Visceral Adiposity Index and Prognostic Nutritional Index in Predicting Atrial Fibrillation after On-Pump Coronary Artery Bypass Operations: a Prospective Study

Engin, Mesut; Ozsin, Kadir Kaan; Savran, Muhammed; Guvenc, Orhan; Yavuz, Senol; Ozyazicioglu, Ahmet Fatih

doi:10.21470/1678-9741-2020-0044

Mesut Engin Correspondence Address: Mesut Engin, https://orcid.org/0000-0003-2418-5823, Department of Cardiovascular Surgery, University of Health Sciences, Mehmet Akif İnan Training and Research Hospital, Esentepe Town. Ertuğrul Street, Karaköprü/Şanlıurfa, Turkey - Zip Code: 63200. E-mail: mesut_kvc_cor@hotmail.com

MD

Department of Cardiovascular Surgery, University of Health Sciences, Mehmet Akif İnan Training and Research Hospital, Karaköprü/Şanlıurfa, Turkey.

https://orcid.org/0000-0003-2418-5823

Kadir Kaan Ozsin

MD

Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.

Muhammed Savran

MD

Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.

Orhan Guvenc

MD

Department of Cardiovascular Surgery, Medical Faculty of Uludağ University, Bursa, Turkey.

Senol Yavuz

MD

Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.

Ahmet Fatih Ozyazicioglu

MD

Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.

Correspondence Address: Mesut Engin, https://orcid.org/0000-0003-2418-5823, Department of Cardiovascular Surgery, University of Health Sciences, Mehmet Akif İnan Training and Research Hospital, Esentepe Town. Ertuğrul Street, Karaköprü/Şanlıurfa, Turkey - Zip Code: 63200. E-mail: mesut_kvc_cor@hotmail.com

No conflict of interest.

Abbreviations, acronyms & symbols
ACE-I	= Angiotensin-converting enzyme inhibitor	HDL-C	= High-density lipoprotein cholesterol
AF	= Atrial fibrillation	HT	= Hypertension
ARB	= Angiotensin receptor blocker	ICU	= Intensive care unit
AUC	= Areas under the curve	LDL-C	= Low-density lipoprotein cholesterol
BMI	= Body mass index	OR	= Odds ratio
CABG	= Coronary artery bypass grafting	PCI	= Percutaneous coronary intervention
CCt	= Cross-clamp time	PNI	= Prognostic nutritional index
CI	= Confidence interval	PoAF	= Postoperative atrial fibrillation
COPD	= Chronic obstructive pulmonary disease	ROC	= Receiver-operating characteristic
CPB	= Cardiopulmonary bypass	SD	= Standard deviation
CRP	= C-reactive protein	TG	= Triglycerides
ECG	= Electrocardiography	TPt	= Total perfusion time
EuroSCORE II	= European System for Cardiac Operative Risk Evaluation II	TSH	= Thyroid-stimulating hormone
EuroSCORE II		VAI	= Visceral adiposity index
HDL	= High-density lipoprotein	WC	= Waist circumference

Characteristics	Group 1	Group 2	P-value
	(n=144)	(n=55)
Age (years), mean±SD	56.9±8.7	64.3±10.2	< 0.001^† † Student's t-test
Male gender, n (%)	113 (78.4)	45 (81.8)	0.547^* * Chi-square test
Previous PCI, n (%)	24 (16.6)	11 (20)	0.672^* * Chi-square test
Hypertension, n (%)	85 (59.2)	46 (83.6)	0.021^* * Chi-square test
COPD, n (%)	21 (14.5)	21 (38.1)	0.017^* * Chi-square test
BMI (kg/m²)	29.4±4.6	30.4±6.1	0.201^† † Student's t-test
Diabetes mellitus, n (%)	30 (20.8)	13 (23.6)	0.779^* * Chi-square test
Smoking, n (%)	33 (22.9)	16 (29)	0.614^* * Chi-square test
Beta-blocker use, n (%)	35 (24.3)	10 (18.1)	0.572^* * Chi-square test
ACE-I/ARB use, n (%)	44 (30.4)	15 (25.4)	0.718^* * Chi-square test
Ejection fraction (%), mean±SD	50.8±7.5	48.3±6.6	0.196^† † Student's t-test
Left atrial diameter (cm), mean±SD	3.5±0.3	3.7±0.3	0.228^† † Student's t-test
EuroSCORE II	1.6 (0.5-4.8)	1.8 (0.5-5.2)	0.189^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])

