Magoon Rohan, Shri Iti, Kashav Ramesh C, Dey Souvik, Kohli Jasvinder K, Grover Vijay, Gupta Vijay
Department of Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Turk J Anaesthesiol Reanim. 2023 Aug 18;51(4):331-340. doi: 10.4274/TJAR.2023.22995.
New-onset atrial fibrillation (NOAF), an important postoperative complication, has pertinent inflammatory links. Motivated by the encouraging literature on the prognostic role of hypoalbuminemia, leukocytic indices [LIs: neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR)], systemic inflammation response index (SIRI=NLR×monocyte) and platelet-leukocytic indices [PLIs: platelet-to-lymphocyte ratio (PLR)], systemic immune inflammation index (SII=NLR×platelet), aggregate index of systemic inflammation (AISI=NLR×platelet×monocyte), we sought to investigate the NOAF-predictive value of preoperative albumin-adjusted indices (aa-LIs and aa-PLIs) in an off-pump coronary artery bypass grafting (OPCABG) setting.
Of 899 patients, 151 patients (16.79%) developed the primary outcome i.e. NOAF that was analyzed further retrospectively for its predictors instead of the highlighted text perioperative data of 899 patients undergoing elective OPCABG, were retrospectively analyzed. The study participants were categorized into non-NOAF and NOAF groups (defined as new-onset atrial arrhythmia with irregular RR interval with indistinct wave in the first week postoperatively).
One hundred and fifty-one patients (16.79%) developed NOAF. On univariate analysis: age, smoker status, The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, systemic hypertension, diabetes mellitus, prior congestive heart failure (CHF), and a higher preoperative NLR, PLR, SII, and albumin were significant predictors of NOAF. While age, CHF, and EuroSCORE II retained predictive significance in multivariate analysis, LI-PLIs and albumin did not emerge as independent NOAF predictors. Notably, aa-NLR, aa-PLR, and aa-SII independently predicted NOAF on the computation of model-estimates in the regression analysis (Odds ratio; 95% confidence interval: 31.05;15.75-70.61, 1.04;1.02-1.05, 1.12;1.10-1.14, respectively, < 0.001). aa-NLR ≥1.32, aa-PLR ≥52.64, and aa-SII ≥344.38 predicted NOAF with the respective AUC;sensitivity;specificity of 0.66;63.6%;73.3%, 0.63;66.2%;59.0%, and 0.65;58.3%;78.2%. Preoperative aa-NLR, aa-PLR and aa-SII also positively correlated with CHADS-VASc score (R=0.40, 0.45 and 0.42; < 0.001).
The independent NOAF predictive value of aa-NLR, aa-PLR, and aa-SII reiterates the inflammatory relationship of the arrhythmic complication following OPCABG.
新发房颤（NOAF）是一种重要的术后并发症，与炎症存在相关联系。鉴于有关低白蛋白血症、白细胞指数[LIs：中性粒细胞与淋巴细胞比值（NLR）、单核细胞与淋巴细胞比值（MLR）]、全身炎症反应指数（SIRI = NLR×单核细胞）以及血小板 - 白细胞指数[PLIs：血小板与淋巴细胞比值（PLR）]、全身免疫炎症指数（SII = NLR×血小板）、全身炎症聚集指数（AISI = NLR×血小板×单核细胞）的预后作用的文献令人鼓舞，我们试图研究术前白蛋白校正指数（aa - LIs和aa - PLIs）在非体外循环冠状动脉搭桥术（OPCABG）中的NOAF预测价值。
在899例患者中，151例患者（16.79%）出现主要结局即NOAF，对其预测因素进行进一步回顾性分析，而对899例行择期OPCABG患者的围手术期数据进行回顾性分析。研究参与者被分为非NOAF组和NOAF组（定义为术后第一周出现RR间期不规则且波不清晰的新发房性心律失常）。
151例患者（16.79%）发生NOAF。单因素分析显示：年龄、吸烟状态、欧洲心脏手术风险评估系统（EuroSCORE）II、系统性高血压、糖尿病、既往充血性心力衰竭（CHF）以及术前较高的NLR、PLR、SII和白蛋白是NOAF的显著预测因素。虽然年龄、CHF和EuroSCORE II在多因素分析中仍具有预测意义，但LI - PLIs和白蛋白并未成为独立的NOAF预测因素。值得注意的是，在回归分析的模型估计计算中，aa - NLR、aa - PLR和aa - SII独立预测NOAF（比值比；95%置信区间：分别为31.05；15.75 - 70.61、1.04；1.02 - 1.05、1.12；1.10 - 1.14，P < 0.001）。aa - NLR≥1.32、aa - PLR≥52.64和aa - SII≥344.38预测NOAF的曲线下面积（AUC）、敏感性、特异性分别为0.66；63.6%；73.3%、0.63；66.2%；59.0%和0.65；58.3%；78.2%。术前aa - NLR、aa - PLR和aa - SII也与CHADS - VASc评分呈正相关（R = 0.40、0.45和0.42；P < 0.001）。
aa - NLR、aa - PLR和aa - SII对NOAF的独立预测价值再次强调了OPCABG后心律失常并发症与炎症的关系。
