open access

Vol 76, No 2 (2018)
Original articles
Published online: 2017-12-08
Submitted: 2017-10-11
Accepted: 2017-11-20
Get Citation

Baseline and postoperative levels of C-reactive protein and interleukins as inflammatory predictors of atrial fibrillation following cardiac surgery: a systematic review and meta-analysis

Alexander Weymann, Aron-Frederik Popov, Anton Sabashnikov, Sadeq Ali-Hasan-Al-Saegh, Mikhail Ryazanov, Gary Tse, Seyed Jalil Mirhosseini, Tong Liu, Mohammadreza Lotfaliani, Meghdad Sedaghat, William L. Baker, Azam Ghanei, Senol Yavuz, Mohamed Zeriouh, Payman Izadpanah, Hamidreza Dehghan, Luca Testa, Maryam Nikfard, Michel Pompeu Barros de Oliveira Sá, Ahmed Mashhour, Luis Nombela-Franco, Mohammad Rezaeisadrabadi, Fabrizio D'Ascenzo, Konstantin Zhigalov, Umberto Benedetto, Soroosh Aminolsharieh Najafi, Marcin Szczechowicz, Leonardo Roever, Lei Meng, Mengqi Gong, Abhishek J. Deshmukh, Tullio Palmerini, Cecilia Linde, Krzysztof J. Filipiak, Gregg W. Stone, Giuseppe Biondi-Zoccai, Hugh Calkins
DOI: 10.5603/KP.a2017.0242
·
Pubmed: 29354906
·
Kardiol Pol 2018;76(2):440-451.

open access

Vol 76, No 2 (2018)
Original articles
Published online: 2017-12-08
Submitted: 2017-10-11
Accepted: 2017-11-20

Abstract

Background: Postoperative atrial fibrillation (POAF) is a leading arrhythmia with high incidence and serious clinical implications after cardiac surgery. Cardiac surgery is associated with systemic inflammatory response including increase in cytokines and activation of endothelial and leukocyte responses.

Aim This systematic review and meta-analysis aimed to determine the strength of evidence for evaluating the association of inflammatory markers, such as C-reactive protein (CRP) and interleukins (IL), with POAF following isolated coronary artery bypass grafting (CABG), isolated valvular surgery, or a combination of these procedures.

Methods: We conducted a meta-analysis of studies evaluating measured baseline (from one week before surgical procedures) and postoperative levels (until one week after surgical procedures) of inflammatory markers in patients with POAF. A compre­hensive search was performed in electronic medical databases (Medline/PubMed, Web of Science, Embase, Science Direct, and Google Scholar) from their inception through May 2017 to identify relevant studies. A comprehensive subgroup analysis was performed to explore potential sources of heterogeneity.

Results: A literature search of all major databases retrieved 1014 studies. After screening, 42 studies were analysed including a total of 8398 patients. Pooled analysis showed baseline levels of CRP (standard mean difference [SMD] 0.457 mg/L, p < 0.001), baseline levels of IL-6 (SMD 0.398 pg/mL, p < 0.001), postoperative levels of CRP (SMD 0.576 mg/L, p < 0.001), postoperative levels of IL-6 (SMD 1.66 pg/mL, p < 0.001), postoperative levels of IL-8 (SMD 0.839 pg/mL, p < 0.001), and postoperative levels of IL-10 (SMD 0.590 pg/mL, p < 0.001) to be relevant inflammatory parameters significantly associated with POAF.

Conclusions: Perioperative inflammation is proposed to be involved in the pathogenesis of POAF. Therefore, perioperative assessment of CRP, IL-6, IL-8, and IL-10 can help clinicians in terms of predicting and monitoring for POAF.

Abstract

Background: Postoperative atrial fibrillation (POAF) is a leading arrhythmia with high incidence and serious clinical implications after cardiac surgery. Cardiac surgery is associated with systemic inflammatory response including increase in cytokines and activation of endothelial and leukocyte responses.

