Department of Anaesthesia, Royal Melbourne Hospital, Melbourne, Vic, Australia; Melbourne Medical School, University of Melbourne, Melbourne, Vic, Australia.
Department of Anaesthesia, Royal Melbourne Hospital, Melbourne, Vic, Australia.
Heart Lung Circ. 2020 Jul;29(7):1015-1024. doi: 10.1016/j.hlc.2019.11.021. Epub 2019 Dec 19.
The neutrophil-lymphocyte ratio (NLR) is an emerging inflammatory perioperative biomarker which has been studied to predict the incidence of postoperative atrial fibrillation (POAF) after cardiac surgery. This systematic review and meta-analysis aimed to evaluate the prognostic accuracy of elevated perioperative NLR in predicting POAF after cardiac surgery.
Multiple databases were searched from inception to May 2019 for prognostic studies on perioperative NLR and POAF following cardiac surgery. Maximally adjusted odds ratios (OR) with associated confidence intervals were obtained from each included study and pooled using random effects inverse variance modelling for preoperative NLR measurements, while standardised mean differences were pooled for postoperative NLR values. The significance of inter- and intra-study heterogeneity was explored using meta-regression.
1,799 unique studies satisfied selection criteria, from which 12 studies incorporating 9,262 participants were included. Elevated preoperative NLR significantly predicted POAF, with a pooled OR of 1.42 (95% CI 1.16-1.72). Multiple predefined covariates contributed to inter-study heterogeneity; however, only prevalence of hypertension (p=0.0055), history of congestive cardiac failure (p=0.0282) and average ejection fraction (p=0.0359) were significant effect modifiers. Elevated postoperative NLR was not a significant predictor of POAF (standardised mean difference 1.60 [95% CI -0.56-3.77] between POAF+ and POAF- groups).
Elevated preoperative NLR is a promising prognostic biomarker for POAF, but residual sources of heterogeneity remain. Larger scale validation studies are required to justify the integration of preoperative NLR testing into routine clinical practice.
中性粒细胞与淋巴细胞比值（NLR）是一种新兴的炎症性围手术期生物标志物，已被研究用于预测心脏手术后的术后心房颤动（POAF）发生率。本系统评价和荟萃分析旨在评估围手术期 NLR 升高预测心脏手术后 POAF 的预后准确性。
从建库到 2019 年 5 月，我们对心脏手术后 NLR 和 POAF 的围手术期预后研究进行了多数据库检索。从纳入的每项研究中获得了最大调整后的比值比（OR）及其置信区间，并使用随机效应逆方差模型对术前 NLR 测量值进行了汇总，而术后 NLR 值则使用标准化均数差进行了汇总。使用 meta 回归探索了研究内和研究间的异质性。
共有 1,799 项独特的研究符合入选标准，其中包括 12 项研究共纳入 9,262 名患者。术前 NLR 升高显著预测 POAF，汇总 OR 为 1.42（95%CI 1.16-1.72）。多个预先定义的协变量导致了研究间的异质性；然而，只有高血压的患病率（p=0.0055）、充血性心力衰竭史（p=0.0282）和平均射血分数（p=0.0359）是显著的效应修饰因素。术后 NLR 升高不是 POAF 的显著预测因子（POAF+和 POAF-组之间的标准化均数差为 1.60[95%CI -0.56-3.77]）。
术前 NLR 升高是 POAF 的一个有前途的预后生物标志物，但仍存在残留的异质性来源。需要更大规模的验证研究来证明术前 NLR 检测纳入常规临床实践的合理性。
