Relationship between Prediction of Platelet-Lymphocyte Ratio and Atrial Fibrillation in Perioperative Patients: A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.59958/hsf.6851Keywords:
atrial fibrillation, platelet-to-lymphocyte ratio, post-intervention, meta-analysisAbstract
Background: The platelet-to-lymphocyte ratio (PLR) could be a convenient method to predict atrial fibrillation (AF) likelihood and, in turn, to determine the patients' postoperative trajectory. This study aimed to evaluate the prognostic effect of pre-intervention PLR in predicting the occurrence of AF after surgery. Methods: PubMed, Embase, and the Cochrane library were searched for available papers published up to October 2023. The primary outcome was the odds ratio (OR) of numerical PLR in the model predicting AF occurrence. The random-effects model was used in all analyses. Results: Six studies were included. There were 1197 patients with AF and 1998 patients without AF. The combined analysis of all six studies showed that PLR was associated with AF after surgery (OR = 1.01, 95% confidence interval (CI): 1.00–1.01, p = 0.000; I2 = 43.4%, pheterogeneity = 0.116). Three studies examined PLR before coronary artery bypass graft (CABG), and the meta-analysis showed that PLR was associated with AF after CABG (OR = 1.01, 95% CI: 1.00–1.02, p = 0.002; I2 = 0.0%, pheterogeneity = 0.894). The sensitivity analysis showed that the results were not robust. There was no obvious publication bias. Conclusions: Pre-intervention PLR was significantly associated with post-intervention AF in patients who underwent CABG or other surgeries. Elevated PLR is a risk factor for postoperative atrial fibrillation.
References
January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC, Jr, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation. 2019; 140: e125–e151.
Nesheiwat Z, Goyal A, Jagtap M. Atrial Fibrillation. StatPearls: Treasure Island (FL). 2020.
Rienstra M, Lubitz SA, Mahida S, Magnani JW, Fontes JD, Sinner MF, et al. Symptoms and functional status of patients with atrial fibrillation: state of the art and future research opportunities. Circulation. 2012; 125: 2933–2943.
de Craen AJM, Gussekloo J, Teng YKO, Macfarlane PW, Westendorp RGJ. Prevalence of five common clinical abnormalities in very elderly people: population based cross sectional study. BMJ (Clinical Research Ed.). 2003; 327: 131–132.
Wadke R. Atrial fibrillation. Disease-a-month: DM. 2013; 59: 67–73.
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2016; 18: 1609–1678.
Frendl G, Sodickson AC, Chung MK, Waldo AL, Gersh BJ, Tisdale JE, et al. 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. The Journal of Thoracic and Cardiovascular Surgery. 2014; 148: e153–e193.
Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacology & Therapeutics. 2015; 154: 13–20.
Zhang L, Gao S. Systematic Review and Meta-analysis of Atrial Fibrillation Prophylaxis After Lung Surgery. Journal of Cardiovascular Pharmacology. 2016; 67: 351–357.
Bachar BJ, Manna B. Coronary Artery Bypass Graft. StatPearls: Treasure Island (FL). 2023.
Ahmad M, Mehta P, Reddivari AKR, Mungee S. Percutaneous Coronary Intervention. StatPearls: Treasure Island (FL). 2023.
Al-Ghamdi B. Arrhythmias Post Coronary Artery Bypass Surgery. In Wilbert S (ed.) Coronary Artery Bypass Graft Surgery. Aronow: London. 2017.
Dobrev D, Aguilar M, Heijman J, Guichard JB, Nattel S. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nature Reviews. Cardiology. 2019; 16: 417–436.
Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011; 124: e652–e735.
Montrief T, Koyfman A, Long B. Coronary artery bypass graft surgery complications: A review for emergency clinicians. The American Journal of Emergency Medicine. 2018; 36: 2289–2297.
