Prediction of postoperative atrial fibrillation with the systemic immune-inflammation index in patients undergoing cardiac surgery using cardiopulmonary bypass: a retrospective, single-center study

Hinoue, Takuya; Yatabe, Tomoaki; Nishida, Osamu

doi:10.1007/s10047-022-01338-z

Cited by 9 publications

(18 citation statements)

References 23 publications

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“…The majority of study participants were male, comprising 35.2%–78.4% of patients. Six studies enrolled patients undergoing CABG ( 14 , 20 , 21 , 29 – 31 ), whereas one study also included those undergoing other cardiac surgical procedures, including valve replacements ( 22 ). Another study only enrolled patients undergoing mitral valve surgery ( 19 ).…”

Section: Resultsmentioning

confidence: 99%

“…Higher SII levels indicate greater systemic inflammation and immune activation. Emerging studies have reported associations between elevated preoperative SII levels and increased POAF risk following cardiac surgery ( 14 , 19 – 22 ). Proposed mechanisms include the SII representing increased atrial inflammatory infiltrates and fibrosis, which provide the substrate for new-onset POAF, as well as heightened prothrombotic states that precipitate microthromboses and atrial ischemia, thereby contributing to POAF occurrence ( 17 , 18 ) ( 23 – 25 ).…”

Section: Introductionmentioning

confidence: 99%

“…Proposed mechanisms include the SII representing increased atrial inflammatory infiltrates and fibrosis, which provide the substrate for new-onset POAF, as well as heightened prothrombotic states that precipitate microthromboses and atrial ischemia, thereby contributing to POAF occurrence ( 17 , 18 ) ( 23 – 25 ). However, significant between-study heterogeneity exists regarding the predictive efficacy of the SII ( 14 , 19 – 22 ). Therefore, to clarify the utility of the SII as a POAF risk stratification tool among patients undergoing cardiac surgery, additional investigations are needed.…”

Section: Introductionmentioning

confidence: 99%

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Systemic immune–inflammation index for predicting postoperative atrial fibrillation following cardiac surgery: a meta-analysis

Chen,

Liu,

Hsu

et al. 2024

Front. Cardiovasc. Med.

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BackgroundPostoperative atrial fibrillation (POAF) is a frequent complication that may increase morbidity and mortality risk following cardiac surgery. The systemic immune–inflammation index (SII) is an emerging biomarker that provides an integrated measure of inflammation by incorporating neutrophil, lymphocyte, and platelet counts. Recent studies have reported associations between elevated SII and increased POAF risk; however, significant heterogeneity exists regarding its predictive efficacy. This meta-analysis aimed to assess SII's diagnostic efficacy for predicting POAF risk.MethodsTo synthesize existing evidence on the ability of perioperative SII for predicting POAF in patients undergoing cardiac surgery, a systematic review and meta-analysis was conducted. In August 2023, a comprehensive literature search was performed to identify relevant studies reporting SII cutoff values with corresponding sensitivity and specificity. The primary aim was to evaluate SII's diagnostic utility for predicting POAF, whereas secondary outcomes included the pooled incidence of POAF and the relationship between the SII and POAF.ResultsEight studies published between 2021 and 2023 with 3,245 patients were included. Six studies involved coronary artery bypass grafting (CABG) surgery; one encompassed various cardiac procedures, and another focused solely on mitral valve surgery. The pooled incidence of POAF was 23.6% [95% confidence interval (CI), 18.7%–29.2%]. Elevated SII significantly increased the odds of POAF by 3.24-fold (odds ratio, 3.24; 95% CI, 1.6–6.55; p = 0.001). SII's pooled sensitivity and specificity for predicting POAF were 0.80 (95% CI, 0.68–0.89) and 0.53 (95% CI, 0.23–0.8), respectively. The SII had moderate predictive accuracy based on a hierarchical summary receiver operating characteristic (HSROC) area under the curve of 0.78 (95% CI, 0.74–0.81). Subgroup analyses, whether focusing on CABG alone or CABG with cardiopulmonary bypass (CPB), both indicated an area under the HSROC curve of 0.78 (95% CI, 0.74–0.81).ConclusionElevated SII is significantly correlated with an increased POAF risk following cardiac surgery, highlighting its utility as a predictive biomarker. Considering its moderate diagnostic accuracy, further research is essential for clarifying SII's clinical effectiveness, either as an independent predictor or combined with other risk factors, for stratifying patients at high POAF risk.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier [CRD42023456128].

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Systemic immune–inflammation index for predicting postoperative atrial fibrillation following cardiac surgery: a meta-analysis

Chen,

Liu,

Hsu

et al. 2024

Front. Cardiovasc. Med.

