Multi-inflammatory index as a novel predictor of new-onset atrial fibrillation after off-pump coronary artery bypass grafting.

BACKGROUND: To our knowledge, a possible predictive relationship of the multi-inflammatory index (MII) with new-onset atrial fibrillation (AF) after off-pump coronary artery bypass grafting (CABG) has not yet been studied in the literature. AIMS: We aimed to investigate whether the MII is a novel group of hematological markers for predicting postoperative new-onset AF in patients undergoing off-pump CABG. METHODS: A total of 427 patients undergoing isolated off-pump CABG between October 2021 and December 2023 were enrolled in this retrospective observational cohort study and allocated to two groups: the AF group (n = 108) and the non-AF group (n = 319). The groups were compared in terms of baseline clinical patient characteristics, laboratory parameters, and operative and postoperative data. RESULTS: The median values of age, length of hospital stay, platelet and neutrophil count, C-reactive protein level, systemic immune-inflammation index, MII-1, MII-2, and MII-3 were significantly greater in the AF group compared to the non-AF group in univariate analyses. In multiple explanatory variable logistic regression analysis, MII-1, MII-2, and MII-3 were determined to be significant hematological variables, and thereby these indices were considered the independent predictors of postoperative new-onset AF. Receiver operating characteristic curve analyses showed that to predict postoperative new-onset AF, MII-1 of 22.47 constituted the cut-off value with 62.0% sensitivity and 57.0% specificity, MII-2 of 141.77 constituted the cut-off value with 43.5% sensitivity and 76.8% specificity, and MII-3 of 5669 constituted the cut-off value with 63.8% sensitivity and 58.3% specificity. CONCLUSION: This study demonstrated for the first time that all MIIs predicted new-onset AF after off-pump CABG.

Evaluation of the dynamic thiol/disulfide homeostasis in patients with chronic venous insufficiency.

OBJECTIVE: There is no study in the literature evaluating the dynamic thiol/disulfide homeostasis in patients with chronic venous insufficiency. Thus, we designed this study to evaluate the dynamic thiol/disulfide homeostasis as a novel indicator of oxidative stress in patients with chronic venous insufficiency. METHODS: This was a prospective case-control study performed at the department of cardiovascular surgery of a tertiary referral hospital in Turkey. A total of 80 (CEAP C3-C6) patients with lower extremity chronic venous insufficiency (as the study group) and 80 healthy subjects (as the control group) were enrolled to the study. The participants' basic demographic and clinical characteristics as well as serum levels of some laboratory parameters including albumin, ferroxidase, myeloperoxidase, native thiol, total thiol, disulphide, native thiol/total thiol, disulphide/native thiol, and disulphide/total thiol were determined, and then compared between the groups. RESULTS: In terms of basic demographic and clinical characteristics, both groups were statistically similar, and there were no significant differences between the groups. When the laboratory parameters were considered, serum ferroxidase and myeloperoxidase levels were detected to be significantly higher, whereas albumin, native thiol, total thiol, and disulphide levels were detected to be significantly lower in the study group than in the control group. CONCLUSIONS: Dynamic thiol/disulphide homeostasis could be considered as an indicator reflecting the oxidative stress status in patients with chronic venous insufficiency.

Plasma Calcium Level and C-Reactive Protein Albumin Ratio Affect Severe Bleeding After Coronary Artery Bypass Grafting.