Aim This systematic review and meta-analysis aimed to determine the strength of evidence for evaluating the association of inflammatory markers, such as C-reactive protein (CRP) and interleukins (IL), with POAF following isolated coronary artery bypass grafting (CABG), isolated valvular surgery, or a combination of these procedures.

Methods: We conducted a meta-analysis of studies evaluating measured baseline (from one week before surgical procedures) and postoperative levels (until one week after surgical procedures) of inflammatory markers in patients with POAF. A compre­hensive search was performed in electronic medical databases (Medline/PubMed, Web of Science, Embase, Science Direct, and Google Scholar) from their inception through May 2017 to identify relevant studies. A comprehensive subgroup analysis was performed to explore potential sources of heterogeneity.

Results: A literature search of all major databases retrieved 1014 studies. After screening, 42 studies were analysed including a total of 8398 patients. Pooled analysis showed baseline levels of CRP (standard mean difference [SMD] 0.457 mg/L, p < 0.001), baseline levels of IL-6 (SMD 0.398 pg/mL, p < 0.001), postoperative levels of CRP (SMD 0.576 mg/L, p < 0.001), postoperative levels of IL-6 (SMD 1.66 pg/mL, p < 0.001), postoperative levels of IL-8 (SMD 0.839 pg/mL, p < 0.001), and postoperative levels of IL-10 (SMD 0.590 pg/mL, p < 0.001) to be relevant inflammatory parameters significantly associated with POAF.

Conclusions: Perioperative inflammation is proposed to be involved in the pathogenesis of POAF. Therefore, perioperative assessment of CRP, IL-6, IL-8, and IL-10 can help clinicians in terms of predicting and monitoring for POAF.

Get Citation

Keywords

atrial fibrillation, inflammation, C-reactive protein, cytokines, interleukins, review, meta-analysis

Supplementary Files (13)
Supplemental Figure 1. Forest plot of SMD for association between baseline level of IL-8 and occurrence of POAF.
View
11KB
Supplemental Figure 2. Forest plot of SMD for association between baseline level of IL-10 and occurrence of POAF.
View
16KB
Supplemental Figure 3. Forest plot of SMD for association between postoperative level of IL-8 and occurrence of POAF.
View
19KB
Supplemental Figure 4. Forest plot of SMD for association between postoperative level of IL-10 and occurrence of POAF.
View
21KB
Supplemental Figure 5. Funnel plot for publication bias of studies investigating of baseline level of CRP
View
16KB
Supplemental Figure 6. Funnel plot for publication bias of studies investigating of baseline level of IL-6
View
12KB
Supplemental Figure 7. Funnel plot for publication bias of studies investigating of baseline level of IL-8
View
14KB
Supplemental Figure 8. Funnel plot for publication bias of studies investigating of baseline level of IL-10
View
18KB
Supplemental Figure 9. Funnel plot for publication bias of studies investigating of postoperative level of CRP
View
16KB
Supplemental Figure 10. Funnel plot for publication bias of studies investigating of postoperative level of IL-6
View
16KB
Supplemental Figure 11. Funnel plot for publication bias of studies investigating of postoperative level of IL-8
View
17KB
Supplemental Figure 12. Funnel plot for publication bias of studies investigating of postoperative level of IL-10
View
20KB
Supplemental Tables 1, 2, 3
Download
241KB
About this article
Title

Baseline and postoperative levels of C-reactive protein and interleukins as inflammatory predictors of atrial fibrillation following cardiac surgery: a systematic review and meta-analysis

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 76, No 2 (2018)

Pages

440-451

Published online

2017-12-08

DOI

10.5603/KP.a2017.0242

Pubmed

29354906

Bibliographic record

Kardiol Pol 2018;76(2):440-451.

Keywords

atrial fibrillation
inflammation
C-reactive protein
cytokines
interleukins
review
meta-analysis

Authors

Alexander Weymann
Aron-Frederik Popov
Anton Sabashnikov
Sadeq Ali-Hasan-Al-Saegh
Mikhail Ryazanov
Gary Tse
Seyed Jalil Mirhosseini
Tong Liu
Mohammadreza Lotfaliani
Meghdad Sedaghat
William L. Baker
Azam Ghanei
Senol Yavuz
Mohamed Zeriouh
Payman Izadpanah
Hamidreza Dehghan
Luca Testa
Maryam Nikfard
Michel Pompeu Barros de Oliveira Sá
Ahmed Mashhour
Luis Nombela-Franco
Mohammad Rezaeisadrabadi
Fabrizio D'Ascenzo
Konstantin Zhigalov
Umberto Benedetto
Soroosh Aminolsharieh Najafi
Marcin Szczechowicz
Leonardo Roever
Lei Meng
Mengqi Gong
Abhishek J. Deshmukh
Tullio Palmerini
Cecilia Linde
Krzysztof J. Filipiak
Gregg W. Stone
Giuseppe Biondi-Zoccai
Hugh Calkins

References (61)
  1. Hu X, Yuan L, Wang H, et al. Efficacy and safety of vitamin C for atrial fibrillation after cardiac surgery: A meta-analysis with trial sequential analysis of randomized controlled trials. Int J Surg. 2017; 37: 58–64.
  2. Greenberg JW, Lancaster TS, Schuessler RB, et al. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. Eur J Cardiothorac Surg. 2017; 52(4): 665–672.
  3. Mirhosseini SJ, Forouzannia SK, Sayegh AH, et al. Effect of prophylactic low dose of methylprednisolone on postoperative new atrial fibrillation and early complications in patients with severe LV dysfunction undergoing elective off-pump coronary artery bypass surgery. Acta Med Iran. 2011; 49(5): 288–292.
  4. Weymann A, Ali-Hasan-Al-Saegh S, Sabashnikov A, et al. Prediction of New-Onset and Recurrent Atrial Fibrillation by Complete Blood Count Tests: A Comprehensive Systematic Review with Meta-Analysis. Med Sci Monit Basic Res. 2017; 23: 179–222.
  5. Scott DA, Evered LA, Silbert BS. Cardiac surgery, the brain, and inflammation. J Extra Corpor Technol. 2014; 46(1): 15–22.
  6. Hu YF, Chen YJ, Lin YJ, et al. Inflammation and the pathogenesis of atrial fibrillation. Nat Rev Cardiol. 2015; 12: 230–243.
  7. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5: 13.
  8. Wells GA SB, O’Connell D, Peterson J, et al: The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. 2011. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (2011).
  9. Xu S, Zhang J, Xu YL, et al. Relationship between Angiotensin Converting Enzyme, Apelin, and New-Onset Atrial Fibrillation after Off-Pump Coronary Artery Bypass Grafting. Biomed Res Int. 2017; 2017: 7951793.
  10. Saskin H, Serhan Ozcan K, Yilmaz S. High preoperative monocyte count/high-density lipoprotein ratio is associated with postoperative atrial fibrillation and mortality in coronary artery bypass grafting. Interact Cardiovasc Thorac Surg. 2017; 24(3): 395–401.
  11. Şaşkın H, Düzyol Ç, Aksoy R, et al. Do preoperative C-reactive protein and mean platelet volume levels predict development of postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting? Postepy Kardiol Interwencyjnej. 2016; 12(2): 156–163.
  12. Cerit L, Duygu H, Gulsen K, et al. Is SYNTAX Score Predictive of Atrial Fibrillation after On-Pump Coronary Artery Bypass Graft Surgery? Korean Circ J. 2016; 46(6): 798–803.
  13. Anatoĺevna RO, Veniaminovich FO, Mikhaylovich KS. Predictors of new-onset atrial fibrillation in elderly patients with coronary artery disease after coronary artery bypass graft. J Geriatr Cardiol. 2016; 13(5): 444–449.
  14. Geçmen Ç, Babür Güler G, Erdoğan E, et al. SYNTAX score predicts postoperative atrial fibrillation in patients undergoing on-pump isolated coronary artery bypass grafting surgery. Anatol J Cardiol. 2016; 16(9): 655–661.
  15. Korantzopoulos P, Sontis N, Liu T, et al. Association between red blood cell distribution width and postoperative atrial fibrillation after cardiac surgery: A pilot observational study. Int J Cardiol. 2015; 185: 19–21.
  16. Erdem K, Oztürk S, Ayhan S, et al. Predictive value of aortic knob width for postoperative atrial fibrillation in coronary artery bypass surgery. Anadolu Kardiyol Derg. 2014; 14(1): 68–72.
  17. Narducci ML, Pelargonio G, Rio T, et al. Predictors of postoperative atrial fibrillation in patients with coronary artery disease undergoing cardiopulmonary bypass: a possible role for myocardial ischemia and atrial inflammation. J Cardiothorac Vasc Anesth. 2014; 28(3): 512–519.
  18. Limite LR, Magnoni M, Berteotti M, et al. The predictive role of renal function and systemic inflammation on the onset of de novo atrial fibrillation after cardiac surgery. Eur J Prev Cardiol. 2016; 23(2): 206–213.
  19. Erdem K, Ayhan S, Ozturk S, et al. Usefulness of the mean platelet volume for predicting new-onset atrial fibrillation after isolated coronary artery bypass grafting. Platelets. 2014; 25(1): 23–26.
  20. Pilatis ND, Anyfantakis ZA, Spiliopoulos K, et al. The Role of BNP and CRP in Predicting the Development of Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Surgery. ISRN Cardiol. 2013; 2013: 235018.
  21. Cao H, Zhou Q, Wu Y, et al. Preoperative serum soluble receptor activator of nuclear factor-κB ligand and osteoprotegerin predict postoperative atrial fibrillation in patients undergoing cardiac valve surgery. Ann Thorac Surg. 2013; 96(3): 800–806.
  22. Bjorgvinsdottir L, Arnar DO, Indridason OS, et al. Do high levels of n-3 polyunsaturated fatty acids in cell membranes increase the risk of postoperative atrial fibrillation? Cardiology. 2013; 126(2): 107–114.
  23. Sabol F, Jakubová M, Mitro P, et al. [Is there a relationship between inflammatory markers, oxidative stress and postoperative atrial fibrillation?]. Vnitr Lek. 2012; 58(10): 730–734.
  24. Garcia L, Verdejo HE, Kuzmicic J, et al. Impaired cardiac autophagy in patients developing postoperative atrial fibrillation. J Thorac Cardiovasc Surg. 2012; 143(2): 451–459.
  25. Skuladottir GV, Heidarsdottir R, Arnar DO, et al. Plasma n-3 and n-6 fatty acids and the incidence of atrial fibrillation following coronary artery bypass graft surgery. Eur J Clin Invest. 2011; 41(9): 995–1003.
  26. Gabrielli L, Corbalan R, Córdova S, et al. Left atrial dysfunction is a predictor of postcoronary artery bypass atrial fibrillation: association of left atrial strain and strain rate assessed by speckle tracking. Echocardiography. 2011; 28(10): 1104–1108.
  27. Kaireviciute D, Blann AD, Balakrishnan B, et al. Characterisation and validity of inflammatory biomarkers in the prediction of post-operative atrial fibrillation in coronary artery disease patients. Thromb Haemost. 2010; 104(1): 122–127.
  28. Gasparovic H, Burcar I, Kopjar T, et al. NT-pro-BNP, but not C-reactive protein, is predictive of atrial fibrillation in patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg. 2010; 37(1): 100–105.
  29. Gibson PH, Cuthbertson BH, Croal BL, et al. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol. 2010; 105(2): 186–191.
