The Prognostic Value of Elevated Perioperative Neutrophil-Lymphocyte Ratio in Predicting Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Meta-Analysis

Liu, Zhengyang; Khuong, Jacqueline Nguyen; Caruana, Carla Borg; Jackson, Sarah M.; Campbell, Ryan; Ramson, Dhruvesh M.; Penny-Dimri, Jahan C.; Kluger, Michael; Segal, Reny; Perry, Luke A

doi:10.1016/j.hlc.2019.11.021

Cited by 35 publications

(42 citation statements)

References 42 publications

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“…There is an increasing evidence that local and systemic inflammation are known contributing factors in the pathogenesis of POAF 2,8 . Previous studies had focused on the potential feasibility of the inflammatory markers, such as C‐reactive protein (CRP), interleukins, sCD40L, hematological indices in hemogram as a prognostic biomarkers for POAF after coronary artery bypass grafting (CABG) 9‐13 …”

Section: Introductionmentioning

confidence: 99%

“…2,8 Previous studies had focused on the potential feasibility of the inflammatory markers, such as C-reactive protein (CRP), interleukins, sCD40L, hematological indices in hemogram as a prognostic biomarkers for POAF after coronary artery bypass grafting (CABG). [9][10][11][12][13] The CRP/albumin ratio (CAR) is a new inflammation based marker and it has been established as a prognostic marker in infection, rheumatic disease, malignancy and critical illness. [14][15][16][17] Also, CAR may be useful parameter for predicting coronary artery disease severity.…”

Section: Introductionmentioning

confidence: 99%

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The C‐reactive protein/albumin ratio as a new predictor for postoperative atrial fibrillation after coronary artery bypass graft surgery

et al. 2020

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Background This study aimed to investigate the predictive significance of C‐reactive protein/albumin ratio for postoperative atrial fibrillation occurrence in patients who were underwent coronary artery bypass graft surgery. Methods Among 830 patients who underwent coronary artery bypass grafting with cardiopulmonary bypass between January 2016 and February 2020, 137 patients with no prior arrhythmia history were included in this cross sectional study. Results One hundred and thirty‐seven (16.5%) patients developed atrial fibrillation in postoperative period. Patients who experienced postoperative atrial fibrillation were more likely to be older but displayed similar rates of diabetes mellitus, hypertension, hypercholesterolemia, cerebrovascular disease, peripheral vascular disease and chronic obstructive pulmonary disease. For prediction of postoperative atrial fibrillation development, diagnostic odds ratio (OR) and positive likelihood ratio of C‐reactive protein/albumin ratio value (OR: 1.854; confidence interval [CI]: 1.598‐2.142; P < .001) was higher than serum C‐reactive protein and albumin levels. (OR: 1.159; CI: 1.115‐1.201; P < .001; OR: 0.438; CI: 0.258‐0.865; P < .001, respectively). Which means that C‐reactive protein/albumin ratio may detect postoperative atrial fibrillation development better C‐reactive protein itself. Conclusion Based on our results, patients who developed postoperative atrial fibrillation after coronary artery bypass grafting had significantly higher preoperative C‐reactive protein/albumin ratio levels than patients who remained in normal sinus rhythm in the postoperative period. Also, higher C‐reactive protein/albumin ratio value was one of the independent predictive factors for postoperative atrial fibrillation. Therefore, we concluded that evaluating preoperative C‐reactive protein/albumin ratio value might provide early identification of patients with high risk for postoperative atrial fibrillation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The C‐reactive protein/albumin ratio as a new predictor for postoperative atrial fibrillation after coronary artery bypass graft surgery

et al. 2020

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“…9 A growing body of evidence supports NLR as a prognostic marker for morbidity and mortality following cardiac surgery and percutaneous coronary intervention. [10][11][12] Studies over the last 10 years have since begun to investigate NLR as a prognostic biomarker in vascular surgery. 8 We therefore conducted this systematic review and metaanalysis on the prognostic value of preoperatively measured NLR in predicting mortality and other vascular complications in patients undergoing both open and endovascular surgery in elective and emergent patient contexts.…”

Section: Introductionmentioning

confidence: 99%

“…A growing body of evidence supports NLR as a prognostic marker for morbidity and mortality following cardiac surgery and percutaneous coronary intervention. 10 -12 Studies over the last 10 years have since begun to investigate NLR as a prognostic biomarker in vascular surgery. 8…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Preoperative Neutrophil-Lymphocyte Ratio in Vascular Surgery: Systematic Review and Meta-Analysis