Daie M, Hajhossein Talasaz A, Karimi A, Gholami K, Salehiomran A, Ariannejad H, et al. Relationship between Vitamin D Levels and the Incidence of Post Coronary Artery Bypass Graft Surgery Atrial Fibrillation. The Journal of Tehran Heart Center. 2018; 13: 159–165.
Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Current Pharmaceutical Design. 2011; 17: 47–58.
Koupenova M, Clancy L, Corkrey HA, Freedman JE. Circulating Platelets as Mediators of Immunity, Inflammation, and Thrombosis. Circulation Research. 2018; 122: 337–351.
Tabata N, Al-Kassou B, Sugiura A, Shamekhi J, Treede H, Ishii M, et al. Predictive Value of the Platelet-to-Lymphocyte Ratio in Cancer Patients Undergoing Transcatheter Aortic Valve Replacement. JACC. CardioOncology. 2019; 1: 159–169.
Zhao J, Zhang C, Liu J, Zhang L, Cao Y, Wu D, et al. Prognostic Significance of Serum Cysteine-Rich Protein 61 in Patients with Acute Heart Failure. Cellular Physiology and Biochemistry: International Journal of Experimental Cellular Physiology, Biochemistry, and Pharmacology. 2018; 48: 1177–1187.
Lee YSG, Baradi A, Peverelle M, Sultani R, Adams H, Garlick J, et al. Usefulness of Platelet-to-Lymphocyte Ratio to Predict Long-Term All-Cause Mortality in Patients at High Risk of Coronary Artery Disease Who Underwent Coronary Angiography. The American Journal of Cardiology. 2018; 121: 1021–1026.
Ozcan Cetin EH, Cetin MS, Aras D, Topaloglu S, Temizhan A, Kisacik HL, et al. Platelet to Lymphocyte Ratio as a Prognostic Marker of In-Hospital and Long-Term Major Adverse Cardiovascular Events in ST-Segment Elevation Myocardial Infarction. Angiology. 2016; 67: 336–345.
Cho KI, Ann SH, Singh GB, Her AY, Shin ES. Combined Usefulness of the Platelet-to-Lymphocyte Ratio and the Neutrophil-to-Lymphocyte Ratio in Predicting the Long-Term Adverse Events in Patients Who Have Undergone Percutaneous Coronary Intervention with a Drug-Eluting Stent. PloS one. 2015; 10: e0133934.
Hudzik B, Szkodzinski J, Gorol J, Niedziela J, Lekston A, Gasior M, et al. Platelet-to-lymphocyte ratio is a marker of poor prognosis in patients with diabetes mellitus and ST-elevation myocardial infarction. Biomarkers in Medicine. 2015; 9: 199–207.
Larmann J, Handke J, Scholz AS, Dehne S, Arens C, Gillmann HJ, et al. Preoperative neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are associated with major adverse cardiovascular and cerebrovascular events in coronary heart disease patients undergoing non-cardiac surgery. BMC Cardiovascular Disorders. 2020; 20: 230.
Dereli S, Bayramoğlu A, Yontar OC. Usefulness of platelet to lymphocyte ratio for predicting recurrence of atrial fibrillation after direct current cardioversion. Annals of Noninvasive Electrocardiology: the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc. 2019; 24: e12616.
Gungor H, Babu AS, Zencir C, Akpek M, Selvi M, Erkan MH, et al. Association of Preoperative Platelet-to-Lymphocyte Ratio with Atrial Fibrillation after Coronary Artery Bypass Graft Surgery. Medical Principles and Practice: International Journal of the Kuwait University, Health Science Centre. 2017; 26: 164–168.
Navani RV, Baradi A, Colin Huang KL, Jin D, Jiao Y, Nguyen JK, et al. Preoperative Platelet-to-Lymphocyte Ratio Is Not Associated With Postoperative Atrial Fibrillation. The Annals of Thoracic Surgery. 2020; 110: 1265–1270.
