Value of Preoperative Platelet-to-Lymphocyte and Neutrophil-to-Lymphocyte Ratios in Predicting Postoperative Atrial Fibrillation in Patients Undergoing Pulmonary Resection
,
Abstract
Background: The aim of this study was to investigate the association between the platelet/lymphocyte ratio (PLR) and the neutrophil/lymphocyte ratio (NLR) and postoperative atrial fibrillation (POAF) after lung resection.
Methods: After the implementation of the exclusion criteria, 170 patients were retrospectively analyzed. PLR and NLR were obtained from fasting complete blood counts before surgery. POAF was diagnosed using standard clinical criteria. The associations between different variables and POAF, NLR, and PLR were calculated using univariate and multivariate analyses. The receiver operating characteristics (ROC) curve was used to determine the sensitivity and specificity of PLR and NLR.
Results: Of the 170 patients, 32 with POAF (mean age =71.28±7.27 y, 28 males and 4 females) and 138 patients without POAF (mean age =64.69±10.31 y, 125 males and 13 females) were identified, and the difference in the mean age was statistically significant (P=0.001). It was found that PLR (157.67±65.04 vs 127.52±56.80; P=0.005) and NLR (3.90±1.79 vs 2.04±0.88; P=0.001) were statistically significantly higher in the POAF group. In the multivariate regression analysis, age, lung resection size, chronic obstructive pulmonary disease, NLR, PLR, and pulmonary arterial pressure were independent risk factors. In the ROC analysis, PLR had a sensitivity of 100% and a specificity of 33% (AUC, 0.66; P<0.001), and NLR had a sensitivity of 71.9% and a specificity of 87.7% (AUC, 0.87; P<0.001). A comparison of AUC between PLR and NLR showed that NLR was statistically more significant (P<0.001).
Conclusion: This study showed that NLR was a stronger independent risk factor than PLR for the development of POAF after lung resection.
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3. Cardinale D, Colombo A, Sandri MT, Lamantia G, Colombo N, Civelli M, Salvatici M, Veronesi G, Veglia F, Fiorentini C, Spaggiari L, Cipolla CM. Increased perioperative N-terminal pro-B-type natriuretic peptide levels predict atrial fibrillation after thoracic surgery for lung cancer. Circulation 2007;115:1339-1344.
4. Daie M, Hajhossein Talasaz A, Karimi A, Gholami K, Salehiomran A, Ariannejad H, Jalali A. Relationship between Vitamin D Levels and the Incidence of Post Coronary Artery Bypass Graft Surgery Atrial Fibrillation. J Tehran Heart Cent 2018 Oct;13:159-165.
5. Chung MK, Martin DO, Sprecher D, Wazni O, Kanderian A, Carnes CA, Bauer JA, Tchou PJ, Niebauer MJ, Natale A, Van Wagoner DR. C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation. Circulation 2001;104:2886-2891.
6. Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, Tracy RP, Van Wagoner DR, Psaty BM, Lauer MS, Chung MK. Inflammation as a risk factor for atrial fibrillation. Circulation 2003;108:3006-3010.
7. Haghjoo M. Pharmacological and nonpharmacological prevention of atrial fibrillation after coronary artery bypass surgery. J Tehran Heart Cent 2012;7:2-9.
8. Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD. The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases. Ann Lab Med 2019;39:345-357.
9. Dong G, Huang A, Liu L. Platelet-to-lymphocyte ratio and prognosis in STEMI: A meta-analysis. Eur J Clin Invest 2021;51:e13386.
10. Azab B, Shah N, Akerman M, McGinn JT Jr. Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction. J Thromb Thrombolysis 2012;34:326-334.
11. Kang J, Chang Y, Ahn J, Oh S, Koo DH, Lee YG, Shin H, Ryu S. Neutrophil-to-lymphocyte ratio and risk of lung cancer mortality in a low-risk population: A cohort study. Int J Cancer 2019;145:3267-3275.
12. Zhang S, Diao J, Qi C, Jin J, Li L, Gao X, Gong L, Wu W. Predictive value of neutrophil to lymphocyte ratio in patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention: a meta-analysis. BMC Cardiovasc Disord 2018;18:75.