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“…In diabetic patients referred for off-pump surgical revascularization, the postoperative values of SII >952 × 10 3 /mm 3 (SII >952 (HR: 3.44, 95% CI: 1.02-11.66, p = 0.047; AUC: 0.698) were regarded as worse long-term prognostic factors [65]. Systemic index >545 × 10 3 /mm 3 was proposed as postoperative atrial fibrillation risk factor (OR: 10.2; 95% CI: 5.1-20.2, p < 0.001; AUC: 0.91) in on pump surgical revascularization by Honue et al [123]. Dogdus et al [100] in their analysis presented SII value >935 × 10 3 /mL as a better saphenous vein graft predictor than NLR (OR: 3.27, 95% CI: 1.94-5.65, p < 0.001).…”

Section: Systemic Immune Inflammatory Index (Sii)mentioning

confidence: 99%

The Significance of Simple Inflammatory Markers in Off Pump Surgery—Review

Urbanowicz¹,

Olasińska-Wiśniewska²,

Gładki³

et al. 2022

Rev. Cardiovasc. Med.

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The inflammatory background of coronary artery disease is gaining more attention in recent times. Off pump surgery is minimally invasive type of surgical revascularization with relatively low number of applications in cardiac surgery centers worldwide that allows for perioperative inflammatory reactions minimalization. The simple inflammatory markers (neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelets to lymphocyte ratio (PLR), systemic inflammatory index (SII), systemic inflammatory response index (SIRI), aggregate index of systemic inflammation (AISI)) possess a clinically significant impact on patients' prognosis and may help to improve patients' long-term results. The review presents the current knowledge regarding their utility in clinical practice. Assessment of inflammatory indices obtained from whole blood count analysis allows to indicate those patients who need scrupulous follow-up due to predicted worse long-term survival. Perioperative measurement and analysis of simple whole blood counts is inexpensive and easily available and may improve the results of surgical revascularization by better identification of patients at higher risk of worse outcomes.

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“…During surgery, the contact of circulating ex vivo blood with non-physiological surfaces additionally exacerbates the degree of inflammation, which might be highly vulnerable for high-risk group comorbid CAD patients with renal failure and diabetes [ 29 , 30 ]. CAD patients who underwent on-pump bypass surgery exhibited increased systemic levels of (i) circulating neutrophils, (ii) neutrophil elastase [ 31 ], (iii) complement components (C3a and C5a) [ 32 ], (iv) platelet activating factors [ 33 ], (v) C-reactive protein (CRP) (an acute phase reactant), (vi) pro-inflammatory cytokines, TNF-α, IL-6, IL-8 [ 34 ], (vii) adhesion molecules (E-selectin, P-selectin, ICAM-1) [ 35 ], and cardiac troponin I [ 36 , 37 , 38 ]. These findings demand a better understanding of complex CAD pathogenesis for further interventional aspects during perioperative and/or postoperative cardiac bypass surgery.…”

Section: Introductionmentioning

confidence: 99%

Immunophenotyping of Monocyte Migration Markers and Therapeutic Effects of Selenium on IL-6 and IL-1β Cytokine Axes of Blood Mononuclear Cells in Preoperative and Postoperative Coronary Artery Disease Patients

Wacker

Ball

Beer

et al. 2023

IJMS

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Multivessel coronary artery disease (CAD) is characterized by underlying chronic vascular inflammation and occlusion in the coronary arteries, where these patients undergo coronary artery bypass grafting (CABG). Since post-cardiotomy inflammation is a well known phenomenon after CABG, attenuation of this inflammation is required to reduce perioperative morbidity and mortality. In this study, we aimed to phenotype circulating frequencies and intensities of monocyte subsets and monocyte migration markers, respectively, and to investigate the plasma level of inflammatory cytokines and chemokines between preoperative and postoperative CAD patients and later, to intervene the inflammation with sodium selenite. We found a higher amplitude of inflammation, postoperatively, in terms of CCR1high monocytes and significantly increased pro-inflammatory cytokines, IL-6, IL-8, and IL-1RA. Further, in vitro intervention with selenium displayed mitigating effects on the IL-6/STAT-3 axis of mononuclear cells derived from postoperative CAD patients. In addition, in vitro selenium intervention significantly reduced IL-1β production as well as decreased cleaved caspase-1 (p20) activity by preoperative (when stimulated) as well as postoperative CAD mononuclear cells. Though TNF-α exhibited a positive correlation with blood troponin levels in postoperative CAD patients, there was no obvious effect of selenium on the TNF-α/NF-κB axis. In conclusion, anti-inflammatory selenium might be utilized to impede systemic inflammatory cytokine axes to circumvent aggravating atherosclerosis and further damage to the autologous bypass grafts during the post-surgical period.

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Prediction of postoperative atrial fibrillation with the systemic immune-inflammation index in patients undergoing cardiac surgery using cardiopulmonary bypass: a retrospective, single-center study

Cited by 9 publications

References 23 publications

Systemic immune–inflammation index for predicting postoperative atrial fibrillation following cardiac surgery: a meta-analysis

Systemic immune–inflammation index for predicting postoperative atrial fibrillation following cardiac surgery: a meta-analysis

The Significance of Simple Inflammatory Markers in Off Pump Surgery—Review

Immunophenotyping of Monocyte Migration Markers and Therapeutic Effects of Selenium on IL-6 and IL-1β Cytokine Axes of Blood Mononuclear Cells in Preoperative and Postoperative Coronary Artery Disease Patients

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