Zhang H, Li J, Chen X, Wu N, Xie W, Tang H, et al. Association of Systemic Inflammation Score With Atrial Fibrillation: A Case-Control Study With Propensity Score Matching. Heart, Lung & Circulation. 2018; 27: 489–496.
Aksoy F, Uysal D, Ibrişim E. Predictive values of C-reactive protein/albumin ratio in new-onset atrial fibrillation after coronary artery bypass grafting. Revista Da Associacao Medica Brasileira (1992). 2020; 66: 1049–1056.
Engin M. Are Pre and Postoperative Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio Associated with Early Postoperative AKI Following CABG? Brazilian Journal of Cardiovascular Surgery. 2020; 35: 239.
Selçuk AA. A Guide for Systematic Reviews: PRISMA. Turkish Archives of Otorhinolaryngology. 2019; 57: 57–58.
a] Sivri F, Güngör H, Çokpınar S, Sezgin BA, Zencir C. Value of Preoperative Platelet-to-Lymphocyte and Neutrophil-to-Lymphocyte Ratios in Predicting Postoperative Atrial Fibrillation in Patients Undergoing Lung Resection. The Journal of Tehran Heart Center. 2022; 17: 236–242.
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.1. Cochrane Collaboration: London. 2020.
Lo CKL, Mertz D, Loeb M. Newcastle-Ottawa Scale: comparing reviewers' to authors' assessments. BMC Medical Research Methodology. 2014; 14: 45.
Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ (Clinical Research Ed.). 2011; 343: d5928.
Korantzopoulos P, Letsas KP, Tse G, Fragakis N, Goudis CA, Liu T. Inflammation and atrial fibrillation: A comprehensive review. Journal of Arrhythmia. 2018; 34: 394–401.
Joshi KK, Tiru M, Chin T, Fox MT, Stefan MS. Postoperative atrial fibrillation in patients undergoing non-cardiac non-thoracic surgery: A practical approach for the hospitalist. Hospital Practice (1995). 2015; 43: 235–244.
Weymann A, Ali-Hasan-Al-Saegh S, Popov AF, Sabashnikov A, Mirhosseini SJ, Liu T, et al. Haematological indices as predictors of atrial fibrillation following isolated coronary artery bypass grafting, valvular surgery, or combined procedures: a systematic review with meta-analysis. Kardiologia Polska. 2018; 76: 107–118.
Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD. The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases. Annals of Laboratory Medicine. 2019; 39: 345–357.
Dong G, Huang A, Liu L. Platelet-to-lymphocyte ratio and prognosis in STEMI: A meta-analysis. European Journal of Clinical Investigation. 2021; 51: e13386.
Weymann A, Ali-Hasan-Al-Saegh S, Sabashnikov A, Popov AF, Mirhosseini SJ, Liu T, et al. Prediction of New-Onset and Recurrent Atrial Fibrillation by Complete Blood Count Tests: A Comprehensive Systematic Review with Meta-Analysis. Medical Science Monitor Basic Research. 2017; 23: 179–222.
Shao Q, Chen K, Rha SW, Lim HE, Li G, Liu T. Usefulness of Neutrophil/Lymphocyte Ratio as a Predictor of Atrial Fibrillation: A Meta-analysis. Archives of Medical Research. 2015; 46: 199–206.
Kurtul A, Ornek E. Platelet to Lymphocyte Ratio in Cardiovascular Diseases: A Systematic Review. Angiology. 2019; 70: 802–818.
Brugada R, Hong K, Cordeiro JM, Dumaine R. Short QT syndrome. CMAJ: Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne. 2005; 173: 1349–1354.
Smyth SS, McEver RP, Weyrich AS, Morrell CN, Hoffman MR, Arepally GM, et al. Platelet functions beyond hemostasis. Journal of Thrombosis and Haemostasis: JTH. 2009; 7: 1759–1766.
Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. The New England Journal of Medicine. 2003; 348: 138–150.
