Relationship between c-reactive protein/albumin ratio and new-onset atrial fibrillation after coronary artery bypass grafting

Aksoy, Fatih; Uysal, Dinçer; Ibrişim, Erdogan

doi:10.1590/1806-9282.66.8.1070

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Revista da Associação Médica Brasileira

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Sumário

ORIGINAL ARTICLE • Rev. Assoc. Med. Bras. 66 (8) • Aug 2020 • https://doi.org/10.1590/1806-9282.66.8.1070 copy

Relationship between c-reactive protein/albumin ratio and new-onset atrial fibrillation after coronary artery bypass grafting

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE

This study aimed to investigate the predictive value of the newly defined C-Reactive Protein (CRP)/Albumin Ratio (CAR) in determining the development of atrial fibrillation (AF) in comparison with other inflammatory markers, such as Neutrophil/Lymphocyte (N/L) Ratio and Platelet/Lymphocyte (P/L) Ratio, in patients undergoing Coronary Artery Bypass Grafting (CABG) surgery.

METHODS

The population of this observational study consisted of 415 patients undergoing CABG. The study cohort was subdivided into two groups based on the development of AF. Complete blood counts, serum CRP, and serum albumin levels were evaluated before the CABG. The CAR, N/L, and P/L ratios of all the patients were calculated. Predictors of postoperative AF were determined by multiple logistic regression analysis (MLRA).

RESULTS

During follow-up, 136 patients (32.8%) developed postoperative AF. With MLRA, independent risk factors for postoperative AF were determined as follows: fasting glucose level (OR: 1.01; 95 % CI: 1.00-1.01, P <0.001), age (OR: 1.12; 95 % CI: 1.07-1.17, P <0.001), left ventricle ejection fraction (OR: 0.90; 95 % CI: 0.87-0.94, P <0.001), male gender (OR: 3.32; 95 % CI: 1.39-7.90, P = 0.007), 24-hour drainage amount (OR: 1.004; 95 % CI: 1.002-1.005, P <0.001), and CAR (OR: 1.82; 95 % CI: 1.53-2.16, P <0.001). Receiver Operating Characteristic curve analysis showed that CAR (C-statistic: 0.75; 95% CI: 0.71-0.79, p< 0.001) was a significant predictor of AF.

CONCLUSION

Novel inflammatory marker CAR can be used as a reliable marker to predict the development of AF following CABG.

Protein C; Albumins; Atrial fibrillation; Myocardial revascularization; Coronary artery bypass

