title: Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting.
abstract: The neutrophil/lymphocyte (N/L) ratio integrates information on the inflammatory milieu and physiologic stress. It is an emerging marker of prognosis in patients with cardiovascular disease. We investigated the relation between the N/L ratio and postoperative atrial fibrillation (AF) in patients undergoing coronary artery bypass grafting. In a prospective cohort study, 275 patients undergoing nonemergency coronary artery bypass grafting were recruited. Patients with previous atrial arrhythmia or requiring concomitant valve surgery were excluded. The N/L ratio was determined preoperatively and on postoperative day 2. The study end point was AF lasting >30 seconds. Patients who developed AF (n = 107, 39%) had had a greater preoperative N/L ratio (median 3.0 vs 2.4, p = 0.001), but no differences were found in the other white blood cell parameters or C-reactive protein. The postoperative N/L ratio was greater in patients with AF (day 2, median 9.2 vs 7.2, p <0.001), and in multivariate models, a greater postoperative N/L ratio was independently associated with a greater incidence of AF (odds ratio 1.10 per unit increase, p = 0.003: odds ratio for N/L ratio >10.14 [optimal postoperative cutoff in our cohort], 2.83 per unit, p <0.001). Elevated pre- and postoperative N/L ratios were associated with an increased occurrence of AF after coronary artery bypass grafting. In conclusion, these results support an inflammatory etiology in postoperative AF but suggest that other factors are also important.
authors.affiliation: Department of Cardiology, University of Aberdeen and Aberdeen Royal Infirmary, Aberdeen, United Kingdom.
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Gibson
authors.forename: Brian H
authors.initials: BH
authors.lastname: Cuthbertson
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Croal
authors.forename: Daniela
authors.initials: D
authors.lastname: Rae
authors.forename: Hussein
authors.initials: H
authors.lastname: El-Shafei
authors.forename: George
authors.initials: G
authors.lastname: Gibson
authors.forename: Robert R
authors.initials: RR
authors.lastname: Jeffrey
authors.forename: Keith G
authors.initials: KG
authors.lastname: Buchan
authors.forename: Graham S
authors.initials: GS
authors.lastname: Hillis
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011237:Predictive Value of Tests; D012307:Risk Factors
chemical_list: D002097:C-Reactive Protein