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Based on the ultrasensitive C-reactive protein (us-CRP) behavior, Abrantes et al.[1] analyzed the inflammation resulting from myocardial revascularization techniques with (on-pump coronary artery bypass grafting ONCAB) and without (off-pump coronary artery bypass grafting OPCAB) cardiopulmonary bypass. The authors concluded that there was an increase in us-CRP in the postoperative period compared to the preoperative period. This increase occurred in all moments assessed postoperatively. There was no difference in the us-CRP behavior between the two myocardial revascularization techniques[1]. Despite the unexpected result in differentiating the two coronary artery bypass grafting techniques, the importance of the inflammatory reaction triggered by cardiopulmonar bypass is always a contradictory subject. One has the impression that the issue is overestimated, considering the incidence of systemic inflammatory response syndrome (SIRS) in the milieu of cardiac surgery[2]. The search for biomarkers of inflammation is a constant concern, especially considering the cost-benefit ratio. In this regard, cytokine dosage is not justified in clinical and surgical practice. In the search for markers of the inflammatory reaction, the chemiluminescence dosage of the stable nitric oxide (nitrite and nitrate-NOx) products, although low cost, was not relevant[3]. Still taking into account the nitric oxide release pathway, the determination of cyclic guanosine monophosphate (cGMP) could be more sensitive, but the methodology is expensive and difficult to apply in the operating room. Thus, the tendency to search for an inexpensive and easy-to-use biomarker is observed, increasing interest in “old biomarkers” such as C-reactive protein, neutrophilto-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). This trend may be noted in recent publications in the Brazilian Journal of Cardiovascular Surgery (BJCVS)[4]. NLR is a new addition to the long list of these inflammatory markers. NLR, which is calculated from complete blood count with EDITORIAL

Inflammatory Biomarkers in Cardiac Surgery and the Suggestion of an Editors’ Heart Team