OBJECTIVE: In this study, we aimed to determine whether plasma calcium level and C-reactive protein albumin ratio (CAR) as well as other demographic and hematological markers are related in predicting severe bleeding after coronary artery bypass grafting (CABG). METHODS: A total of 227 adult patients who underwent CABG at our hospital between December 2021 and June 2022 were prospectively studied. Total amount of chest tube drainage was evaluated within the first 24 hours postoperatively or until the patient was re-explored for bleeding. The patients were divided into two groups - Group 1, patients with low amount of bleeding (n=174), and Group 2, patients with severe bleeding (n=53). Univariate and multivariate regression analyzes were performed to determine independent parameters related to severe bleeding within the first 24 hours after surgery. RESULTS: When the groups were compared in terms of demographic, clinical, and preoperative blood parameters; cardiopulmonary bypass time and serum C-reactive protein (CRP) levels were found to be significantly higher in Group 2 compared to the low bleeding group. In addition, lymphocytes, hemoglobin, calcium, albumin, and CAR were found to be significantly lower in Group 2. In multivariate analysis, calcium, albumin, CRP, and CAR were found to be independent predictors of significant association with excessive bleeding. A cut-off value of 8.7 (94.3% sensitivity and 94.8% specificity) for calcium and 0.155 (75.4% sensitivity and 80.4% specificity) for CAR predicted excessive bleeding. CONCLUSION: Plasma calcium level, CRP, albumin, and CAR can be used to predict severe bleeding after CABG.

Plasma Calcium Level and C-Reactive Protein Albumin Ratio Affect Severe Bleeding After Coronary Artery Bypass Grafting

ABSTRACT Objective: In this study, we aimed to determine whether plasma calcium level and C-reactive protein albumin ratio (CAR) as well as other demographic and hematological markers are related in predicting severe bleeding after coronary artery bypass grafting (CABG). Methods: A total of 227 adult patients who underwent CABG at our hospital between December 2021 and June 2022 were prospectively studied. Total amount of chest tube drainage was evaluated within the first 24 hours postoperatively or until the patient was re-explored for bleeding. The patients were divided into two groups - Group 1, patients with low amount of bleeding (n=174), and Group 2, patients with severe bleeding (n=53). Univariate and multivariate regression analyzes were performed to determine independent parameters related to severe bleeding within the first 24 hours after surgery. Results: When the groups were compared in terms of demographic, clinical, and preoperative blood parameters; cardiopulmonary bypass time and serum C-reactive protein (CRP) levels were found to be significantly higher in Group 2 compared to the low bleeding group. In addition, lymphocytes, hemoglobin, calcium, albumin, and CAR were found to be significantly lower in Group 2. In multivariate analysis, calcium, albumin, CRP, and CAR were found to be independent predictors of significant association with excessive bleeding. A cut-off value of 8.7 (94.3% sensitivity and 94.8% specificity) for calcium and 0.155 (75.4% sensitivity and 80.4% specificity) for CAR predicted excessive bleeding. Conclusion: Plasma calcium level, CRP, albumin, and CAR can be used to predict severe bleeding after CABG.

Systemic immune-inflammation index for predicting poor outcome after carotid endarterectomy: A novel hematological marker.

OBJECTIVE: To investigate the predictive role of systemic immune-inflammation index (SII) on postoperative poor outcome in patients undergoing carotid endarterectomy (CEA). METHODS: A total of 347 patients undergoing elective isolated CEA between March 2010 and April 2022 were included in this multicenter retrospective observational cohort and risk-prediction study and were divided into two groups as poor outcome group (n = 23) and favorable outcome group (n = 324). Poor outcome was defined as the presence of at least one of the complications within 30 days of surgery including stroke, myocardial infarction, and death. The patients' baseline clinical characteristics, comorbidities, and hematological indices were derived from the complete blood count (CBC) analysis, and perioperative data, outcomes, and complications were screened, recorded, and then compared between the groups. Multivariate logistic regression and receiver-operating characteristic (ROC) curve analyses were conducted following univariate analyses to detect the independent predictors of poor outcome as well as the cutoff values with sensitivity and specificity rates. RESULTS: A total of 23 patients out of 347 (6.6%) manifested poor outcome; and stroke, myocardial infarction, and death occurred in 13, 3, and 7 cases, respectively. There were no significant differences between the groups in terms of basic clinical characteristics, comorbidities, and perioperative data, except for lengths of intensive care unit and hospital stays. Although the median values of PLT, PLR, NLR, and SII of the poor outcome group were found to be significantly higher than the favorable outcome group in univariate analysis, only SII was detected to be a significant and independent predictor of poor outcome in multivariate logistic regression analysis (OR = 1.0008; 95% CI: 1.0004-1.0012; p = 0.002). ROC curve analysis revealed that SII of 1356 × 103/mm3 constituted the cutoff value for predicting poor outcome with 78.3% sensitivity and 64.5% specificity (AUC = 0.746; 95% CI: 0.64-0.851). CONCLUSIONS: Our study revealed for the first time in the literature that SII significantly predicted poor outcome after CEA.