Characteristics	Group 1	Group 2	P-value
Characteristics	(n=144)	(n=55)	P-value
Hemoglobin (g/dL)	14.1 (12.2-16)	13.5 (12.4-16.8)	0.284^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
White blood cell (10³/µL)	8 (6.5-9.9)	8 (6.5-10.7)	0.201^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
Neutrophil (10³/µL)	4.4 (3.5- 9.7)	4.7 (3.6-9.9)	0.267^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
Lymphocyte (10³/µL)	2.2 (0.8-3.9)	1.8 (0.7-3.8)	0.004^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
Creatinine (mg/dL)	1.1 (0.36-1.49)	1.2 (0.44-1.48)	0.556^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
LDL-C (mmol/L)	3.3 (2.3-4.6)	3.5 (3-4.8)	0.216^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
HDL-C (mmol/L)	1 (0.7-1.4)	1.1 (0.7-1.6)	0.196^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
Triglyceride (mmol/L)	2 (0.7-5.5)	2.4 (0.9-5.9)	0.038^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
C-reactive protein (mg/dL)	7.4 (1.6-38)	9.1 (1.9-40)	0.018^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
Albumin (g/L)	39.2 (35-53)	38.7 (34.4-54)	0.212^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
Free T3 (pg/mL)	2.8 (2.3-5.2)	3 (2.2-5.5)	0.283^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
Free T4 (ng/dL)	0.7 (0.5-1.2)	0.8 (0.5-1.3)	0.678^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
TSH (µIU/L)	1.3 (0.8-4)	1.4 (0.7-4.2)	0.317^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
VAI	3.5 (1.2-14.9)	5.2 (2.4-15)	<0.001^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
PNI	48 (35-69)	45 (34-58)	0.003^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
Distal anastomosis number, n	4 (1-6)	4 (2-6)	0.393^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
CCt (minutes)	67 (44-91)	72 (52-96)	0.214^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
TPt (minutes)	96 (70-130)	120 (93-138)	0.302^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
Total chest tube drainage (ml)	450 (250-1350)	500 (300-1400)	0.418^‡ ‡ Mann-Whitney U test (data is expressed as median [interquartile range])
Inotropic support, n (%)	8 (5.5)	12 (21.8)	0.094^* * Chi-square test
ICU length of stay (days)	2.5±1	3.4±1.2	< 0.001^† † Student's t-test (data is expressed as mean±standard deviation)
Total hospital length of stay (days)	6.8±1.2	8.5±1.2	< 0.001^† † Student's t-test (data is expressed as mean±standard deviation)

