The C‐reactive protein/albumin ratio as a new predictor for postoperative atrial fibrillation after coronary artery bypass graft surgery

Abstract

Background This study aimed to investigate the predictive significance of C‐reactive protein/albumin ratio for postoperative atrial fibrillation occurrence in patients who were underwent coronary artery bypass graft surgery. Methods Among 830 patients who underwent coronary artery bypass grafting with cardiopulmonary bypass between January 2016 and February 2020, 137 patients with no prior arrhythmia history were included in this cross sectional study. Results One hundred and thirty‐seven (16.5%) patients developed atrial fibrillation in postoperative period. Patients who experienced postoperative atrial fibrillation were more likely to be older but displayed similar rates of diabetes mellitus, hypertension, hypercholesterolemia, cerebrovascular disease, peripheral vascular disease and chronic obstructive pulmonary disease. For prediction of postoperative atrial fibrillation development, diagnostic odds ratio (OR) and positive likelihood ratio of C‐reactive protein/albumin ratio value (OR: 1.854; confidence interval [CI]: 1.598‐2.142; P < .001) was higher than serum C‐reactive protein and albumin levels. (OR: 1.159; CI: 1.115‐1.201; P < .001; OR: 0.438; CI: 0.258‐0.865; P < .001, respectively). Which means that C‐reactive protein/albumin ratio may detect postoperative atrial fibrillation development better C‐reactive protein itself. Conclusion Based on our results, patients who developed postoperative atrial fibrillation after coronary artery bypass grafting had significantly higher preoperative C‐reactive protein/albumin ratio levels than patients who remained in normal sinus rhythm in the postoperative period. Also, higher C‐reactive protein/albumin ratio value was one of the independent predictive factors for postoperative atrial fibrillation. Therefore, we concluded that evaluating preoperative C‐reactive protein/albumin ratio value might provide early identification of patients with high risk for postoperative atrial fibrillation.

Relationship Between Serum Albumin and Risk of Atrial Fibrillation: A Dose-Response Meta-Analysis

“…Eight studies ( 7 – 11 , 20 – 23 ) (nine cohorts) with 28,641 participants were included in the exposure–effect analysis. A 10-g/L increment in serum albumin decreased the risk of AF by 36% (95% CI: 0.51–0.81, I 2 = 87%, P < 0.001) ( Figure 2B ).…”

“…Decreased serum albumin levels imply an undernourished state, which usually leads to poor clinical outcomes. For example, AF post cardiac operation was one of the most common complications, low albumin levels have been reported to be a significant predictor for AF after coronary artery bypass graft surgery ( 7 ). However, currently, there is limited evidence to assess the effect of albumin on reducing the risk of AF.…”

“…The details of the reasons to exclude them are described in Supplementary Table 3. Finally, 9 (7)(8)(9)(10)(11)(20)(21)(22)(23) eligible studies (10 cohorts) with 32,130 individuals were included.…”

“…Hypoalbuminemia, usually defined as <35 g/L, is a significant indicator of malnutrition, inflammation, or cachexia and has been recognized as a robust biomarker for various noncardiovascular and cardiovascular diseases (3,4) in the general population or patients with coexisting diverse comorbidities (5,6). Several studies and our previous study have reported the malnutrition status and the risk of AF (7)(8)(9)(10)(11) as an indicator of malnutrition, however, the serum albumin and associated risk of AF is inconclusive. Moreover, the dose-response relationship of albumin and AF is still unclear.…”

Molecular Basis of Atrial Fibrillation Initiation and Maintenance

“…Steroidal anti-inflammatory agents can suppress atrial tachycardia induced electrophysiological changes in dogs through significantly reducing C-reactive protein (CRP) and attenuating the tachycardia induced activation of endothelial nitric oxide synthases (eNOS) [124]. Patients developing AF after coronary bypass surgery have been shown to have significantly higher preoperative CRP levels [125]. Additionally, increased CRP baseline levels have been linked to an increased risk of developing AF in the general population in a Korean health screening program spanning 11 years and a stepwise CRP elevation was seen with an increasing AF burden [126,127].…”