Predictors of post-operative cardiovascular complications for Behçet's disease with pre-operative immunosuppressive therapy.

Objectives: Patients with Behçet's disease (BD) with cardiovascular involvement often have more post-operative complications in correcting the pathology by surgical means. This study aims to explore the benefits of pre-operative immunosuppressive therapy, predict complications using inflammatory biomarkers, and evaluate optimal surgery timing.

Methods: This retrospective study analysed predictors of post-operative complications in BD patients who underwent cardiovascular surgery with perioperative immunosuppressive therapy at Guangdong Provincial People's Hospital from 2012 to 2024.

Results: In-hospital complications were lower in patients who received pre-operative immunosuppressive therapy (9% vs. 58.8%, p<0.001). Rheumatoid factor (RF, hazard ratio [HR] 1.088; 95% confidence interval [CI], 0.998-1.187; p=0.056), platelet-to-lymphocyte ratio (PLR, HR 1.004; 95% CI, 1.000-1.008; p=0.075), and neutrophil-to-lymphocyte ratio (NLR, HR 1.065; 95% CI, 1.002-1.133; p=0.045) were identified as independent risk factors for post-operative complications, while pre-operative immunosuppressive therapy (HR 0.206; 95% CI, 0.061-0.693; p=0.011) was a protective factor. The area under the curve (AUC) for the receiver operating characteristic curve for four or more positive biomarkers was 0.849.

Conclusions: Pre-operative immunosuppressive therapy is vital for BD patients. Monitoring inflammatory biomarkers helps identify the best timing for surgery and reduces complications.