Variables	Univariate analysis			Multivariate analysis
	P-value	Exp (B)	95% CI	P-value	Exp (B)	95% CI
		Odds ratio	Lower-upper		Odds ratio	Lower-upper
Age	< 0.001	1.151	1.008-1.244	0.009^a a Multivariate analysis Model 1 (the goodness of fit of the model was confirmed by a P-value of 0.695 in the Hosmer-Lemeshow test)	1.084^a a Multivariate analysis Model 1 (the goodness of fit of the model was confirmed by a P-value of 0.695 in the Hosmer-Lemeshow test)	1.010-1-176^a a Multivariate analysis Model 1 (the goodness of fit of the model was confirmed by a P-value of 0.695 in the Hosmer-Lemeshow test)
Age	< 0.001	1.151	1.008-1.244	0.012^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)	1.078^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)	1.008-1.194^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)
Hypertension	0.026	0.824	0.756-0.978	0.096^a a Multivariate analysis Model 1 (the goodness of fit of the model was confirmed by a P-value of 0.695 in the Hosmer-Lemeshow test)	0.876^a a Multivariate analysis Model 1 (the goodness of fit of the model was confirmed by a P-value of 0.695 in the Hosmer-Lemeshow test)	0.794-1.100^a a Multivariate analysis Model 1 (the goodness of fit of the model was confirmed by a P-value of 0.695 in the Hosmer-Lemeshow test)
Hypertension	0.026	0.824	0.756-0.978	0.112^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)	0.914^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)	0.678-1.145^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)
COPD	0.023	0.653	0.312-0.776	0.048^a a Multivariate analysis Model 1 (the goodness of fit of the model was confirmed by a P-value of 0.695 in the Hosmer-Lemeshow test)	0.798^a a Multivariate analysis Model 1 (the goodness of fit of the model was confirmed by a P-value of 0.695 in the Hosmer-Lemeshow test)	0.664-0.928^a a Multivariate analysis Model 1 (the goodness of fit of the model was confirmed by a P-value of 0.695 in the Hosmer-Lemeshow test)
COPD	0.023	0.653	0.312-0.776	0.114^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)	0.678^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)	0.479-1.217^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)
Triglyceride	0.064	0.897	0.674-1.010	--	--	--
Lymphocyte	0.010	0.396	0.294-0.804	--	--	--
Lymphocyte	0.010	0.396	0.294-0.804	0.032^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)	0.412^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)	0.374-0.778^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)
CRP	0.028	1.050	1.008-1.212	0.108^a a Multivariate analysis Model 1 (the goodness of fit of the model was confirmed by a P-value of 0.695 in the Hosmer-Lemeshow test)	1.090^a a Multivariate analysis Model 1 (the goodness of fit of the model was confirmed by a P-value of 0.695 in the Hosmer-Lemeshow test)	0.928-1.234^a a Multivariate analysis Model 1 (the goodness of fit of the model was confirmed by a P-value of 0.695 in the Hosmer-Lemeshow test)
CRP	0.028	1.050	1.008-1.212	0.176^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)	1.078^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)	0.879-1.194^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)
PNI	0.002	1.024	1.010-1.196	0.011^a a Multivariate analysis Model 1 (the goodness of fit of the model was confirmed by a P-value of 0.695 in the Hosmer-Lemeshow test)	1.052^a a Multivariate analysis Model 1 (the goodness of fit of the model was confirmed by a P-value of 0.695 in the Hosmer-Lemeshow test)	1.015-1.379^a a Multivariate analysis Model 1 (the goodness of fit of the model was confirmed by a P-value of 0.695 in the Hosmer-Lemeshow test)
VAI	< 0.001	1.412	1.186-1.697	< 0.001^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)	1.516^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)	1.314-2.154^b b Multivariate analysis Model 2 (the goodness of fit of the model was confirmed by a P-value of 0.741 in the Hosmer-Lemeshow test)

Authors' roles & responsibilities
ME	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; drafting the work or revising it critically for important intellectual content; final approval of the version to be published
KKO	Substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work; final approval of the version to be published
MS	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; final approval of the version to be published
OG	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; final approval of the version to be published
SY	Drafting the work or revising it critically for important intellectual content; final approval of the version to be published
AFO	Drafting the work or revising it critically for important intellectual content; final approval of the version to be published

\begin{matrix} Females : VAI (\frac{WC}{36.58 x (1.89 x BMI)}) x (\frac{TG}{0.81}) x (\frac{1.52}{HDL}) \\ Males : VAI = (\frac{WC}{39.68 x (1.88 x BMI)}) x (\frac{TG}{1.03}) x (\frac{1.31}{HDL}) \end{matrix}

[1] Correspondence Address: Mesut Engin, https://orcid.org/0000-0003-2418-5823, Department of Cardiovascular Surgery, University of Health Sciences, Mehmet Akif İnan Training and Research Hospital, Esentepe Town. Ertuğrul Street, Karaköprü/Şanlıurfa, Turkey - Zip Code: 63200. E-mail: mesut_kvc_cor@hotmail.com

Brasil

Brasil

Visceral Adiposity Index and Prognostic Nutritional Index in Predicting Atrial Fibrillation after On-Pump Coronary Artery Bypass Operations: a Prospective Study

Abstract

Introduction:

Methods:

Results:

Conclusion: