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 MashhourLuis 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

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

30 Citations (Scopus)
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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.

Original languageEnglish
Pages (from-to)440-451
Number of pages12
JournalKardiologia Polska
Issue number2
Early online date8 Dec 2017
Publication statusPublished - 16 Feb 2018


  • Atrial fibrillation
  • C-reactive protein
  • Cytokines
  • Inflammation
  • Interleukins
  • Meta-analysis
  • Review


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