Arrhythmias & electrophysiology
Updated evidence on peri-operative neutrophil-to-lymphocyte ratio in cardiac surgery: A dual analysis of prognostic and diagnostic value for post-operative atrial fibrillation
Pooled result · Pre-operative NLR (studies excluding pre-operative atrial fibrillation)Result — go to the resultSMD 0.51 95% CI 0.34–0.67Authors' conclusion
Elevated NLR is associated with increased risk of POAF. Distinguishing new-onset POAF and accounting for surgical type are essential when evaluating NLR as a predictive biomarker.
Study context
- Population
- Adult cardiac surgery patients with pre-operative or post-operative neutrophil-to-lymphocyte ratio (NLR) and post-operative atrial fibrillation (POAF) incidence reported27 studies excluding pre-operative atrial fibrillation 13,630 · 4 studies including patients with prior atrial fibrillation 6,364
- Participants
- 20,056 patients32 studies
- Comparison
- NLR in patients with vs without POAF; pre-operative NLR as predictor of POAF
- Outcome
- Pre-operative NLR (studies excluding pre-operative atrial fibrillation)
- Follow-up
- Pre-operative
Methodological detailsdiagnostic test accuracy analysis, subgroup analyses and meta-regression
- Diagnostic test accuracy analysis
- Subgroup analyses and meta-regression
Pooled result
As reported in the abstract
SMD
0.51
95% CI 0.34–0.67
P < 0.001
POAFvs no POAF
SMD 0.51 (95% CI 0.34–0.67); P < 0.001
Further pooled results
| Outcome | SMD (95% CI) | P value | |
|---|---|---|---|
| Post-operative NLRI2 = 70.7%; elevated in POAF | 0.30 (0.13–0.47) | P < 0.001 | |
| −0.200.20.40.6Difference (linear scale) |
| Outcome | SMD | P value |
|---|---|---|
| NLR in studies including patients with prior atrial fibrillationNo significant association | 0.04 | P = 0.21 |
- NLR in studies including patients with prior atrial fibrillation: 4 studies (6364 patients)
Diagnostic accuracy of pre-operative NLR for POAF
- Pooled sensitivity
- 0.52
- Specificity
- 0.71
- Diagnostic odds ratio
- 3.74
- AUC
- 0.713
- Moderate diagnostic accuracy
- 12 studies
Original publication
Updated evidence on peri-operative neutrophil-to-lymphocyte ratio in cardiac surgery: A dual analysis of prognostic and diagnostic value for post-operative atrial fibrillation. Heart Rhythm. Published 30 September 2025. doi:10.
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