Does pulmonary hypertension affect early-term outcomes of off-pump coronary artery bypass surgery?

OBJECTIVE: This study aimed to investigate the effect of preoperative pulmonary hypertension (PHT) on postoperative early mortality and morbidity in patients undergoing off-pump coronary artery bypass grafting (CABG). METHODS: A total of 1107 patients undergoing elective first-time off-pump CABG between January 2011 and April 2022 were included in this retrospective observational cohort study. The patients were categorized into two groups according to their preoperative systolic pulmonary artery pressure (SPAP) values. The PHT group (n=104) consisted of patients with a SPAP value >30 mmHg, while the non-PHT group (n=1003) consisted of patients with a SPAP value ≤30 mmHg. Patients' preoperative demographics and clinical features, operative data, and postoperative outcomes were recorded and then compared between the groups. RESULTS: In the PHT group, the median age was significantly higher (66 vs. 63 years, p=0.001) and the median left ventricular ejection fraction level was significantly lower (45 vs. 50%, p=0.045) as compared to the non-PHT group. Additionally, the PHT group included a significantly greater percentage of patients with chronic obstructive pulmonary disease (22.1 vs. 7.4%, p=0.019). As perioperative early-term outcomes, complications, and mortality were considered, the groups were statistically similar, and there were no significant differences between the groups, except for the development of atrial fibrillation. CONCLUSION: For the first time in the literature, this study revealed that mild PHT (mean SPAP=38.9±8.7 mmHg) did not significantly affect early-term outcomes of off-pump CABG.

Systemic immune-inflammation index as a novel predictor of atrial fibrillation after off-pump coronary artery bypass grafting.

OBJECTIVE: This study aims to examine the predictive role of systemic immune-inflammation index on postoperative new-onset atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting. METHODS: A total of 722 patients undergoing elective off-pump coronary artery bypass grafting between January 2017 and September 2021 were included in this study and divided into two groups as the atrial fibrillation group (n=172) and the non-atrial fibrillation group (n=550). Both groups were compared in terms of patients' baseline clinical features, operative and postoperative variables, and preoperative hematological indices derived from the complete blood count analysis. Multivariate logistic regression and receiver-operating characteristic curve analyses were performed to detect the independent predictors of postoperative new-onset atrial fibrillation. RESULTS: The median age and length of hospital stay in the atrial fibrillation group were significantly higher than those in the non-atrial fibrillation group. The median values of white blood cell, platelet, neutrophil, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and systemic immune-inflammation in the atrial fibrillation group were significantly greater than in those in the non- atrial fibrillation group. Logistic regression analysis demonstrated that age, platelet, platelet/lymphocyte ratio, and systemic immune-inflammation were independent predictors of postoperative new-onset atrial fibrillation. receiver-operating characteristic curve analysis revealed that systemic immune-inflammation of 706.7×103/mm3 constituted cut-off value to predict the occurrence of new-onset atrial fibrillation with 86.6% sensitivity and 29.3% specificity. CONCLUSION: Our study revealed for the first time that systemic immune-inflammation predicted new-onset atrial fibrillation after off-pump coronary artery bypass grafting.

