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The letter reviews findings on SIRI and SII, suggests possible reasons for non-significant differences, and notes limitations such as retrospective single-center design, sample size, and biomarker 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\n[https://doi.org/10.1590/1806-9282.20250999](https://doi.org/10.1590/1806-9282.20250999)  \nComment on: Inflammatory indexes in predicting postoperative atrial fibrillation  \nCihan Aydın1*  , Aykut Demirkıran1  , Hüseyin Orta1   \nDear Editor,  \nWe read the article by Erkan et al. entitled “The role of the systemic inflammatory response index in predicting postoperative atrial fibrillation” with great interest1. We congratulate the authors for their valuable contribution. We would like to make some additional comments. Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, which causes increased morbidity and extended hospitalizations2 . Inflammation is recognized as a crucial factor in the pathogenesis of POAF that occurs following coronary artery bypass grafting. This inflammatory reaction increases the risk of atrial fibrillation by aggravating myocardial injury and disrupting electrical stability. In this study, the value of biomarkers reflecting the degree of inflammation and immune response, such as Systemic Immuno-Inflammatory Index (SII) and Systemic Inflammatory Response Index (SIRI), in predicting POAF was investigated. Although SIRI and SII values were higher in the patient group developing POAF, no significant difference was observed (p>0.05). In addition, age and family history of coronary artery disease were found to be important factors significantly affecting the development of POAF (p=0.048 and p=0.01, respectively) .  \nThe reason for the similarity of the inflammation indices may be the intensive use of acetylsalicylic acid, which has an anti-inflammatory effect, in both groups. In addition, the small number of patients included in the study and the calculation  \nof these indices from blood only once at a certain time may have prevented accurate results.  \nPreoperative measurement of left atrium diameters, volumes, and volume indices associated with atrial fibrillation (AF) in these patient groups could have contributed to the study3,4 .  \nThe use of antiarrhythmic drugs such as amiodarone, which will reduce the incidence of AF in the preoperative period, may affect the development of POAF. This situation could have been stated by the authors in the article. In addition to the SIRI and SII, other indices such as the neutrophil–lymphocyte ratio and Prognostic Nutritional Index could have been examined in the study. The receiver operating characteristic curve analysis could have been performed to calculate the cut-off values for predicting POAF for these indices.  \nThe authors recognize that the study’s retrospective, single-center design restricts its generalizability.  \nAUTHORS’CONTRIBUTIONS  \nCA: Writing – original draft. AD: Formal Analysis. HO: Conceptualization, Formal Analysis.  \nDATA AVAILABILITY STATEMENT  \nThe datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.  \nREFERENCES  \n1. Erkan MH, Rahman ÖF, Dur na F. The role of the systemic inflammatory response index in predicting postoperative atrial fibrillation. Rev Assoc Med Bras (1992). 2025;71(2):e20240783 . [https://doi.org/10.1590/1806-9282.20240783](https://doi.org/10.1590/1806-9282.20240783)  \n2. Engin M, Aydın U, Ata Y, Yavuz S. New-onset atrial fibrillation after coronary artery bypass graft surgery. Rev Assoc Med Bras (1992). 2023;69(4):e20221413. [https://doi.org/10.1590/1806-9282.20221413](https://doi.org/10.1590/1806-9282.20221413)  \n3. Aykaç H, Aydın C, Demirkıran A, Uslu N, Alpsoy Ş . Natriuretic peptide concentrations and echocardiography findingsin patients with micro-atrial fibrillation. Kardiologiia. 2024;64(8):56-63 . [https://doi.org/10.18087/cardio.2024.8.n2633](https://doi.org/10.18087/cardio.2024.8.n2633)  \n[4](4). Aydın C. Possible predictors of stroke in patients with atrial microfibrillation. Kardiologiia. 2023;63(5):40-6 . [https://doi](https://doi). org/10.18087/cardio.2023.5.n2158  \n1Tekirdağ Na","cbCaijjM9Q9bGunh","https://ap.wps.com/l/cbCaijjM9Q9bGunh","pdf",110569,"English","# Letter to the Editor\n## Summary and congratulatory remarks\n## Comments on inflammatory indices and study limitations\n## Additional analyses and suggestions\n## Authors’ contributions and data availability\n## References","[{\"question\":\"What is the main purpose of this letter?\",\"answer\":\"To provide additional comments on an article about using systemic inflammatory response indices to predict postoperative atrial fibrillation.\"},{\"question\":\"Why might SIRI and SII not have shown significant differences in this study?\",\"answer\":\"The letter suggests similarity could be influenced by intensive acetylsalicylic acid use in both groups and by limitations such as small patient numbers and measuring indices only once at a fixed time.\"},{\"question\":\"What methodological or analytical improvements does the letter recommend?\",\"answer\":\"It recommends considering preoperative left atrial measurements, evaluating effects of antiarrhythmic drugs like amiodarone, examining additional inflammatory/nutritional indices, and performing ROC curve analysis to derive cut-off values.\"}]","Comment on Inflammatory Indexes in Predicting Postoperative Atrial Fibrillation - Letter to the Editor | PDF"]