13. Gungor H, Babu AS, Zencir C, Akpek M, Selvi M, Erkan MH, Durmaz S. Association of Preoperative Platelet-to-Lymphocyte Ratio with Atrial Fibrillation after Coronary Artery Bypass Graft Surgery. Med Princ Pract 2017;26:164-168.
14. Bagheri R, Yousefi Y, Rezai R, Azemonfar V, Keshtan FG. Atrial fibrillation after lung surgery: incidence, underlying factors, and predictors. Kardiochir Torakochirurgia Pol 2019;16:53-56.
15. Schotten U, Verheule S, Kirchhof P, Goette A. Pathophysiological mechanisms of atrial fibrillation: a translational appraisal. Physiol Rev 2011;91:265-325.
16. Hollings DD, Higgins RS, Faber LP, Warren WH, Liptay MJ, Basu S, Kim AW. Age is a strong risk factor for atrial fibrillation after pulmonary lobectomy. Am J Surg 2010;199:558-561.
17. Nattel S, Harada M. Atrial remodeling and atrial fibrillation: recent advances and translational perspectives. J Am Coll Cardiol 2014;63:2335-2345.
18. Koura T, Hara M, Takeuchi S, Ota K, Okada Y, Miyoshi S, Watanabe A, Shiraiwa K, Mitamura H, Kodama I, Ogawa S. Anisotropic conduction properties in canine atria analyzed by high-resolution optical mapping: preferential direction of conduction block changes from longitudinal to transverse with increasing age. Circulation 2002;105:2092-2098.
19. Camici GG, Savarese G, Akhmedov A, Lüscher TF. Molecular mechanism of endothelial and vascular aging: implications for cardiovascular disease. Eur Heart J 2015;36:3392-3403.
20. Chen CY, Liao KM. The impact of atrial fibrillation in patients with COPD during hospitalization. Int J Chron Obstruct Pulmon Dis 2018;13:2105-2112.
21. Sekine Y, Kesler KA, Behnia M, Brooks-Brunn J, Sekine E, Brown JW. COPD may increase the incidence of refractory supraventricular arrhythmias following pulmonary resection for non-small cell lung cancer. Chest 2001;120:1783-1790.
22. Ishibashi H, Wakejima R, Asakawa A, Baba S, Nakashima Y, Seto K, Kobayashi M, Okubo K. Postoperative Atrial Fibrillation in Lung Cancer Lobectomy-Analysis of Risk Factors and Prognosis. World J Surg 2020;44:3952-3959.
23. Mercurio V, Peloquin G, Bourji KI, Diab N, Sato T, Enobun B, Housten-Harris T, Damico R, Kolb TM, Mathai SC, Tedford RJ, Tocchetti CG, Hassoun PM. Pulmonary arterial hypertension and atrial arrhythmias: incidence, risk factors, and clinical impact. Pulm Circ 2018;8:2045894018769874.
24. Akça B, Dönmez K, Dişli OM, Akgül Erdil F, Çolak MC, Aydemir İK, Battaloğlu B, Erdil N. The effects of pulmonary hypertension on early outcomes inpatients undergoing coronary artery bypass surgery. Turk J Med Sci 2016;46:1162-1167.
25. Bagheri R, Yousefi Y, Rezai R, Azemonfar V, Keshtan FG. Atrial fibrillation after lung surgery: incidence, underlying factors, and predictors. Kardiochir Torakochirurgia Pol 2019;16:53-56.
26. Wang H, Wang Z, Zhou M, Chen J, Yao F, Zhao L, He B. Postoperative atrial fibrillation in pneumonectomy for primary lung cancer. J Thorac Dis 2021;13:789-802.
27. Ueda T, Suzuki K, Matsunaga T, Takamochi K, Oh S. Postoperative atrial fibrillation is less frequent in pulmonary segmentectomy compared with lobectomy. Gen Thorac Cardiovasc Surg 2018;66:95-100.
28. Fink T, Sciacca V, Heeger CH, Vogler J, Eitel C, Reissmann B, Rottner L, Rillig A, Mathew S, Maurer T, Ouyang F, Kuck KH, Metzner A, Tilz RR. Atrial fibrillation ablation in patients with pulmonary lobectomy or pneumectomy: Procedural challenges and efficacy. Pacing Clin Electrophysiol 2020;43:1115-1125.
29. Yadava M, Hughey AB, Crawford TC. Postoperative Atrial Fibrillation: Incidence, Mechanisms, and Clinical Correlates. Heart Fail Clin 2016;12:299-308.
30. Frendl G, Sodickson AC, Chung MK, Waldo AL, Gersh BJ, Tisdale JE, Calkins H, Aranki S, Kaneko T, Cassivi S, Smith SC Jr, Darbar D, Wee JO, Waddell TK, Amar D, Adler D; American Association for Thoracic Surgery. 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. J Thorac Cardiovasc Surg 2014;148:e153-193.
31. Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther 2015;154:13-20.
32. Nakamura Y, Nakamura K, Fukushima-Kusano K, Ohta K, Matsubara H, Hamuro T, Yutani C, Ohe T. Tissue factor expression in atrial endothelia associated with nonvalvular atrial fibrillation: possible involvement in intracardiac thrombogenesis. Thromb Res 2003;111:137-142.
33. Tselentakis EV, Woodford E, Chandy J, Gaudette GR, Saltman AE. Inflammation effects on the electrical properties of atrial tissue and inducibility of postoperative atrial fibrillation. J Surg Res 2006;135:68-75.
34. Ishii Y, Schuessler RB, Gaynor SL, Hames K, Damiano RJ Jr. Postoperative atrial fibrillation: The role of the inflammatory response. J Thorac Cardiovasc Surg 2017;153:1357-1365.
35. Durukan AB, Gurbuz HA, Unal EU, Tavlasoglu M, Durukan E, Salman N, Ucar HI, Yorgancioglu C. Role of neutrophil/lymphocyte ratio in assessing the risk of postoperative atrial fibrillation. J Cardiovasc Surg (Torino) 2014;55:287-293.
36. Şaşkın H, Düzyol Ç, Özcan KS, Aksoy R, Idiz M. Preoperative Platelet to Lymphocyte Ratio Is Associated with Early Morbidity and Mortality after Coronary Artery Bypass Grafting. Heart Surg Forum 2015;18:E255-262.
37. Walsh KJ, Tan KS, Zhang H, Amar D. Neutrophil-lymphocyte ratio and risk of atrial fibrillation after thoracic surgery. Interact Cardiovasc Thorac Surg 2017;24:555-559.
2. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021;42:373-498.
3. Cardinale D, Colombo A, Sandri MT, Lamantia G, Colombo N, Civelli M, Salvatici M, Veronesi G, Veglia F, Fiorentini C, Spaggiari L, Cipolla CM. Increased perioperative N-terminal pro-B-type natriuretic peptide levels predict atrial fibrillation after thoracic surgery for lung cancer. Circulation 2007;115:1339-1344.
4. Daie M, Hajhossein Talasaz A, Karimi A, Gholami K, Salehiomran A, Ariannejad H, Jalali A. Relationship between Vitamin D Levels and the Incidence of Post Coronary Artery Bypass Graft Surgery Atrial Fibrillation. J Tehran Heart Cent 2018 Oct;13:159-165.
5. Chung MK, Martin DO, Sprecher D, Wazni O, Kanderian A, Carnes CA, Bauer JA, Tchou PJ, Niebauer MJ, Natale A, Van Wagoner DR. C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation. Circulation 2001;104:2886-2891.
6. Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, Tracy RP, Van Wagoner DR, Psaty BM, Lauer MS, Chung MK. Inflammation as a risk factor for atrial fibrillation. Circulation 2003;108:3006-3010.
7. Haghjoo M. Pharmacological and nonpharmacological prevention of atrial fibrillation after coronary artery bypass surgery. J Tehran Heart Cent 2012;7:2-9.
8. Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD. The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases. Ann Lab Med 2019;39:345-357.
9. Dong G, Huang A, Liu L. Platelet-to-lymphocyte ratio and prognosis in STEMI: A meta-analysis. Eur J Clin Invest 2021;51:e13386.
10. Azab B, Shah N, Akerman M, McGinn JT Jr. Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction. J Thromb Thrombolysis 2012;34:326-334.
11. Kang J, Chang Y, Ahn J, Oh S, Koo DH, Lee YG, Shin H, Ryu S. Neutrophil-to-lymphocyte ratio and risk of lung cancer mortality in a low-risk population: A cohort study. Int J Cancer 2019;145:3267-3275.
12. Zhang S, Diao J, Qi C, Jin J, Li L, Gao X, Gong L, Wu W. Predictive value of neutrophil to lymphocyte ratio in patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention: a meta-analysis. BMC Cardiovasc Disord 2018;18:75.
13. Gungor H, Babu AS, Zencir C, Akpek M, Selvi M, Erkan MH, Durmaz S. Association of Preoperative Platelet-to-Lymphocyte Ratio with Atrial Fibrillation after Coronary Artery Bypass Graft Surgery. Med Princ Pract 2017;26:164-168.
14. Bagheri R, Yousefi Y, Rezai R, Azemonfar V, Keshtan FG. Atrial fibrillation after lung surgery: incidence, underlying factors, and predictors. Kardiochir Torakochirurgia Pol 2019;16:53-56.
15. Schotten U, Verheule S, Kirchhof P, Goette A. Pathophysiological mechanisms of atrial fibrillation: a translational appraisal. Physiol Rev 2011;91:265-325.
16. Hollings DD, Higgins RS, Faber LP, Warren WH, Liptay MJ, Basu S, Kim AW. Age is a strong risk factor for atrial fibrillation after pulmonary lobectomy. Am J Surg 2010;199:558-561.
17. Nattel S, Harada M. Atrial remodeling and atrial fibrillation: recent advances and translational perspectives. J Am Coll Cardiol 2014;63:2335-2345.
18. Koura T, Hara M, Takeuchi S, Ota K, Okada Y, Miyoshi S, Watanabe A, Shiraiwa K, Mitamura H, Kodama I, Ogawa S. Anisotropic conduction properties in canine atria analyzed by high-resolution optical mapping: preferential direction of conduction block changes from longitudinal to transverse with increasing age. Circulation 2002;105:2092-2098.
19. Camici GG, Savarese G, Akhmedov A, Lüscher TF. Molecular mechanism of endothelial and vascular aging: implications for cardiovascular disease. Eur Heart J 2015;36:3392-3403.
20. Chen CY, Liao KM. The impact of atrial fibrillation in patients with COPD during hospitalization. Int J Chron Obstruct Pulmon Dis 2018;13:2105-2112.
21. Sekine Y, Kesler KA, Behnia M, Brooks-Brunn J, Sekine E, Brown JW. COPD may increase the incidence of refractory supraventricular arrhythmias following pulmonary resection for non-small cell lung cancer. Chest 2001;120:1783-1790.
22. Ishibashi H, Wakejima R, Asakawa A, Baba S, Nakashima Y, Seto K, Kobayashi M, Okubo K. Postoperative Atrial Fibrillation in Lung Cancer Lobectomy-Analysis of Risk Factors and Prognosis. World J Surg 2020;44:3952-3959.
23. Mercurio V, Peloquin G, Bourji KI, Diab N, Sato T, Enobun B, Housten-Harris T, Damico R, Kolb TM, Mathai SC, Tedford RJ, Tocchetti CG, Hassoun PM. Pulmonary arterial hypertension and atrial arrhythmias: incidence, risk factors, and clinical impact. Pulm Circ 2018;8:2045894018769874.
24. Akça B, Dönmez K, Dişli OM, Akgül Erdil F, Çolak MC, Aydemir İK, Battaloğlu B, Erdil N. The effects of pulmonary hypertension on early outcomes inpatients undergoing coronary artery bypass surgery. Turk J Med Sci 2016;46:1162-1167.
25. Bagheri R, Yousefi Y, Rezai R, Azemonfar V, Keshtan FG. Atrial fibrillation after lung surgery: incidence, underlying factors, and predictors. Kardiochir Torakochirurgia Pol 2019;16:53-56.
26. Wang H, Wang Z, Zhou M, Chen J, Yao F, Zhao L, He B. Postoperative atrial fibrillation in pneumonectomy for primary lung cancer. J Thorac Dis 2021;13:789-802.
27. Ueda T, Suzuki K, Matsunaga T, Takamochi K, Oh S. Postoperative atrial fibrillation is less frequent in pulmonary segmentectomy compared with lobectomy. Gen Thorac Cardiovasc Surg 2018;66:95-100.
28. Fink T, Sciacca V, Heeger CH, Vogler J, Eitel C, Reissmann B, Rottner L, Rillig A, Mathew S, Maurer T, Ouyang F, Kuck KH, Metzner A, Tilz RR. Atrial fibrillation ablation in patients with pulmonary lobectomy or pneumectomy: Procedural challenges and efficacy. Pacing Clin Electrophysiol 2020;43:1115-1125.
29. Yadava M, Hughey AB, Crawford TC. Postoperative Atrial Fibrillation: Incidence, Mechanisms, and Clinical Correlates. Heart Fail Clin 2016;12:299-308.
30. Frendl G, Sodickson AC, Chung MK, Waldo AL, Gersh BJ, Tisdale JE, Calkins H, Aranki S, Kaneko T, Cassivi S, Smith SC Jr, Darbar D, Wee JO, Waddell TK, Amar D, Adler D; American Association for Thoracic Surgery. 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. J Thorac Cardiovasc Surg 2014;148:e153-193.
31. Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther 2015;154:13-20.
32. Nakamura Y, Nakamura K, Fukushima-Kusano K, Ohta K, Matsubara H, Hamuro T, Yutani C, Ohe T. Tissue factor expression in atrial endothelia associated with nonvalvular atrial fibrillation: possible involvement in intracardiac thrombogenesis. Thromb Res 2003;111:137-142.
33. Tselentakis EV, Woodford E, Chandy J, Gaudette GR, Saltman AE. Inflammation effects on the electrical properties of atrial tissue and inducibility of postoperative atrial fibrillation. J Surg Res 2006;135:68-75.
34. Ishii Y, Schuessler RB, Gaynor SL, Hames K, Damiano RJ Jr. Postoperative atrial fibrillation: The role of the inflammatory response. J Thorac Cardiovasc Surg 2017;153:1357-1365.
35. Durukan AB, Gurbuz HA, Unal EU, Tavlasoglu M, Durukan E, Salman N, Ucar HI, Yorgancioglu C. Role of neutrophil/lymphocyte ratio in assessing the risk of postoperative atrial fibrillation. J Cardiovasc Surg (Torino) 2014;55:287-293.
36. Şaşkın H, Düzyol Ç, Özcan KS, Aksoy R, Idiz M. Preoperative Platelet to Lymphocyte Ratio Is Associated with Early Morbidity and Mortality after Coronary Artery Bypass Grafting. Heart Surg Forum 2015;18:E255-262.
37. Walsh KJ, Tan KS, Zhang H, Amar D. Neutrophil-lymphocyte ratio and risk of atrial fibrillation after thoracic surgery. Interact Cardiovasc Thorac Surg 2017;24:555-559.
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| Issue | Vol 17 No 4 (2022): J Teh Univ Heart Ctr | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v17i4.11613 | |
| Keywords | ||
| platelet-to-lymphocyte neutrophil-to-lymphocyte postoperative atrial fibrillation | ||
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How to Cite
1.
Sivri F, Güngör H, Çokpınar S, SEZGİN BA, Zencir C. Value of Preoperative Platelet-to-Lymphocyte and Neutrophil-to-Lymphocyte Ratios in Predicting Postoperative Atrial Fibrillation in Patients Undergoing Pulmonary Resection. J Tehran Heart Cent. 2022;17(4):236-242.