  30. Ji Q, Mei Y, Wang X, et al. Effect of preoperative atorvastatin therapy on atrial fibrillation following off-pump coronary artery bypass grafting. Circ J. 2009; 73(12): 2244–2249.
  31. Girerd N, Pibarot P, Fournier D, et al. Middle-aged men with increased waist circumference and elevated C-reactive protein level are at higher risk for postoperative atrial fibrillation following coronary artery bypass grafting surgery. Eur Heart J. 2009; 30(10): 1270–1278.
  32. Choi YS, Shim JK, Hong SW, et al. Risk factors of atrial fibrillation following off-pump coronary artery bypass graft surgery: predictive value of C-reactive protein and transfusion requirement. Eur J Cardiothorac Surg. 2009; 36(5): 838–843.
  33. Antoniades C, Van-Assche T, Shirodaria C, et al. Preoperative sCD40L levels predict risk of atrial fibrillation after off-pump coronary artery bypass graft surgery. Circulation. 2009; 120(11 Suppl): S170–S176.
  34. Sezai A, Hata M, Niino T, et al. Study of the factors related to atrial fibrillation after coronary artery bypass grafting: a search for a marker to predict the occurrence of atrial fibrillation before surgical intervention. J Thorac Cardiovasc Surg. 2009; 137(4): 895–900.
  35. Fontes ML, Amar D, Kulak A, et al. Increased preoperative white blood cell count predicts postoperative atrial fibrillation after coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2009; 23(4): 484–487.
  36. Ziabakhsh-Tabari S. Can perioperative C-reactive protein and interleukin-6 levels predict atrial fibrillation after coronary artery bypass surgery? Saudi Med J. 2008; 29(10): 1429–1431.
  37. Oc M, Ucar HI, Pinar A, et al. Heat shock protein70: a new marker for subsequent atrial fibrillation development? Artif Organs. 2008; 32(11): 846–850.
  38. Canbaz S, Erbas H, Huseyin S, et al. The role of inflammation in atrial fibrillation following open heart surgery. J Int Med Res. 2008; 36(5): 1070–1076.
  39. Qian Yj, Xiao Xj, Luo Tx, et al. [Study on levels of angiotensin converting enzyme and C-reactive protein in peripheral blood of mitral valve replacement preoperative patients with atrial fibrillation]. Sichuan Da Xue Xue Bao Yi Xue Ban. 2008; 39(1): 122–125.
  40. Pretorius M, Donahue BS, Yu C, et al. Plasminogen activator inhibitor-1 as a predictor of postoperative atrial fibrillation after cardiopulmonary bypass. Circulation. 2007; 116(11 Suppl): I1–I7.
  41. Ucar HI, Tok M, Atalar E, et al. Predictive significance of plasma levels of interleukin-6 and high-sensitivity C-reactive protein in atrial fibrillation after coronary artery bypass surgery. Heart Surg Forum. 2007; 10(2): E131–E135.
  42. Ahlsson AJ, Bodin L, Lundblad OH, et al. Postoperative atrial fibrillation is not correlated to C-reactive protein. Ann Thorac Surg. 2007; 83(4): 1332–1337.
  43. Hogue CW, Palin CA, Kailasam R, et al. C-reactive protein levels and atrial fibrillation after cardiac surgery in women. Ann Thorac Surg. 2006; 82(1): 97–102.
  44. Ishida K, Kimura F, Imamaki M, et al. Relation of inflammatory cytokines to atrial fibrillation after off-pump coronary artery bypass grafting. Eur J Cardiothorac Surg. 2006; 29(4): 501–505.
  45. Lo B, Fijnheer R, Nierich AP, et al. C-reactive protein is a risk indicator for atrial fibrillation after myocardial revascularization. Ann Thorac Surg. 2005; 79(5): 1530–1535.
  46. Cosgrave J, Foley JB, Kelly R, et al. Perioperative serum inflammatory response and the development of atrial fibrillation after coronary artery bypass surgery. Heart. 2005; 91(11): 1475–1476.