Systemic immune-inflammation index as a novel predictor of atrial fibrillation after off-pump coronary artery bypass grafting

SUMMARY OBJECTIVE: This study aims to examine the predictive role of systemic immune-inflammation index on postoperative new-onset atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting. METHODS: A total of 722 patients undergoing elective off-pump coronary artery bypass grafting between January 2017 and September 2021 were included in this study and divided into two groups as the atrial fibrillation group (n=172) and the non-atrial fibrillation group (n=550). Both groups were compared in terms of patients' baseline clinical features, operative and postoperative variables, and preoperative hematological indices derived from the complete blood count analysis. Multivariate logistic regression and receiver-operating characteristic curve analyses were performed to detect the independent predictors of postoperative new-onset atrial fibrillation. RESULTS: The median age and length of hospital stay in the atrial fibrillation group were significantly higher than those in the non-atrial fibrillation group. The median values of white blood cell, platelet, neutrophil, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and systemic immune-inflammation in the atrial fibrillation group were significantly greater than in those in the non- atrial fibrillation group. Logistic regression analysis demonstrated that age, platelet, platelet/lymphocyte ratio, and systemic immune-inflammation were independent predictors of postoperative new-onset atrial fibrillation. receiver-operating characteristic curve analysis revealed that systemic immune-inflammation of 706.7×103/mm3 constituted cut-off value to predict the occurrence of new-onset atrial fibrillation with 86.6% sensitivity and 29.3% specificity. CONCLUSION: Our study revealed for the first time that systemic immune-inflammation predicted new-onset atrial fibrillation after off-pump coronary artery bypass grafting.

Platelet distribution width in young patients with chronic venous insufficiency.

OBJECTIVE: Platelet distribution width (PDW) has been reported in a wide range of pathological settings. In this study, we aimed to investigate the relationship between PDW and lower extremity chronic venous insufficiency (CVI) by comparing the levels of PDW and other parameters derived from complete blood count (CBC) tests in young individuals with or without lower extremity CVI. METHODS: This prospective clinical study was conducted between January 2020 and December 2020. A total of 108 patients, 72 patients with lower extremity CVI (study group) and 36 healthy volunteers (control group) were enrolled from the Bursa Yuksek Ihtisas Education Research Hospital and the Bolu Abant Izzet Baysal University Training and Research Hospital. The age range of the participants was between 18 and 50 years old. Participants' baseline clinical features and CBC parameters including PDW, white blood cell, hemoglobin, hematocrit, mean corpuscular volume, red cell distribution width, neutrophil, lymphocyte, platelet count, mean platelet volume, plateletcrit, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were compared between the two groups. RESULTS: The groups were statistically similar in terms of baseline clinical features. The median PDW value was significantly higher for the CVI patients relative to the control group (17.6 vs 16.8; p < 0.001). In terms of other CBC parameters, there were no significant differences between the groups. According to ROC analysis, area under the curve of PDW was 0.749 (95% confidence interval: 0.653-0.846 and p < 0.001). If the value of PDW was accepted as 17, it could predict CVI with 76% sensitivity and 59% specificity, whereas a PDW value of 17.5 could predict CVI with 51% sensitivity and 81% specificity. CONCLUSION: Platelet distribution width might be a useful marker to determine an increased inflammatory response and thrombotic status in young patients with CVI.

Does pulmonary hypertension affect early-term outcomes of off-pump coronary artery bypass surgery?

SUMMARY OBJECTIVE: This study aimed to investigate the effect of preoperative pulmonary hypertension (PHT) on postoperative early mortality and morbidity in patients undergoing off-pump coronary artery bypass grafting (CABG). METHODS: A total of 1107 patients undergoing elective first-time off-pump CABG between January 2011 and April 2022 were included in this retrospective observational cohort study. The patients were categorized into two groups according to their preoperative systolic pulmonary artery pressure (SPAP) values. The PHT group (n=104) consisted of patients with a SPAP value >30 mmHg, while the non-PHT group (n=1003) consisted of patients with a SPAP value ≤30 mmHg. Patients' preoperative demographics and clinical features, operative data, and postoperative outcomes were recorded and then compared between the groups. RESULTS: In the PHT group, the median age was significantly higher (66 vs. 63 years, p=0.001) and the median left ventricular ejection fraction level was significantly lower (45 vs. 50%, p=0.045) as compared to the non-PHT group. Additionally, the PHT group included a significantly greater percentage of patients with chronic obstructive pulmonary disease (22.1 vs. 7.4%, p=0.019). As perioperative early-term outcomes, complications, and mortality were considered, the groups were statistically similar, and there were no significant differences between the groups, except for the development of atrial fibrillation. CONCLUSION: For the first time in the literature, this study revealed that mild PHT (mean SPAP=38.9±8.7 mmHg) did not significantly affect early-term outcomes of off-pump CABG.

Contribution of Current Comorbid Conditions to Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass and Stroke Distribution in Carotid Artery Stenosis Groups.

OBJECTIVE: The aim of this study was to contribute to the issue of "Who should we perform Doppler ultrasonography on?" and determine the contribution of comorbid diseases to the development of carotid artery stenosis (CAS) and preoperative CAS by examining comorbid diseases in patients undergoing coronary artery bypass graft operation (CABG) and also discussing the effect of carotid stenosis levels on postoperative stroke. METHOD: Between 2011-2015, a total of 921 patients who underwent cardiac surgery retrospectively were examined. Of these, 594 CABG patients aged 60 and over who underwent preoperative carotid Doppler examination were analyzed. RESULTS: Sixty-five percent of patients were male, and 35% were female. The mean age was 69.3 years. Sixty-nine percent of patients were in the 0-29% stenosis group, 12.9% in the 30-49% group, 14.6% in the 50-69% group, 3% in the 70-99% group, and 0.3% in the 100% occlusion group. Peripheral artery disease (PAD), age, gender, and diabetes mellitus (DM) were found to have significant (P < 0.05) effects on the occurrence of CAS. CAS increased by 0.9% with an increase of one year in age, 10.8% with the presence of PAD, 3% with male sex, 3.8% with presence of chronic obstructive pulmonery disease (COPD), 1.9% with presence of left main coronary disease (LMCAD), and 0.9% with presence of hypertension. In the decision tree analysis, the rate of 50% and above CAS in the presence of PAH + DM and age older than 65 years was 62.5%. Cerebrovascular accident (CVA) distribution was 2.1% in the 0-29% group, 2.5% in the 30-49% group, 4.5% in the 50-69% group, and 11.1% in the 70-99% group. Postoperative CVA was not observed in 10 patients who underwent carotid endarterectomy (CE). Postoperative CVA developed in six patients with 50% or more stenosis who did not undergo CE. CONCLUSION: For the preoperative detection of CAS in patients undergoing CABG, the association of advanced age, PAD, DM, male gender, COPD, LMCAD, and hypertension risk factors should be considered. We suggest that carotid screening should be performed in those over 65 years of age and with PAD+DM. Studies with large populations are needed to observe the effects of aortic atherosclerosis load, surgical procedure, and unilateral/bilateral CAS presence on the development of stroke in patients with severe CAS and postoperative CVA.

Association between vitamin D levels and lower-extremity deep vein thrombosis: a case-control study.

BACKGROUND: Vitamin D has relationships with pathogenesis and inflammation pathways in many diseases. Its deficiency may make clinicians think not only of supplementation but also of presence of other diseases. OBJECTIVE: To investigate the relationship between vitamin D levels and deep vein thrombosis (DVT), given that reduced levels are related to increased risk of cardiovascular diseases. DESIGN AND SETTING: Case-control study conducted in the cardiovascular surgery and family medicine departments of a hospital in Turkey. METHODS: A total of 280 participants were included: 140 each in the DVT and control groups. Basic clinical characteristics, comorbidities and serum 25-hydroxyvitamin D (25(OH)D) levels were recorded and then compared between the groups. Serum 25(OH)D levels were also evaluated separately in three subgroups (sufficient, insufficient and deficient). RESULTS: Serum 25(OH)D levels were significantly lower in the DVT group than in the controls (P < 0.001). Females in the DVT group had lower 25(OH)D levels than those in the control group (P = 0.002). Nonetheless, the median 25(OH)D level (16.41 ng/ml) of the control group was still below the reference value. Logistic regression analysis showed that 25(OH)D was a significant predictor of DVT. Weight, height and body mass index, which all presented interaction, were significant in the logistic regression analysis but not in individual analyses. CONCLUSION: The serum vitamin D levels of DVT patients were lower than those of controls. If the results obtained from our study are supported by further large-scale randomized controlled trials, vitamin D replacement may be brought into the agenda for protection against DVT.

Association between vitamin D levels and lower-extremity deep vein thrombosis: a case-control study

ABSTRACT BACKGROUND: Vitamin D has relationships with pathogenesis and inflammation pathways in many diseases. Its deficiency may make clinicians think not only of supplementation but also of presence of other diseases. OBJECTIVE: To investigate the relationship between vitamin D levels and deep vein thrombosis (DVT), given that reduced levels are related to increased risk of cardiovascular diseases. DESIGN AND SETTING: Case-control study conducted in the cardiovascular surgery and family medicine departments of a hospital in Turkey. METHODS: A total of 280 participants were included: 140 each in the DVT and control groups. Basic clinical characteristics, comorbidities and serum 25-hydroxyvitamin D (25(OH)D) levels were recorded and then compared between the groups. Serum 25(OH)D levels were also evaluated separately in three subgroups (sufficient, insufficient and deficient). RESULTS: Serum 25(OH)D levels were significantly lower in the DVT group than in the controls (P < 0.001). Females in the DVT group had lower 25(OH)D levels than those in the control group (P = 0.002). Nonetheless, the median 25(OH)D level (16.41 ng/ml) of the control group was still below the reference value. Logistic regression analysis showed that 25(OH)D was a significant predictor of DVT. Weight, height and body mass index, which all presented interaction, were significant in the logistic regression analysis but not in individual analyses. CONCLUSION: The serum vitamin D levels of DVT patients were lower than those of controls. If the results obtained from our study are supported by further large-scale randomized controlled trials, vitamin D replacement may be brought into the agenda for protection against DVT.

Dynamic thiol/disulphide homeostasis metrics as a risk factor for peripheral arterial disease.

OBJECTIVE: To examine dynamic thiol/disulphide homeostasis metrics as a novel risk factor of oxidative stress in patients with peripheral arterial disease. METHODS: One hundred patients with lower extremity peripheral arterial disease (a study group) and 100 control subjects were included in this prospective case-control study. Participants' baseline clinical characteristics and laboratory data including some oxidant/antioxidant status parameters such as albumin, ferroxidase and myeloperoxidase, and thiol/disulphide homeostasis parameters such as native thiol, total thiol and disulphide, as well as native thiol/total thiol, disulphide/native thiol and disulphide/total thiol ratios were all recorded and then compared between the groups. RESULTS: Mean albumin and ferroxidase, and median myeloperoxidase levels were found to be significantly higher in patients with the peripheral arterial disease than in control group (p = 0.045, p = 0.000 and p = 0.000, respectively). Mean native thiol and total thiol, and median disulphide levels were found to be significantly lower in the study group as compared with the control group (p = 0.000, p = 0.000 and p = 0.037, respectively). According to the results of logistic regression analysis, systolic blood pressure, ferroxidase and myeloperoxidase levels were detected to be the independent predictors of peripheral arterial disease. CONCLUSION: Our report is the first one in the literature investigating dynamic thiol/disulphide homeostasis metrics as a novel risk factor of oxidative stress in peripheral arterial disease. Dynamic thiol/disulphide homeostasis metrics may be used as a valuable risk factor of oxidative stress in patients with the peripheral arterial disease since it is readily available, easily calculated and relatively cheap.

Predictive Value of Neutrophil-Lymphocyte Ratio for Long-Term Cardiovascular Event Following Coronary Artery Bypass Grafting.

OBJECTIVE: To investigate the predictive value of preoperative neutrophil-lymphocyte ratio (NLR) for long-term major adverse cardiac and cerebrovascular events (MACCE), which have not yet been well described, in patients undergoing coronary artery bypass grafting (CABG). METHODS: The records of 751 consecutive patients who underwent elective CABG between January 2008 and January 2010 were retrospectively enrolled and stratified according to quartiles of preoperative NLR. At 7.8-year follow-up, MACCE was considered as an endpoint. RESULTS: Overall MACCE was 11.6% of all cases. Long-term myocardial infarction, percutaneous coronary intervention, stroke and cardiovascular mortality were found associated with the upper NLR quartile (P<0.001, P<0.001, P=0.005, P<0.001, respectively). In multivariate analysis, NLR on admission remained an independent predictor of long-term MACCE (OR 1.087, 95% CI 1.026-1.151; P=0.004), in all EuroSCORE risk groups (P<0.001; P<0.001; P=0.029). The receiver operating characteristic (ROC) curve analyses revealed an NLR cut-off value of 4.32 predicting MACCE. CONCLUSION: NLR is a useful and readily available predictive marker of long-term MACCE following CABG, independent of the EuroSCORE.

Effects of Lidocaine Oropharyngeal Spray Applied Before Endotracheal Intubation on QT Dispersion in Patients Undergoing Coronary Artery Bypass Grafting: A Prospective Randomized Controlled Study.

OBJECTIVE: To investigate the effects of lidocaine oropharyngeal spray applied before endotracheal intubation on hemodynamic responses and electrocardiographic parameters in patients undergoing coronary artery bypass grafting. METHODS: A total of 60 patients who underwent coronary artery bypass grafting surgery were included in this prospective randomized controlled study. Patients were randomly divided into two groups, the topical lidocaine group (administration of 10% lidocaine oropharyngeal spray, five minutes before laryngoscopy and endotracheal intubation) and the control group. Both groups were compared with each other in terms of main hemodynamic parameters including mean arterial pressure and heart rate, as well as P and QT wave dispersion durations, before and after endotracheal intubation. RESULTS: The groups were similar in terms of age, gender, and other demographics and basic clinical characteristics. There was a statistically significant difference between the groups in terms of QT dispersion durations after laryngoscopy and endotracheal intubation. The increase in QT dispersion duration was not statistically significant in the topical lidocaine group, whereas the increase in QT dispersion duration was statistically significant in the control group. When the groups were compared in terms of P wave dispersion durations, there were significant decreases in both groups, but there was no significant difference between the groups. CONCLUSION: Our study revealed that the topical lidocaine administration before endotracheal intubation prevented increase of QT dispersion duration in patients undergoing coronary artery bypass grafting. TRIAL REGISTRATION: NCT03304431.

Predictive value of neutrophil-lymphocyte ratio for long-term cardiovascular event following coronary artery bypass grafting

Abstract Objective: To investigate the predictive value of preoperative neutrophil-lymphocyte ratio (NLR) for long-term major adverse cardiac and cerebrovascular events (MACCE), which have not yet been well described, in patients undergoing coronary artery bypass grafting (CABG). Methods: The records of 751 consecutive patients who underwent elective CABG between January 2008 and January 2010 were retrospectively enrolled and stratified according to quartiles of preoperative NLR. At 7.8-year follow-up, MACCE was considered as an endpoint. Results: Overall MACCE was 11.6% of all cases. Long-term myocardial infarction, percutaneous coronary intervention, stroke and cardiovascular mortality were found associated with the upper NLR quartile (P<0.001, P<0.001, P=0.005, P<0.001, respectively). In multivariate analysis, NLR on admission remained an independent predictor of long-term MACCE (OR 1.087, 95% CI 1.026-1.151; P=0.004), in all EuroSCORE risk groups (P<0.001; P<0.001; P=0.029). The receiver operating characteristic (ROC) curve analyses revealed an NLR cut-off value of 4.32 predicting MACCE. Conclusion: NLR is a useful and readily available predictive marker of long-term MACCE following CABG, independent of the EuroSCORE.

