Tesis

Peran Rasio Neutrofil-Limfosit dan Monosit-Limfosit Praoperasi sebagai Prediktor Fibrilasi Atrium Pascaprosedur Bedah Pintas Arteri Koroner Konvensional = The Role of Preoperative Neutrophil-to-Lymphocyte and Monocyte-to-Lymphocyte Ratios as Predictors of Postoperative Atrial Fibrillation Following Conventional Coronary Artery Bypass Grafting.

Latar Belakang: Fibrilasi atrium pascaoperasi (FAPO) adalah komplikasi yang paling paling sering terjadi pascaprosedur bedah pintas arteri koroner (BPAK) konvensional. Inflamasi memiliki peranan penting dalam memicu FAPO. Rasio neutrophil limfosit (RNL) dan rasio monosit limfosit (RML) praoperasi merupakan penanda biologis yang mudah dan murah, dianggap berpotensi sebagai prediktor independen FAPO. Metode: Penelitian ini merupakan kohort retrospektif dari pasien penyakit jantung koroner (PJK) yang menjalani operasi BPAK konvensional antara Januari 2024 – Mei 2025 di Rumah Sakit Pusat Jantung Nasional Harapan Kita (RSPJNHK). Keluaran utama adalah fibrilasi atrium yang terjadi dalam waktu 72 jam pascaoperasi. Titik potong optimal RNL dan RML ditentukan menggunakan kurva receiver operating characteristic (ROC). Analisis survival Kaplan - Meier digunakan untuk membandingkan kejadian bebas FAPO, dan analisis multivariat Cox Regression diaplikasikan untuk mengidentifikasi prediktor independen terhadap kejadian FAPO. Hasil: Sebanyak 481 subjek termasuk dalam analisis. Insiden FAPO ≤72 jam adalah 25,6% (123 dari 481 pasien). Nilai AUC RNL dan RML praoperasi masingmasing adalah 0,667 (p < 0,001) dan 0,675 (p < 0,001). Titik potong optimal RNL praoperasi adalah ≥1,73 (sensitivitas 80,5%, spesifisitas 38,8%.) dan RML praoperasi adalah ≥0,26 (sensitivitas 70,7%, spesifisitas 53,9%). Analisis multivariat mengidentifikasi faktor risiko independen yang signifikan yaitu RML praoperasi (aHR 3,68; p = 0,02), RNL praoperasi (aHR 1,26; p < 0,001), dan usia yang lebih lanjut (aHR 1,05; p < 0,001). Kesimpulan: RNL dan RML praoperasi serta usia yang lebih lanjut adalah prediktor independen yang kuat untuk fibrilasi atrium pascaprosedur BPAK konvensional.
Kata Kunci: rasio neutrophil limfosit, rasio monosit limfosit, fibrilasi atrium pascaoperasi, bedah pintas arteri koroner, penyakit jantung koroner


Background: Postoperative atrial fibrillation (POAF) is the most common complication following conventional coronary artery bypass grafting (CABG). Inflammation plays a central role in the development of POAF. The preoperative neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are simple and inexpensive biomarkers that may serve as potential independent predictors of POAF. Methods: This study was a retrospective cohort study involving patients with coronary artery disease who underwent conventional CABG between January 2024 and May 2025 at National Cardiovascular Center Harapan Kita Hospital. The primary outcome was the occurrence of atrial fibrillation within 72 hours postoperatively. Optimal cut-off values for NLR and MLR were determined using receiver operating characteristic (ROC) analysis. Kaplan–Meier survival analysis was used to compare event-free survival, and multivariate Cox regression analysis was performed to identify independent predictors of POAF within 72 hours after surgery. Results: A total of 481 subjects were included in the analysis. The incidence of POAF within ≤72 hours was 25.6% (123 of 481 patients). The AUC values for preoperative NLR and MLR were 0.667 (p < 0.001) and 0.675 (p < 0.001), respectively. The optimal cut-off point for preoperative NLR was ≥1.73 (sensitivity 80.5%, specificity 38.8%), and for preoperative MLR was ≥0.26 (sensitivity 70.7%, specificity 53.9%). Multivariate analysis identified preoperative MLR (aHR 3.68; p=0.02), preoperative NLR (aHR 1.26; p < 0.001), and older age (aHR 1.05; p < 0.001) as significant independent risk factors. Conclusion: Preoperative NLR and MLR, as well as older age, are strong independent predictors of atrial fibrillation within 72 hours following conventional CABG.
Keywords: neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, postoperative atrial fibrillation, coronary artery bypass grafting, coronary artery disease