  47. Mandal K, Torsney E, Poloniecki J, et al. Association of high intracellular, but not serum, heat shock protein 70 with postoperative atrial fibrillation. Ann Thorac Surg. 2005; 79(3): 865–71; discussion 871.
  48. Fontes ML, Mathew JP, Rinder HM, et al. Multicenter Study of Perioperative Ischemia (McSPI) Research Group. Atrial fibrillation after cardiac surgery/cardiopulmonary bypass is associated with monocyte activation. Anesth Analg. 2005; 101(1): 17–23, table of contents.
  49. Wang Ch, Hu Dy, Tang Cz, et al. [Changes of interleukin-1beta and tumor necrosis factor-alpha of right atrial appendages in patients with rheumatic valvular disease complicated with chronic atrial fibrillation]. Zhonghua Xin Xue Guan Bing Za Zhi. 2005; 33(6): 522–525.
  50. Mandal K, Jahangiri M, Mukhin M, et al. Association of anti-heat shock protein 65 antibodies with development of postoperative atrial fibrillation. Circulation. 2004; 110(17): 2588–2590.
  51. Weymann A, Ali-Hasan-Al-Saegh S, Sabashnikov A, et al. Surgery And Cardiology-Group Imcsc-Group IM. Platelets Cellular and Functional Characteristics in Patients with Atrial Fibrillation: A Comprehensive Meta-Analysis and Systematic Review. Med Sci Monit Basic Res. 2017; 23: 58–86.
  52. Weymann A, Sabashnikov A, Ali-Hasan-Al-Saegh S, et al. Cardiac Surgery And Cardiology-Group Imcsc-Group IM. Predictive Role of Coagulation, Fibrinolytic, and Endothelial Markers in Patients with Atrial Fibrillation, Stroke, and Thromboembolism: A Meta-Analysis, Meta-Regression, and Systematic Review. Med Sci Monit Basic Res. 2017; 23: 97–140.
  53. Ali-Hassan-Sayegh S, Mirhosseini SJ, Tahernejad M, et al. Impact of antioxidant supplementations on cardio-renal protection in cardiac surgery: an updated and comprehensive meta-analysis and systematic review. Cardiovasc Ther. 2016; 34(5): 360–370.
  54. Weymann A, Ali-Hasan-Al-Saegh S, Popov AF, et al. Hematologic indices as predictors of atrial fibrillation following isolated coronary artery bypass grafting, valvular surgery or combined procedures: A systematic review with meta-analysis. Kardiol Pol. 2017 [Epub ahead of print].
  55. Anogeianaki A, Angelucci D, Cianchetti E, et al. Atherosclerosis: a classic inflammatory disease. Int J Immunopathol Pharmacol. 2011; 24(4): 817–825.
  56. Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg. 2002; 21(2): 232–244.
  57. Zakkar M, Ascione R, James AF, et al. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther. 2015; 154: 13–20.
  58. Dreyer WJ, Phillips SC, Lindsey ML, et al. Interleukin 6 induction in the canine myocardium after cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2000; 120(2): 256–263.
  59. Hu YF, Chen YJ, Lin YJ, et al. Inflammation and the pathogenesis of atrial fibrillation. Nat Rev Cardiol. 2015; 12(4): 230–243.
  60. Yo CH, Lee SH, Chang SS, et al. Value of high-sensitivity C-reactive protein assays in predicting atrial fibrillation recurrence: a systematic review and meta-analysis. BMJ Open. 2014; 4(2): e004418.
  61. Rezaei Y, Gholami-Fesharaki M, Dehghani MR, et al. Statin Antiarrhythmic Effect on Atrial Fibrillation in Statin-Naive Patients Undergoing Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials. J Cardiovasc Pharmacol Ther. 2016; 21(2): 167–176.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., Świętokrzyska 73 street, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl