Kirolos A Jacob1, Marc P Buijsrogge2, Jos F Frencken3, Maarten J Ten Berg4, Willem J L Suyker2, Diederik van Dijk2, Jan M Dieleman2. 1. Department of Cardio-thoracic Surgery, University Medical Centre, Utrecht, The Netherlands; Department of Anesthesiology and Intensive Care Medicine, University Medical Centre, Utrecht, The Netherlands. Electronic address: k.a.jacob@umcutrecht.nl. 2. Department of Cardio-thoracic Surgery, University Medical Centre, Utrecht, The Netherlands. 3. Department of Anesthesiology and Intensive Care Medicine, University Medical Centre, Utrecht, The Netherlands. 4. Department of Clinical Chemistry and Hematology, University Medical Centre, Utrecht, The Netherlands.
Abstract
BACKGROUND: Postoperative new-onset atrial fibrillation (PNAF) is the most common complication following cardiac surgery. The inflammatory response, as a potential underlying mechanism, has been extensively studied. In small studies, the white blood cell count (WBC) has been shown to be the only consistent inflammatory marker associated with PNAF. This study aimed to determine the association between perioperative WBC response and PNAF in a larger study cohort. METHODS: Patients ≥18years, undergoing elective cardiac surgery with a preoperative sinus rhythm were included. WBC was routinely measured preoperatively, and daily during the first four postoperative days. Main outcomes were the difference between peak postoperative WBC and neutrophil/lymphocyte ratio (N/L ratio) and preoperative WBC and N/L ratio (ΔWBC and ΔN/L ratio respectively). Development of PNAF was evaluated in all patients with continuous 12-lead ECG monitoring. RESULTS: 657 patients were included and 277 (42%) developed PNAF. Univariable analyses showed a statistically significant relationship between ΔWBC (P=0.030) and ΔN/L ratio (P=0.002), and PNAF. In multivariable analysis no significant relationship was found between ΔWBC (OR: 1.14 per 1×109/L increase; 95% CI: 0.65-2.03; P=0.645), ΔN/L ratio (OR: 1.65 per 1×109/L increase; 95% CI: 0.94-2.90; P=0.089), and PNAF. Increasing age (OR: 1.08 per year; 95% CI: 1.01-1.16; P=0.022) and (additional) valve surgery (versus CABG) (OR: 4.96; 95% CI: 2.07-6.91; P≤0.001) were associated with PNAF. CONCLUSIONS: The perioperative WBC response and its components were not associated with the development of PNAF.
BACKGROUND: Postoperative new-onset atrial fibrillation (PNAF) is the most common complication following cardiac surgery. The inflammatory response, as a potential underlying mechanism, has been extensively studied. In small studies, the white blood cell count (WBC) has been shown to be the only consistent inflammatory marker associated with PNAF. This study aimed to determine the association between perioperative WBC response and PNAF in a larger study cohort. METHODS:Patients ≥18years, undergoing elective cardiac surgery with a preoperative sinus rhythm were included. WBC was routinely measured preoperatively, and daily during the first four postoperative days. Main outcomes were the difference between peak postoperative WBC and neutrophil/lymphocyte ratio (N/L ratio) and preoperative WBC and N/L ratio (ΔWBC and ΔN/L ratio respectively). Development of PNAF was evaluated in all patients with continuous 12-lead ECG monitoring. RESULTS: 657 patients were included and 277 (42%) developed PNAF. Univariable analyses showed a statistically significant relationship between ΔWBC (P=0.030) and ΔN/L ratio (P=0.002), and PNAF. In multivariable analysis no significant relationship was found between ΔWBC (OR: 1.14 per 1×109/L increase; 95% CI: 0.65-2.03; P=0.645), ΔN/L ratio (OR: 1.65 per 1×109/L increase; 95% CI: 0.94-2.90; P=0.089), and PNAF. Increasing age (OR: 1.08 per year; 95% CI: 1.01-1.16; P=0.022) and (additional) valve surgery (versus CABG) (OR: 4.96; 95% CI: 2.07-6.91; P≤0.001) were associated with PNAF. CONCLUSIONS: The perioperative WBC response and its components were not associated with the development of PNAF.
Authors: Dursun Topal; Ufuk Turan Kursat Korkmaz; Yusuf Velioglu; Ahmet Yuksel; Ibrahim Donmez; Erhan Renan Uçaroğlu; Seyit Ali Kayis Journal: Rev Assoc Med Bras (1992) Date: 2022-09 Impact factor: 1.712