Inflammatory Biomarkers and Clinical-Surgical Factors Predict Postoperative Atrial Fibrillation After Cardiac Surgery with Cardiopulmonary Bypass

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Abstract
Patients with cardiovascular diseases often require cardiac surgery with cardiopulmonary bypass (CPB), which triggers inflammation and increases the risk of postoperative atrial fibrillation (POAF). This study assessed the predictive value of inflammatory biomarkers and clinical and surgical variables for POAF in patients undergoing coronary artery by-pass grafting (CABG; n = 36), valve surgery (n = 40), or combined CABG and valve surgery (n = 13), all of whom utilized CPB. Levels of IL-6, IL-8, IL-10, and C-reactive protein (CRP) were measured preoperatively, at 24 and 48 hours postoperatively, and at discharge. Sta-tistical analyses included t-tests, Mann–Whitney U tests, correlation analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis. Sixteen of 89 patients (18%) developed POAF between 48 and 72 hours after surgery. The Society of Thoracic Surgeons (STS) score and hemoglobin at 24 hours were significantly different (p < 0.05) between the POAF and non-POAF groups. At 24 hours, POAF patients had significantly higher IL-6, IL-8, and IL-10 levels (p < 0.02); IL-6 remained elevated at 48 hours (p < 0.05), while CRP declined at discharge (p = 0.05). A multivariable model including STS score, IL-6 at 24 hours, and postoperative magnesium yielded an AUC of 0.82, with an optimism-corrected AUC of 0.77 after internal bootstrap validation. Integrating inflammatory and clinical variables produced a robust predictive model.

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