Circulating Levels of Ferritin, RDW, PTLs as Predictive Biomarkers of Postoperative Atrial Fibrillation Risk after Cardiac Surgery in Extracorporeal Circulation

Altieri, Claudia; Pisano, Calogera; Vincenzo, Labriola; Ferrante, Maria Sabrina; Pellerito, Valentina; Nardi, Paolo; Bassano, Carlo; Buioni, Dario; Greco, Ernesto; Ruvolo, Giovanni; Balistreri, Carmela Rita

doi:10.3390/ijms232314800

Cited by 6 publications

(3 citation statements)

References 40 publications

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“…It is significantly raised in AF. [332,333] Fibrinogen Fibrinogen (including γ ′ [334]) levels are commonly raised in inflammatory diseases [335]. Fibrinogen levels are higher in individuals with AF (and in those having a higher CHA 2 DS 2 -VASc score and likelihood of stroke), consistent with a role of microclots in the onset of AF.…”

Section: Ferritinmentioning

confidence: 92%

Fibrinaloid Microclots and Atrial Fibrillation

Kell,

Lip,

Pretorius

2024

Biomedicines

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Atrial fibrillation (AF) is a comorbidity of a variety of other chronic, inflammatory diseases for which fibrinaloid microclots are a known accompaniment (and in some cases, a cause, with a mechanistic basis). Clots are, of course, a well-known consequence of atrial fibrillation. We here ask the question whether the fibrinaloid microclots seen in plasma or serum may in fact also be a cause of (or contributor to) the development of AF. We consider known ‘risk factors’ for AF, and in particular, exogenous stimuli such as infection and air pollution by particulates, both of which are known to cause AF. The external accompaniments of both bacterial (lipopolysaccharide and lipoteichoic acids) and viral (SARS-CoV-2 spike protein) infections are known to stimulate fibrinaloid microclots when added in vitro, and fibrinaloid microclots, as with other amyloid proteins, can be cytotoxic, both by inducing hypoxia/reperfusion and by other means. Strokes and thromboembolisms are also common consequences of AF. Consequently, taking a systems approach, we review the considerable evidence in detail, which leads us to suggest that it is likely that microclots may well have an aetiological role in the development of AF. This has significant mechanistic and therapeutic implications.

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Section: Ferritinmentioning

confidence: 92%

Fibrinaloid Microclots and Atrial Fibrillation

Kell,

Lip,

Pretorius

2024

Biomedicines

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“…In recent years, increasing attention has been paid to hematologic biomarkers that can reflect underlying inflammatory states and may hold prognostic value for various postoperative complications (12)(13)(14). The systemic immune-inflammation index (SII), calculated as the product of peripheral neutrophil, platelet, and lymphocyte counts, provides an integrated measure of the inflammatory and prothrombotic response (15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Systemic immune–inflammation index for predicting postoperative atrial fibrillation following cardiac surgery: a meta-analysis

Chen,

Liu,

Hsu

et al. 2024

Front. Cardiovasc. Med.

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BackgroundPostoperative atrial fibrillation (POAF) is a frequent complication that may increase morbidity and mortality risk following cardiac surgery. The systemic immune–inflammation index (SII) is an emerging biomarker that provides an integrated measure of inflammation by incorporating neutrophil, lymphocyte, and platelet counts. Recent studies have reported associations between elevated SII and increased POAF risk; however, significant heterogeneity exists regarding its predictive efficacy. This meta-analysis aimed to assess SII's diagnostic efficacy for predicting POAF risk.MethodsTo synthesize existing evidence on the ability of perioperative SII for predicting POAF in patients undergoing cardiac surgery, a systematic review and meta-analysis was conducted. In August 2023, a comprehensive literature search was performed to identify relevant studies reporting SII cutoff values with corresponding sensitivity and specificity. The primary aim was to evaluate SII's diagnostic utility for predicting POAF, whereas secondary outcomes included the pooled incidence of POAF and the relationship between the SII and POAF.ResultsEight studies published between 2021 and 2023 with 3,245 patients were included. Six studies involved coronary artery bypass grafting (CABG) surgery; one encompassed various cardiac procedures, and another focused solely on mitral valve surgery. The pooled incidence of POAF was 23.6% [95% confidence interval (CI), 18.7%–29.2%]. Elevated SII significantly increased the odds of POAF by 3.24-fold (odds ratio, 3.24; 95% CI, 1.6–6.55; p = 0.001). SII's pooled sensitivity and specificity for predicting POAF were 0.80 (95% CI, 0.68–0.89) and 0.53 (95% CI, 0.23–0.8), respectively. The SII had moderate predictive accuracy based on a hierarchical summary receiver operating characteristic (HSROC) area under the curve of 0.78 (95% CI, 0.74–0.81). Subgroup analyses, whether focusing on CABG alone or CABG with cardiopulmonary bypass (CPB), both indicated an area under the HSROC curve of 0.78 (95% CI, 0.74–0.81).ConclusionElevated SII is significantly correlated with an increased POAF risk following cardiac surgery, highlighting its utility as a predictive biomarker. Considering its moderate diagnostic accuracy, further research is essential for clarifying SII's clinical effectiveness, either as an independent predictor or combined with other risk factors, for stratifying patients at high POAF risk.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier [CRD42023456128].

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“…The prediction of atrial fibrillation in patients receiving extracorporeal circulation after cardiac surgery is the subject of the original article of Altieri et al [6]. Postoperative atrial fibrillation is very frequent for patients undergoing conventional extracorporeal circulation after surgery, but its pathophysiology needs to be better clarified.…”

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confidence: 99%