Association between platelet-to-lymphocyte ratio and prognosis in patients receiving coronary artery bypass grafting: a meta-analysis.

Abstract

<h4>Background</h4>Emerging evidence indicates a possible relation of the platelet-to-lymphocyte ratio (PLR) to clinical outcomes in the coronary artery disease (CAD) population receiving coronary artery bypass grafting (CABG). However, current findings remain inconclusive and inconsistent. Our study examines the prognostic value of PLR in CAD patients undergoing CABG.<h4>Methods</h4>PubMed, Embase, Web of Science, as well as Cochrane Library, were thoroughly retrieved until April 15, 2025. Data for categorical and continuous variables were merged separately using odds ratio (OR), 95% confidence interval (CI), and standardized mean difference (SMD). In addition, the result stability was rated, and possible sources of heterogeneity were identified via sensitivity and subgroup analyses.<h4>Results</h4>Twenty-seven studies were encompassed, comprising nine cohort studies and eighteen case-control studies, with an aggregate sample size of 17,120 patients. Meta-analysis of categorical data revealed that elevated PLR was notably linked to an elevated incidence of postoperative atrial fibrillation (POAF) (OR =1.02, 95% CI: 1.01-1.02; P<0.001), all-cause mortality (ACM) (OR =1.69, 95% CI: 1.04-2.74; P=0.03), and delirium (OR =1.05, 95% CI: 1.03-1.07; P<0.001). Statistically significant relations were noted between PLR and acute kidney injury (AKI) (OR =1.04, 95% CI: 0.97-1.11; P=0.30) or saphenous vein graft disease (SVGD) (OR =1.34, 95% CI: 0.81-2.20; P=0.25). For continuous variables, elevated PLR values were associated with a greater likelihood of POAF, AKI, ACM, and SVGD; however, no significant correlations were found with delirium or other adverse events. Subgroup analyses suggested that the predictive value of PLR for POAF was influenced by study design, patient age, geographic location, and PLR cutoff values, while region and time of PLR measurement affected its prognostic significance for AKI.<h4>Conclusions</h4>An elevated PLR correlated with a potential risk of POAF, AKI, ACM, delirium, and SVGD in the CAD population undergoing CABG. PLR may be a valuable and accessible biomarker for prognostic assessment in this patient population, thereby aiding clinical decision-making in the context of surgical management of CAD.