Preoperative C‑reactive protein‑to‑albumin ratio as a predictor of postoperative atrial fibrillation after coronary artery bypass grafting

Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG), leading to higher rates of morbidity and greater demands on healthcare resources. This study aimed to assess the relationship between the C-reactive protein to albumin ratio (CAR) and the development of POAF in patients undergoing CABG. A retrospective cohort study was conducted on 109 patients who underwent elective CABG. CAR was measured preoperatively. The primary outcome was the incidence of POAF within the first postoperative week. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to evaluate the predictive value of CAR and other clinical variables. POAF occurred in 29 patients (26.6%). The mean CAR was significantly higher in the POAF group, with ROC analysis demonstrating excellent discriminatory ability (AUC = 0.9713, cut-off = 1.44). Additionally, CAR showed a moderate ability to predict mortality (AUC = 0.698, cut-off = 2.27), a novel finding not extensively reported in prior studies. The odds of developing POAF increased by 50% for each unit increase in CAR (OR: 1.50; 95% CI: 1.20, 1.88; p = 0.001), reinforcing its potential as a biomarker for risk stratification. Preoperative CAR is a strong, independent predictor of POAF after CABG. Incorporating CAR into routine risk assessment may help identify high-risk patients and guide prophylactic strategies.