Jackson

Perry

Borg

et al. 2020

Vasc Endovascular Surg

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Objective: The global burden of surgical vascular disease is increasing and with it, the need for cost-effective, accessible prognostic biomarkers to aid optimization of peri-operative outcomes. The neutrophil-lymphocyte ratio (NLR) is emerging as a potential candidate biomarker for perioperative risk stratification. We therefore performed this systematic review and meta-analysis on the prognostic value of elevated preoperative NLR in vascular surgery. Methods: We searched Embase (Ovid), Medline (Ovid), and the Cochrane Library database from inception to June 2019. Screening was performed, and included all peer-reviewed original research studies reporting preoperative NLR in adult emergent and elective vascular surgical patients. Studies were assessed for bias and quality of evidence using a standardized tool. Meta-analysis was performed by general linear (mixed-effects) modelling where possible, and otherwise a narrative review was conducted. Between-study heterogeneity was estimated using the Chi-squared statistic and explored qualitatively. Results: Fourteen studies involving 5,652 patients were included. The overall methodological quality was good. Elevated preoperative NLR was associated with increased risk of long-term mortality (HR 1.40 [95%CI: 1.13-1.74], Chi-squared 60.3%, 7 studies, 3,637 people) and short-term mortality (OR: 3.08; 95%CI: 1.91-4.95), Chi-squared 66.59%, 4 studies, 945 people). Outcome measures used by fewer studies such as graft patency and amputation free survival were assessed via narrative review. Conclusions: NLR is a promising, readily obtainable, prognostic biomarker for mortality outcomes following vascular surgery. Heterogeneity in patient factors, severity of vascular disease, and type of vascular surgery performed renders direct comparison of outcomes from the current literature challenging. This systematic review supports further investigation for NLR measurement in pre-vascular surgical risk stratification. In particular, the establishment of a universally accepted NLR cut-off value is of importance in real-world implementation of this biomarker.

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“…and related surgeries. For example, for cardiac surgery patients, the value of the neutrophil-to-lymphocyte ratio (NLR) can serve as a predictor of early and late mortality (5) (6), postoperative acute kidney injury (7), and postoperative atrial brillation (8,9), while the platelet-to-lymphocyte ratio (PLR) has been reported to be a predictor of prognosis in patients with aortic dissection (10).…”

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confidence: 99%

Preoperative Lymphocyte-To-Monocyte Ratio as a Prognostic Predictor of Long-term Mortality Among Cardiac Surgery Patients: A Propensity Score Matching Analysis Based on a 4-year Follow-up Cohort

Zhou¹,

Liang²,

Huang³

et al. 2020

Preprint

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BackgroundCardiac surgery is associated with a specific inflammatory response. The lymphocyte-to-monocyte ratio (LMR) has been shown to be related to the prognosis of many cardiovascular diseases. We aimed to evaluate the prognostic value of the preoperative LMR in patients who underwent cardiac surgery.MethodsClinical data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC)-III database. The optimum cutoff value of the LMR for 4-year mortality was determined by X-tile software. The Cox proportional hazard model was applied for the identification of independent prognostic factors of 4-year mortality. Survival curves were estimated using the Kaplan-Meier method, and receiver operating characteristic (ROC) curves were constructed. The 1:1 propensity score matching (PSM) method was performed to balance the influence of selection bias and potential confounding factors.ResultsA total of 1701 patients were included. The X‐tile software indicated that the optimum cutoff value of the LMR for 4-year mortality was 3.58. After PSM, 489 pairs of score-matched patients were generated. The Cox proportional hazard model showed that patients with an LMR < 3.58 had a significantly higher 4-year mortality than patients with an LMR ≥ 3.58 in the entire cohort (HR = 1.925, 95%CI: 1.509-2.456, p < 0.001) and the PSM subset (HR = 1.568, 95%CI: 1.2-2.05, p = 0.001). The Kaplan-Meier survival curves showed that patients with an LMR < 3.58 had a significantly lower 4-year survival rate in the entire cohort (71.7% vs. 88.5%, P < 0.001) and the PSM subset (73.2% vs. 81.4%, P = 0.002).ConclusionsA lower LMR (< 3.58) was associated with a higher risk of 4-year mortality and can potentially predict the long-term mortality of cardiac surgery patients.

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The Prognostic Value of Elevated Perioperative Neutrophil-Lymphocyte Ratio in Predicting Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Meta-Analysis

Cited by 35 publications

References 42 publications

The C‐reactive protein/albumin ratio as a new predictor for postoperative atrial fibrillation after coronary artery bypass graft surgery

The C‐reactive protein/albumin ratio as a new predictor for postoperative atrial fibrillation after coronary artery bypass graft surgery

Prognostic Significance of Preoperative Neutrophil-Lymphocyte Ratio in Vascular Surgery: Systematic Review and Meta-Analysis

Preoperative Lymphocyte-To-Monocyte Ratio as a Prognostic Predictor of Long-term Mortality Among Cardiac Surgery Patients: A Propensity Score Matching Analysis Based on a 4-year Follow-up Cohort

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