Effects of lidocaine oropharyngeal spray applied before endotracheal intubation on qt dispersion in patients undergoing coronary artery bypass grafting: a prospective randomized controlled study

Abstract Objective: To investigate the effects of lidocaine oropharyngeal spray applied before endotracheal intubation on hemodynamic responses and electrocardiographic parameters in patients undergoing coronary artery bypass grafting. Methods: A total of 60 patients who underwent coronary artery bypass grafting surgery were included in this prospective randomized controlled study. Patients were randomly divided into two groups, the topical lidocaine group (administration of 10% lidocaine oropharyngeal spray, five minutes before laryngoscopy and endotracheal intubation) and the control group. Both groups were compared with each other in terms of main hemodynamic parameters including mean arterial pressure and heart rate, as well as P and QT wave dispersion durations, before and after endotracheal intubation. Results: The groups were similar in terms of age, gender, and other demographics and basic clinical characteristics. There was a statistically significant difference between the groups in terms of QT dispersion durations after laryngoscopy and endotracheal intubation. The increase in QT dispersion duration was not statistically significant in the topical lidocaine group, whereas the increase in QT dispersion duration was statistically significant in the control group. When the groups were compared in terms of P wave dispersion durations, there were significant decreases in both groups, but there was no significant difference between the groups. Conclusion: Our study revealed that the topical lidocaine administration before endotracheal intubation prevented increase of QT dispersion duration in patients undergoing coronary artery bypass grafting. Trial Registration: NCT03304431

Novel Mortality Markers for Critically Ill Patients.

AIM: Inflammatory markers, such as the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), derived from a complete blood count have recently attracted attention as potential markers of morbidity and mortality in various diseases. The aim of the present study was to assess the usefulness of the NLR and PLR as markers of hospital stay and mortality of patients in intensive care units (ICUs). METHODS: Patients treated in the ICU of our institution between October 2016 and August 2017 were enrolled in the study. After obtaining approval from the institutional committee, patient data were sourced from the institution's computerized database and retrospectively analyzed. The patients were assigned to 2 groups according to the outcomes: survivors and deceased. RESULTS: The NLR of survivors and deceased patients was 2.06 (1.18-21.68) and 10.42 (2.85-48.2), respectively. The NLR was significantly elevated in deceased patients as compared with that of survivors (P < .001). Similarly, the median PLR of patients in the deceased group (268.9 [150-3000]) was significantly higher than that of patients in the survivor group (55.7 [11.8-152.5]). The difference in the PLR between groups was significant (P < .001). CONCLUSION: Both the NLR and PLR, as well as C-reactive protein, predicted mortality in this critically ill population. The PLR and NLR are easy-to-measure, inexpensive markers. Physicians should be aware of elevations in PLR and NLR in patient care in ICUs.

Predictors of Postoperative Atrial Fibrillation after Beating-Heart Coronary Artery Bypass Surgery: Is Cardiopulmonary Bypass a Risk Factor?

BACKGROUND: To determine the risk factors and postoperative outcomes of new-onset atrial fibrillation (AF) following beating-heart coronary artery bypass grafting (CABG) surgery. METHODS: A total of 458 patients who underwent beating-heart CABG without the use of aortic cross clamping and cardioplegic arrest between January 2011 and January 2015 were included in the study, and they were divided into two groups according to the development of new-onset AF as the AF group (n = 143) and non-AF group (n = 315). Both groups were compared in terms of preoperative clinical features and perioperative data, and the risk factors and postoperative outcomes of AF following beating-heart CABG were determined. RESULTS: The incidence of postoperative AF was 31.2%. Patients in the AF group were significantly older (68.08 ± 7.76 vs. 61.76 ± 9.83 years, p ≤ 0.001) and had significantly higher use of cardiopulmonary bypass during surgery (69.2% vs. 43.2%, p ≤ 0.001) than the patients in the non-AF group. The patients with AF also had statistically significantly longer lengths of intensive care unit and hospital stay than those without AF (43.79 ± 32.39 vs. 30.49 ± 33.31 hours, p ≤ 0.001, and 8.20 ± 4.37 vs. 5.77 ± 2.16 days, p ≤ 0.001, respectively). CONCLUSIONS: Our study revealed that age and the use of cardiopulmonary bypass during surgery were independent predictors of AF following beating-heart CABG. In addition, postoperative AF was associated with prolonged intensive care unit and hospital stay. Further prospective randomized studies with larger patient series are required to support our research and attain more accurate data.