POSTOPERATİF ATRİYAL FİBRİLASYON GELİŞİMİNİ ÖNGÖRMEDE ALBUMİN / GLOBULİN ORANI ERKEN PREDİKTİF BİR BELİRTEÇ OLABİLİR Mİ ?

Year 2022, , 107 - 114, 17.01.2022

Rifat Ozmen , Inayet Gunturk , Aydın Tuncay , Şaban Keleşoğlu Cevat Yazıcı , Osman Okan Özocak , Kutay Taşdemir

https://doi.org/10.18229/kocatepetip.867481

Abstract

AMAÇ: Atriyal fibrilasyon (AF), klinik pratikte yaygın olarak karşılaşılan bir aritmi çeşidi olup açık kalp cerrahisi sonrası da sıklıkla ortaya çıkan iyi tanımlanmış bir komplikasyondur. Postoperatif AF (POAF), koroner arter baypas greftleme (KABG) sonrası ikinci günde en yüksek insidansa sahip olmak üzere 2-4 gün içinde hastaların % 5-40’ında rapor edilmiştir. POAF’ın patofizyolojisi tam olarak anlaşılamamıştır. Bunun en önemli nedeni, patolojiye katılan çok sayıda faktörün gösterilmiş olmasıdır. Bu faktörler, kardiyopulmoner baypas (KPB)’ın non-fizyolojik doğası, enflamatuvar cevap, kardiyoplejik arrest, kardiyak manipülasyonlar, miyokardiyal iskemi-reperfüzyon hasarı ve kullanılan farmakolojik ajanlar olabilir. Albumin ve globulinler, sistemik enflamatuvar sürece katılan iki major serum protein kompanentidir. Serum albumin düzeyi kronik enflamasyonla yakından ilişkili iken, globulinlerin artmış seviyeleri de kronik enflamatuvar cevabın bir belirteci olarak işlev görür ve çeşitli proenflamatuvar sitokinlerin kümülatif maruziyeti yansıtması açısından önemlidir. Bu çalışmada Albumin globulin oranı (AGO)’nın, hem bağımsız olarak hem de POAF gelişimi için öne sürülen diğer risk faktörleri ile birlikte değerlendirilerek, POAF gelişimindeki prediktif öneminin araştırılmasını amaçladık.
GEREÇ VE YÖNTEM: Erciyes Üniversitesi Tıp Fakültesi Kardiyovasküler Cerrahi Ana Bilim Dalında 01.01.2018 - 31.12.2020 tarihleri arasında izole KABG cerrahisi geçiren 288 hastanın (62 kadın ve 226 erkek) verileri retrospektif olarak incelendi. Hastaların preoperatif ve postoperatif kan değerleri, bazal karakteristik özellikleri ve intraoperatif parametreleri değerlendirildi. Çoklu regresyon analizi, Backward: Wald metoduna göre yapıldı.
BULGULAR: 288 hasta içerisinde . ortanca yaş 63 (56-69) yıl olup AF gelişen grupta ise ortanca yaş, 66,0 (61,2-72,0) yıl (P: 0.003)’dır. POAF gelişme durumlarına göre hastalar gruplandırıldıklarında, iki grup arasında yaş (P: 0.003), total anastomoz sayısı (P:0.004) ve safen ven grefti (SVG) distal anastomoz sayısı (P: 0.006), preoperatif platelet sayısı (P:0.027), kan üre azotu (BUN) (P:0.004), kreatinin (P:0.001) ve postoperatif BUN (P:0.005) değerleri açısından istatistiksel olarak anlamlı fark olduğu saptanırken, preoperatif ve postoperatif AGO değerleri (P: 0,140, P: 0.313) bakımından gruplar arasında istatistiksel açıdan fark olmadığı saptandı. Çoklu regresyon analizindeki Backward: Wald metoduna göre son basamakta, POAF gelişen hastalarda; yaş, preoperatif platelet sayısı, kreatinin seviyeleri, periferik arte hastalığı (PAH) varlığı ve total anastomoz sayısı bağımsız risk faktörleri olarak bulundular.
SONUÇ: Bu çalışmada, AGO değerleri ve POAF gelişimi arasında istatistiksel olarak anlamlı bir ilişki tespit edilmedi. KABG uygulanan hastalarda POAF’ın ortaya çıkışında hem genel popülasyonda, hem de ayrı bir alt grup olarak Diabetes Mellitus hastalarında preoperatif kreatinin seviyesi ve platelet sayılarının değerlendirilmesinin önemli olduğu bulunmuştur. Ayrıca, preoperatif kreatinin, yaş, total anastomoz sayısı ve preoperatif platelet sayısı bağımsız risk faktörleridir.

Keywords

Koroner arter baypas greftleme, Postoperatif atriyal fibrilasyon, Albümin, Globulin, Albümin globülin oranı

Supporting Institution

destekleyen kurum yoktur

COULD ALBUMIN / GLOBULIN RATIO BE AN EARLY PREDICTIVE MARKER IN PREDICTING THE DEVELOPMENT OF POSTOPERATIVE ATRIAL FIBRILLATION ?

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.

Keywords

Coronary artery bypass grefting, Postoperative atrial fibrillation, Albumin, Globulin, Albumin globulin ratio

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