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Original articles
Published online: 2017-09-13
Submitted: 2017-06-20
Accepted: 2017-08-03
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Hematologic indices as predictors of atrial fibrillation following isolated coronary artery bypass grafting, valvular surgery or combined procedures: A systematic review with meta-analysis

Alexander Weymann, Sadeq Ali-Hasan-Al-Saegh, Aron-Frederik Popov, Anton Sabashnikov, Seyed Jalil Mirhosseini, Tong Liu, Gary Tse, Mohammadreza Lotfaliani, Azam Ghanei, Luca Testa, Fabrizio D'Ascenzo, Umberto Benedetto, Hamidreza Dehghan, Leonardo Roever, Michel Pompeu Barros de Oliveira Sá, William L. Baker, Senol Yavuz, Mohamed Zeriouh, Ahmed Mashhour, Luis Nombela-Franco, Jae-Sik Jang, Lei Meng, Mengqi Gong, Abhishek J. Deshmukh, Tullio Palmerini, Cecilia Linde, Krzysztof J. Filipiak, Giuseppe Biondi-Zoccai, Hugh Calkins, Gregg W. Stone
DOI: 10.5603/KP.a2017.0179

open access

Ahead of print
Original articles
Published online: 2017-09-13
Submitted: 2017-06-20
Accepted: 2017-08-03

Abstract

Background: New postoperative atrial fibrillation (POAF) is one of the most critical and common complications after cardiovascular surgery precipitating early and late morbidities. Complete blood count (CBC) is an imperative blood test in clinical practice routinely used in the examination of cardiovascular diseases. This systematic review with meta-analysis aimed to determine the strength of evidence for evaluating the association of hematological indices in the CBC tests with atrial fibrillation following isolated coronary artery bypass graft (CABG), isolated valvular surgery or combination of these treatments.

Methods: We conducted a meta-analysis of studies evaluating pre and postoperative hematologic indices in patients with POAF. A comprehensive subgroup analysis was performed to explore potential sources of heterogeneity.

Results: The literature search of all major databases retrieved 732 studies. After screening, 22 studies were analyzed including a total of 6098 patients. Pooled analysis showed preoperative platelet count (PC) (weighted mean difference (WMD)= -7.07 x109/L and p<0.001), preoperative mean platelet volume (MPV) (WMD=0.53 FL and p<0.001), preoperative white blood cell (WBC) (WMD=0.130 x 109/L and p<0.001), preoperative neutrophil to lymphocyte ratio (NLR) (WMD=0.33 and p<0.001), and preoperative red blood cell distribution width (RDW) (WMD=0.36% and p<0.001), and postoperative WBC (WMD= 1.36 x 109/L and p<0.001), and postoperative NLR (WMD=0.74 and p<0.001) as associated factors with POAF.

Conclusions: Hematological indices may predict the risk of POAF before surgery. These easily performable tests should definitely be taken into account in patients undergoing isolated CABG, valvular surgery or combined procedures.

Abstract

Background: New postoperative atrial fibrillation (POAF) is one of the most critical and common complications after cardiovascular surgery precipitating early and late morbidities. Complete blood count (CBC) is an imperative blood test in clinical practice routinely used in the examination of cardiovascular diseases. This systematic review with meta-analysis aimed to determine the strength of evidence for evaluating the association of hematological indices in the CBC tests with atrial fibrillation following isolated coronary artery bypass graft (CABG), isolated valvular surgery or combination of these treatments.

Methods: We conducted a meta-analysis of studies evaluating pre and postoperative hematologic indices in patients with POAF. A comprehensive subgroup analysis was performed to explore potential sources of heterogeneity.

Results: The literature search of all major databases retrieved 732 studies. After screening, 22 studies were analyzed including a total of 6098 patients. Pooled analysis showed preoperative platelet count (PC) (weighted mean difference (WMD)= -7.07 x109/L and p<0.001), preoperative mean platelet volume (MPV) (WMD=0.53 FL and p<0.001), preoperative white blood cell (WBC) (WMD=0.130 x 109/L and p<0.001), preoperative neutrophil to lymphocyte ratio (NLR) (WMD=0.33 and p<0.001), and preoperative red blood cell distribution width (RDW) (WMD=0.36% and p<0.001), and postoperative WBC (WMD= 1.36 x 109/L and p<0.001), and postoperative NLR (WMD=0.74 and p<0.001) as associated factors with POAF.

Conclusions: Hematological indices may predict the risk of POAF before surgery. These easily performable tests should definitely be taken into account in patients undergoing isolated CABG, valvular surgery or combined procedures.

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Keywords

atrial fibrillation, complete blood count, coronary artery bypass, cardiac surgical procedure, review, meta-analysis

Supplementary Files (15)
Supplemental Table 1. Included, and excluded studies according to primary hematological parameters
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Supplemental Table 2. Extra details of characteristics of each study for exploration of heterogeneity factors.
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Supplemental Table 3. Subgroup-analysis
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Supplemental Figure 1. Funnel plot for publication bias of studies investigating of preoperative platelet count
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Supplemental Figure 2. Funnel plot for publication bias of studies investigating of preoperative mean platelet volume
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Supplemental Figure 3. Funnel plot for publication bias of studies investigating of preoperative white blood cell counts
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Supplemental Figure 4. Funnel plot for publication bias of studies investigating of preoperative neutrophil to lymphocyte ratio
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Supplemental Figure 5. Funnel plot for publication bias of studies investigating of preoperative red blood cell distribution width
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Supplemental Figure 6. Funnel plot for publication bias of studies investigating of preoperative hematocrit
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Supplemental Figure 7. Funnel plot for publication bias of studies investigating of preoperative hemoglobin
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Supplemental Figure 8. Funnel plot for publication bias of studies investigating of postoperative white blood cell counts
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Supplemental Figure 9. Funnel plot for publication bias of studies investigating of postoperative neutrophil to lymphocyte ratio
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Supplemental Figure 10. Funnel plot for publication bias of studies investigating of postoperative hematocrit
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Supplemental Figure 11. Funnel plot for publication bias of studies investigating of postoperative hemoglobin
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Supplemental Data: Checklist
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About this article
Title

Hematologic indices as predictors of atrial fibrillation following isolated coronary artery bypass grafting, valvular surgery or combined procedures: A systematic review with meta-analysis

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Ahead of print

Published online

2017-09-13

DOI

10.5603/KP.a2017.0179

Keywords

atrial fibrillation
complete blood count
coronary artery bypass
cardiac surgical procedure
review
meta-analysis

Authors

Alexander Weymann
Sadeq Ali-Hasan-Al-Saegh
Aron-Frederik Popov
Anton Sabashnikov
Seyed Jalil Mirhosseini
Tong Liu
Gary Tse
Mohammadreza Lotfaliani
Azam Ghanei
Luca Testa
Fabrizio D'Ascenzo
Umberto Benedetto
Hamidreza Dehghan
Leonardo Roever
Michel Pompeu Barros de Oliveira Sá
William L. Baker
Senol Yavuz
Mohamed Zeriouh
Ahmed Mashhour
Luis Nombela-Franco
Jae-Sik Jang
Lei Meng
Mengqi Gong
Abhishek J. Deshmukh
Tullio Palmerini
Cecilia Linde
Krzysztof J. Filipiak
Giuseppe Biondi-Zoccai
Hugh Calkins
Gregg W. Stone

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