Systemic Immune-Inflammation Index: A Novel Predictor for Risk of Postoperative Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting
Systemic Immune-inflammation Index
DOI:
https://doi.org/10.1532/hsf.4861Keywords:
Coronary artery bypass, postoperative atrial fibrillation, systemic immune-inflammation index, P-wave dispersion, HATCH scoreAbstract
Objective: To investigate the utility of systemic immune-inflammation index (SII) and inflammatory panel in predicting the risk of postoperative atrial fibrillation (PoAF) among patients undergoing elective isolated coronary artery bypass grafting (CABG).
Methods: A total of 116 patients (mean age: 61.9 ± 9.8 years, 78.4% were males) undergoing isolated CABG were included in this retrospective study. Patients were divided into two groups, including those who developed PoAF
(N = 26) and those without PoAF (N = 90). Inflammatory panel was evaluated in both groups.
Results: Patients with PoAF had significantly higher values for P-wave dispersion (PWD; 53.9 ± 5.9 versus 40.2 ± 5.1, P < .001), HATCH score (2.4 ± 1.3 versus 1 ± 1.1,
P < .001), and left atrial dimension (4.0 ± 0.3 versus 3.8 ± 0.2 cm, P = .003). In the multivariate analysis with inclusion of PWD, HATCH score and SII, only SII (OR 1.007, 95% CI 1.002 to 1.012, P = .003) and PWD (OR 1.86, 95% CI 1.225 to 2.757, P = .002) were shown to be independent predictors of increased risk for PoAF.
Conclusion: Preoperative SII seems to be a non-invasive readily available marker that significantly predicts the risk of PoAF in patients undergoing isolated CABG.
References
Achmad C, Tiksnadi BB, Akbar MR, et al. 2021. Left Volume Atrial Index and P-wave Dispersion as Predictors of Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft: A Retrospective Cohort Study. Curr Probl Cardiol. Oct 27:101031.
Adegbala O, Olagoke O, Akintoye E, et al. 2019. Predictors, Burden, and the Impact of Arrhythmia on Patients Admitted for Acute Myocarditis. Am J Cardiol. 123, 139–144.
Aranki SF, Shaw DP, Adams DH, et al. 1996. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation. Aug 1;94(3):390-7.
Ata Y, Abanoz M. 2021. Predictive Roles of Right Coronary Artery Disease Severity and Systemic Immune Inflammation Index in Predicting Atrial Fibrillation After Coronary Bypass Operations in Patients with Right Coronary Artery Disease. Heart Surg Forum. Nov 30;24(6):E977-E982.
Aviles RJ, Martin DO, Apperson-Hansen C, et al. 2003. Inflammation as a risk factor for atrial fibrillation. Circulation. 108, 3006–3010.
Aziz MH, Sideras K, Aziz NA, et al. 2019. The systemic-immune-inflammation index independently predicts survival and recurrence in resectable pancreatic cancer and its prognostic value depends on bilirubin levels: A retrospective multicenter cohort study. Ann. Surg. 270, 139–146.
Bağcı A, Aksoy F. 2021. Systemic immune-inflammation index predicts new-onset atrial fibrillation after ST elevation myocardial infarction. Biomark Med. Jun;15(10):731-739.
Candemir M, Kiziltunc E, Nurkoc S, Şahinarslan A. 2021. Relationship between systemic immune-inflammation index (SII) and the severity of stable coronary artery disease. Angiology. 72, 575–581.
Ceylan O, Bayata S, Yeşil M, Arikan E, Postaci N. 2010. Value of interatrial conduction time and P wave dispersion in the prediction of atrial fibrillation following coronary bypass surgery. Anadolu Kardiyol Derg. Dec;10(6):495-501.
Chandy J, Nakai T, Lee RJ, et al. 2004. Increases in P-wave dispersion predict postoperative atrial fibrillation after coronary artery bypass graft surgery. Anesth Analg. Feb;98(2):303-310.
Chen K, Bai R, Deng W, et al. 2015. HATCH score in the prediction of new-onset atrial fibrillation after catheter ablation of typical atrial flutter. Heart Rhythm. Jul;12(7):1483-9.
De Vos CB, Pisters R, Nieuwlaat R, et al. 2010. Progression from paroxysmal to persistent atrial fibrillation: clinical correlates and prognosis. J AmColl Cardiol. 55: 725–731.
Dey S, Kashav R, Kohli JK, et al. 2021. Systemic immune-Inflammation Index predicts poor outcome after elective off-pump CABG: A retrospective, single-center study. J. Cardiothorac. Vasc. Anesth. 35, 2397–2404.
Dilaveris PE, Gialafos JE. 2001. P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol. Apr;6(2):159-65.
Dogan U, Dogan EA, Tekinalp M, et al. 2012. P-wave dispersion for predicting paroxysmal atrial fibrillation in acute ischemic stroke. Int J Med Sci. 9(1):108-14.
Eikelboom R, Sanjanwala R, Le M, Yamashita MH, Arora RC. 2021. Postoperative atrial fibrillation after cardiac surgery: a systematic review and meta-analysis. Ann Thorac Surg. 111:544-54.
El-Chami MF, Kilgo P, Thourani V, et al. 2010. New-onset atrial fibrillation predicts long-term mortality after coronary artery bypass graft. J Am Coll Cardiol. 55(13): 1370-6.
Emren V, Aldemir M, Duygu H, et al. 2016. Usefulness of HATCH score as a predictor of atrial fibrillation after coronary artery bypass graft. Kardiol Pol. 74(8):749-753.
Engin M, Aydın C. 2021. Investigation of the Effect of HATCH Score and Coronary Artery Disease Complexity on Atrial Fibrillation after On-Pump Coronary Artery Bypass Graft Surgery. Med Princ Pract. 30(1):45-51.
Erdoğan M, Erdöl MA, Öztürk S, Durmaz T. 2020. Systemic immune-inflammation index is a novel marker to predict functionally significant coronary artery stenosis. Biomark Med. 14:1553-61.
Erdolu B, As AK, Engin M. 2020. The relationship between the HATCH score, neutrophil to lymphocyte ratio and postoperative atrial fibrillation afer off-pump coronary artery bypass graf surgery. Heart Surg Forum. 23(1):E88e92.
Fan K, Lee KL, Chiu CS, et al. 2000. Effects of biatrial pacing in prevention of postoperative atrial fibrillation after coronary artery bypass surgery. Circulation. 102(7): 755-60.
Filardo G, Damiano RJ Jr, Ailawadi G, et al. 2018. Epidemiology of new-onset atrial fibrillation following coronary artery bypass graft surgery. Heart. 104:985-92.
Filardo G, Hamilton C, Hebeler RF, Hamman B, Grayburn P. 2009. New-onset postoperative atrial fibrillation after isolated coronary artery bypass graft surgery and long-term survival. Circ Cardiovasc Qual Outcomes. 2:164–169.
Gibson PH, Cuthbertson BH, Croal BL, et al. 2010. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol. 105:186-91.
Hashemi JM, Amirpour A, Zavvar R, Behjati M, Gharipour M. 2012. Predictive value of P-wave duration and dispersion in post coronary artery bypass surgery atrial fibrillation. ARYA Atheroscler. Summer;8(2):59-62.
Hu YF, Chen YJ, Lin YJ, Chen SA. 2015. Inflammation and the pathogenesis of atrial fibrillation. Nat Rev Cardiol. 12:230-43.
Huang J, Zhang Q, Wang R, et al. 2019. Systemic immune-inflammatory index predicts clinical outcomes for elderly patients with acute myocardial infarction receiving percutaneous coronary intervention. Med Sci Monit. 25:9690–701.
Iliopoulos I, Alder MN, Cooper DS, et al. 2020. Preoperative neutrophil-lymphocyte ratio predicts low cardiac output in children after cardiac surgery. Cardiol. Young, 30, 521–525.
Jacob KA, Nathoe HM, Dieleman JM, van Osch D, Kluin J, van Dijk D. 2014. Inflammation in new-onset atrial fibrillation after cardiac surgery: a systematic review. Eur J Clin Invest. 44:402-28.
Lomivorotov VV, Efremov SM, Pokushalov EA, Karaskov AM. 2016. New-Onset Atrial Fibrillation After Cardiac Surgery: Pathophysiology, Prophylaxis, and Treatment. J Cardiothorac Vasc Anesth. Jan; 30(1):200-16.
Lowres N, Mulcahy G, Jin K, Gallagher R, Neubeck L, Freedman B. 2018. Incidence of postoperative atrial fibrillation recurrence in patients discharged in sinus rhythm after cardiac surgery: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 26:504-11.
