Updated evidence on peri-operative neutrophil-to-lymphocyte ratio in cardiac surgery: A dual analysis of prognostic and diagnostic value for post-operative atrial fibrillation.
Mohamed K A Awad, Ahmed E Ali, Muhammad S Mazroua, Karim Ali, Radwa K Awad, Toqa R Mohamed, Mohamed Abdelmaksoud, Mahmoud A Hashim, Redi Nikollari, Panos N Vardas, Hussein Abu-Daya
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引用次数: 0
Abstract
Background: Post-operative atrial fibrillation (POAF) is a frequent complication after cardiac surgery, increasing morbidity. The neutrophil-to-lymphocyte ratio (NLR), a simple marker of systemic inflammation, has been studied as a predictor.
Objective: We aimed to assess the association between NLR and new-onset POAF.
Methods: We systematically searched PubMed, Scopus, Web of Science, and Embase through June 2025 for studies reporting pre-operative or post-operative NLR and incidence of POAF in adult cardiac surgery patients. Diagnostic test accuracy (DTA) was assessed to evaluate the predictive performance of pre-operative NLR for POAF, using pooled sensitivity, specificity, and likelihood ratios. Subgroup analyses and meta-regression were conducted to explore sources of heterogeneity.
Results: 32 studies (20,056 patients) were included. In 27 studies excluding pre-operative atrial fibrillation (13,630 patients), POAF was associated with significantly higher pre-operative NLR (standardized mean difference [SMD] = 0.51; 95% confidence interval [CI]: 0.34-0.67; P < .001; I2 = 94.0%). Post-operative NLR was also elevated in POAF patients (SMD = 0.30; 95% CI: 0.13-0.47; P < .001; I2 = 70.7%). Among 4 studies including patients with prior atrial fibrillation (6364 patients), no significant association was observed (SMD = 0.04; P = .21). DTA analysis of 12 studies showed pooled sensitivity of 0.52, specificity of 0.71, and diagnostic odds ratio of 3.74 (area under the curve [AUC] = 0.713), indicating moderate diagnostic accuracy.
Conclusion: Elevated NLR is associated with increased risk of POAF. Distinguishing new-onset POAF and accounting for surgical type are essential when evaluating NLR as a predictive biomarker.
期刊介绍:
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.