COULD ALBUMIN / GLOBULIN RATIO BE AN EARLY PREDICTIVE MARKER IN PREDICTING THE DEVELOPMENT OF POSTOPERATIVE ATRIAL FIBRILLATION ?
Journal Title: Kocatepe Medical Journal - Year 2022, Vol 23, Issue 1
Abstract
OBJECTIVE: Atrial fibrillation (AF) is a widely encountered type of arrhythmia in clinical practice and is a well-defined complication that occurs frequently after open heart surgery. Postoperative AF (POAF) has been reported in 5-40% of patients within 2-4 days with the highest incidence on the second day after coronary artery bypass grafting (CABG) surgery. The pathophysiology of POAF is not fully understood. The most important reason for this is that many factors involved in pathology have been shown. These factors may be the non-physiological nature of cardiopulmonary bypass (CPB), inflammatory response, cardioplegic arrest, cardiac manipulations, myocardial ischemia-reperfusion injury and the pharmacological agents used. Albumin and globulins are two major serum protein components involved in the systemic inflammatory process. While serum albumin level is closely associated with chronic inflammation, increased levels of globulins also serve as a marker of chronic inflammatory response and are important in reflecting the cumulative exposure of various proinflammatory cytokines. In this study, we aimed to investigate the predictive significance of Albumin globulin ratio (AGO) in the development of POAF by evaluating it both independently and together with other risk factors suggested for the development of POAF. MATERIAL AND METHODS: The data of 288 patients (62 females and 226 males) who underwent isolated CABG surgery between 01.01.2018 and 31.12.2020 in the Cardiovascular Surgery Department of Erciyes University Faculty of Medicine were retrospectively analyzed. Preoperative and postoperative blood values, baseline characteristics and intraoperative parameters of the patients were evaluated. Multiple regression analysis was performed using the Backward: Wald method. RESULTS: The median age among 288 patients was 63 (56-69)years, and the median age in the AF-developing group was 66.0 (61.2-72.0)years (P: 0.003). When the patients were grouped according to their POAF development status, there was a statistically significant difference between two groups in terms of age (P: 0.003), total anastomosis number (P: 0.004), Saphenous Vein graft (SVG) distal anastomosis number (P: 0.006), preoperative platelet number (P: 0.027), Blood Urea Nitrogen (BUN) (P: 0.004), creatinine (P: 0.001) and postoperative BUN (P: 0.005) values, while there was no statistically significant difference between the groups in terms of preoperative and postoperative AGO values (P: 0.140, P: 0.313). According to Backward: Wald method in multiple regression analysis, in the last step, in patients with POAF; age, preoperative platelet numbers, creatinine levels, presence of peripheral artery disease (PAD) and number of total anastomoses in the patients with POAF were found to be independent risk factors. CONCLUSIONS: In this study, no statistically significant relationship was found between AGO values and the development of POAF. It has been found that preoperative creatinine level and platelet numbers were important in the emergence of POAF in patients a CABG both in the general population and the Diabetes Mellitus patients as a separate subgroup. Additionally, preoperative creatinine, age, total anastomosis number and preoperative platelet number were independent risk factors.
Authors and Affiliations
Rifat OZMEN Inayet GUNTURK Aydın TUNCAY Şaban KELEŞOĞLU Cevat YAZICI Osman Okan ÖZOCAK Kutay TAŞDEMİR
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- EP ID EP699155
- DOI https://doi.org/10.18229/kocatepetip.867481
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