	Without AF (n = 279)	With AF (n= 136)	P-value
Age (years)	60.5 ± 12.4	67.5 ± 8.9	< 0.001
Body mass index	29.0 ± 5.2	28.0 ± 4.4	0.05
Female gender (n, %)	90 ( 32.3 )	26 (19.1)	0.003
Diabetes mellitus (n, %)	114 (40.9)	73 (53.7)	0.009
Hypertension (n, %)	202 ( 72.4)	121 (89.0)	< 0.001
Congestive heart failure (n, %)	14 (5.1)	27 (20.8)	< 0.001
Peripheral vascular disease (n, %)	72 (25.8)	50 (36.8)	0.015
History of CVA (n, %)	36 (13.8)	24 (21.8)	0.04
Ejection fraction (%)	56.6 ± 8.4	50.3 ± 10.0	< 0.0001
Left atrial diameter (mm)	39.1 ± 6.1	38.3 ± 7.7	0.289
LVEDD (mm)	47.3 ± 5.5	46.9 ± 4.9	0.379
LVESD (mm)	29.8 ± 6.9	31.7 ± 5.6	0.007
IVSD (mm)	12.0 ± 3.1	12.6 ± 3.4	0.007
PWD (mm)	11.1 ± 2.2	11.1 ± 0.9	0.988
AoD (mm)	26.9 ± 3.5	26.8 ± 3.3	0.832
Total cholesterol (mg/dl)	201.2 ± 41.3	196.9 ± 39.4	0.412
HDL cholesterol (mg/dl)	41.8 ± 10.2	41.2 ± 9.0	0.632
LDL cholesterol (mg/dl)	126.0 ± 40.4	124.3 ± 41.5	0.760
Triglycerides (mg/dl)	158.2 ± 104.1	141.9 ± 48.6	0.187
Creatinine(mg/dl)	1.0 ± 0.3	11.1 ± 0.3	0.103
Glucose(mg/dl)	142.5 ± 67	198.6 ± 119.9	< 0.001
Lymphocyte (103/μl)	2556 ± 0.978	2576 ± 1.063	0.849
Platelet (103/μl)	230 ± 63	232 ± 78	0.773
CAR, median (IQR)	0.96 (0.5-2.0)	4.3 (1.1-8.6)	< 0.001
N/L ratio	3.3 ± 3.1	4.3 ± 6.8	0.05
P/L Ratio	11.3 ± 9.4	140 ± 17.2	0.04
CRP (mg/l) , median (IQR)	4.00(2.00-8.00)	16.00 (4.25-33.0)	<0.001
Albumin (g/l)	3.8± 0.4	3.7±0.3	0.002
WBC (103/μl)	8952±4227	8751±2240	0.513
Operative and postoperative parameters
Cardiopulmonary bypass time ( min)	78.8 ± 27.3	86.8 ± 39.6	0,02
X Clamp time (min)	47.5 ± 18.8	46.7 ± 16.2	0,686
24-hour drainage ( ml)	28.2 ± 14.5	388.7 ± 232.3	0,003
48-hour drainage ( ml)	147.8 ± 83.9	159.9 ± 69.8	0,148
Duration of the hospitalization at the intensive care unit ( days)	2.1 ± 0.4	2.6 ± 1.4	< 0.001
Bypass number ( n)	2.4±1.7	2.6±2.1	0.158
Reoperation due to hemorrhage (n, %)	6 (2.2)	2 (1.5)	0.985
İntraoperative mortality (n, %)	-	-
In-hospital mortality (n, %)	8 (2.9)	6 (4.4)	0.786

	Unadjusted Odds Ratio	Confidence Interval	P-value	Adjusted Odds Ratio	Confidence interval	P value
Diabetes mellitus	1.67	1.11-2.53	0.014
Hypertension	3.075	1.69-5.58	< 0.001
Congestive heart failure	4.85	2.44-9.61	< 0.001
Peripheral vascular disease	1.67	1.07-2.59	0.02
BMI	0.96	0.92-1.00	0.06
Fasting glucose level	1.006	1.004-1.009	< 0.001	1.01	1.00-1.01	< 0.001
Age	1.06	1.04-1.08	< 0.001	1.12	1.07-1.17	< 0.001
Male gender	2.015	1.22-3.33	0.006	3.32	1.39-7.90	0.007
24-hour drainage	1.002	1.001-1.003	0.004	1.004	1.002-1.005	< 0.001
Left ventricle ejection fraction	0.93	0.91-0.95	< 0.001	0.90	0.87-0.94	< 0.001
Cardiopulmonary bypass time	1.007	1.00-1.01	0.04
CRP to Albumin Ratio	1.575	1.40-1.76	< 0.001	1.82	1.53-2.16	< 0.001
N to L ratio	1.040	0.89-1.08	0.06
P to L ratio	1.01	1.00-1.03	0.04
CRP	1.12	1.09-1.15	< 0.001
Albumin	0.395	0.21-0.71	0.002

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[1] CORRESPONDING AUTHOR: Fatih Aksoy Suleyman Demirel Unşversity – Faculty of Medicine, Cardiology Department – Isparta, Turkey – 32040 Tel.: +90505 2313661, Fax: +90 2462324510 E-mail: dr.aksoy@hotmail.com