. All procedures were elective cases. Patients undergoing emergency operations, including those with acute type A aortic dissection, were excluded from the study. Data were collected on demographics, laboratory results, procedure duration, ejection fraction, and presence of multi-vessel disease. All patients included in the study underwent open heart surgery with the use of cardiopulmonary bypass (CPB). Patients who underwent off-pump coronary artery bypass grafting (OPCAB) or other procedures not requiring CPB were excluded. Both preoperative and postoperative Modified Glasgow Prognostic Score were analyzed to assess their association with early postoperative outcomes. Preoperative mGPS was found to be significantly associated with early mortality (p < 0.05). A one-unit increase in Modified Glasgow Prognostic Score was associated with a 2.85-fold increase in mortality risk (95% CI: 1.85–4.41). However, no significant relationship was observed between postoperative Modified Glasgow Prognostic Score and mortality (p > 0.05). Preoperative Modified Glasgow Prognostic Score serves as a valuable prognostic marker for early mortality in open heart surgery patients. It provides independent predictive value and can enhance preoperative risk assessment, ultimately improving patient outcomes and guiding surgical management. • a. What is known about the topic? The modified Glasgow Prognostic Score (mGPS) is widely recognized as an inflammation-based prognostic scoring system, primarily used in cancer patients. It combines CRP and serum albumin levels to predict clinical outcomes, particularly in assessing systemic inflammation and its role in disease prognosis. Cardiopulmonary Bypass (CPB) used during open-heart surgeries is known to trigger a systemic inflammatory response, which can lead to postoperative complications and increased mortality. While mGPS has been validated in various settings, its utility in predicting postoperative mortality in cardiac surgery patients, especially those undergoing CPB, has not been extensively studied. • b. What does this study add? This study provides evidence that preoperative mGPS is significantly associated with early mortality in adult patients undergoing open-heart surgery with CPB. It suggests that mGPS can serve as a valuable preoperative screening tool for identifying patients at higher risk of mortality. Additionally, this study highlights mGPS as an independent predictor of poor clinical outcomes in the short term, emphasizing its potential role in risk assessment and the management of postoperative complications in cardiac surgery. The findings underscore the need for larger, multi-center studies to validate mGPS as a practical tool in the clinical management of cardiac surgery patients.