Maisel WH, Rawn JD, Stevenson WG. 2001. Atrial fibrillation after cardiac surgery. Ann Intern Med. Dec 18;135(12):1061-73.
Noubiap JJ, Sanders P, Nattel S, et al. 2021. Biomarkers in Atrial Fibrillation: Pathogenesis and Clinical Implications. Card Electrophysiol Clin. Mar;13(1):221-233.
Omae T, Kanmura Y. 2012. Management of postoperative atrial fibrillation. J Anesth. 26:429-37.
Osranek M, Fatema K, Qaddoura F, et al. 2006. Left atrial volume predicts the risk of atrial fibrillation after cardiac surgery: a prospective study. J Am Coll Cardiol. Aug 15;48(4):779-86.
Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuke A. 2016. P-wave dispersion: an update. Indian Pacing Electrophysiol J. Jul-Aug;16(4):126-133.
Pritchett AM, Jacobsen SJ, Mahoney DW, Rodeheffer RJ, Bailey KR, Redfield MM. 2003. Left atrial volume as an index of left atrial size: a population-based study. J Am Coll Cardiol. Mar 19;41(6):1036-43.
Racca V, Torri A, Grati P, et al. 2020. Inflammatory Cytokines During Cardiac Rehabilitation After Heart Surgery and Their Association to Postoperative Atrial Fibrillation. Sci Rep. May 25;10(1):8618.
Savran M, Engin M, Guvenc O, et al. 2021. Predictive Value of HATCH Scoring and Waist-to-Height Ratio in Atrial Fibrillation Following Coronary Artery Bypass Operations Performed with Cardiopulmonary Bypass. J Saudi Heart Assoc. Feb 10;33(2):117-123.
Saxena A, Dinh DT, Smith JA, Shardey GC, Reid CM, Newcomb AE. 2012. Usefulness of postoperative atrial fibrillation as an independent predictor for worse early and late outcomes after isolated coronary artery bypass grafting (multicenter Australian study of 19,497 patients). Am J Cardiol. Jan 15;109(2):219-25.
Selcuk M, Cinar T, Saylik F, Dogan S, Selcuk I, Orhan AL. 2021. Predictive Value of Systemic Immune Inflammation Index for Postoperative Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting. Medeni Med J. Dec 19;36(4):318-324.
Selvi M, Gungor H, Zencir C, et al. 2018. A new predictor of atrial fibrillation after coronary artery bypass graft surgery: HATCH score. J Investig Med. Mar;66(3):648-652.
Seo M, Yamada T, Morita T, et al. 2018. P589Prognostic value of systemic immune-inflammation index in patients with chronic heart failure. Eur Heart J. 39(Suppl. 1), 70.
Shen J, Lall S, Zheng V, Buckley P, Damiano RJJ, Schuessler RB. 2011. The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades. J Thorac Cardiovasc Surg. Feb;141(2):559-70.
Vaziri SM, Larson MG, Benjamin EJ, Levy D. 1994. Echocardiographic predictors of nonrheumatic atrial fibrillation: the Framingham Heart study. Circulation. 89:724–30.
Villareal RP, Hariharan R, Liu BC, et al. 2004. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol. Mar 3;43(5):742-8.
Weedle RC, Da Costa M, Veerasingam D, Soo AWS. 2019. The use of neutrophil lymphocyte ratio to predict complications post cardiac surgery. Ann Transl Med. 7, 778.
Yang YL, Wu CH, Hsu PF, et al. 2020. Systemic immune-inflammation index (SII) predicted clinical outcome in patievnts with coronary artery disease. Eur J Clin Invest. 50:e13230.
Yoon J, Jung J, Ahn Y, Oh J. 2021. Systemic Immune-Inflammation Index Predicted Short-Term Outcomes in Patients Undergoing Isolated Tricuspid Valve Surgery. J Clin Med. Sep 14;10(18):4147.
Zarauza J, Rodríguez Lera MJ, Fariñas Alvarez C, et al. 2006. Relationship between C-reactive protein level and early recurrence of atrial fibrillation after electrical cardioversion. Rev Esp Cardiol. 59:125–9.
Zhou X, Dudley SC Jr. 2020. Evidence for Inflammation as a Driver of Atrial Fibrillation. Front Cardiovasc Med. Apr 29;7:62.
