Association between preoperative monocyte-to-HDL cholesterol ratio and postoperative atrial fibrillation after esophagectomy for ESCC: a propensity score-matched retrospective cohort study
- 1Department of Pathology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu Province China
Abstract
Background: Postoperative atrial fibrillation (POAF) is a frequent complication after esophagectomy. The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) integrates monocyte-related inflammatory burden with HDL-C-related anti-inflammatory and antioxidative capacity. We examined the association between preoperative MHR and POAF after radical esophagectomy for esophageal squamous cell carcinoma (ESCC).
Methods: Consecutive patients with pathologically confirmed ESCC who underwent radical esophagectomy from January 2022 to December 2024 were screened, and 413 patients were included. MHR was calculated as monocyte count divided by HDL-C measured within 7 days before surgery. POAF was defined as new-onset atrial fibrillation lasting ≥ 30 s within 7 postoperative days. ROC/Youden analysis was used to derive an exploratory cut-off. Primary propensity score matching (PSM) based on sex, BMI, smoking, drinking, and diabetes mellitus yielded 147 matched pairs. An expanded PSM analysis was performed as a sensitivity analysis. The primary inferential analyses modeled MHR continuously, with additional exploratory categorical, quartile-based, restricted cubic spline, and Firth penalized logistic regression analyses.
Results: POAF occurred in 48 of 413 patients (11.6%). ROC analysis showed moderate discrimination for MHR (AUC 0.765). The exploratory Youden-derived cut-off was 0.355, with sensitivity of 0.92 and specificity of 0.53. POAF was more frequent in the high-MHR group than in the low-MHR group before matching (20.3% vs. 2.0%) and after primary PSM (21.1% vs. 2.0%). In age/sex-adjusted models, each 0.1 increase in MHR was associated with higher odds of POAF in the full cohort (OR 3.05, 95% CI 2.10–4.42), the primary PSM cohort (OR 3.01, 95% CI 1.88–4.82), and the expanded PSM cohort (OR 2.52, 95% CI 1.60–3.96; all P < 0.001). Restricted cubic spline analysis showed a significant overall association (P for overall < 0.001), without evidence of non-linearity (P = 0.746).
Conclusions: Elevated preoperative MHR was consistently associated with higher odds of POAF after radical esophagectomy for ESCC. Because the cut-off was data-derived and the study was retrospective, MHR should be considered a candidate biomarker requiring prospective multicenter validation before clinical implementation.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s13019-026-04621-9.
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BibTeX
@article{zhang2026association,
title = {{Association between preoperative monocyte-to-HDL cholesterol ratio and postoperative atrial fibrillation after esophagectomy for ESCC: a propensity score-matched retrospective cohort study}},
author = {Zhengwei Zhang and Haiyan Liu and Bo Xia and Wenguang He and Qianqian Ma and Yanan Zhong and Yaning Zhu},
journal = {Journal of Cardiothoracic Surgery},
year = {2026},
month = aug,
doi = {10.1186/s13019-026-04621-9},
url = {https://doi.org/10.1186/s13019-026-04621-9},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Association between preoperative monocyte-to-HDL cholesterol ratio and postoperative atrial fibrillation after esophagectomy for ESCC: a propensity score-matched retrospective cohort study
AU - Zhengwei Zhang
AU - Haiyan Liu
AU - Bo Xia
AU - Wenguang He
AU - Qianqian Ma
AU - Yanan Zhong
AU - Yaning Zhu
PY - 2026
DA - 2026/08/10
JO - Journal of Cardiothoracic Surgery
DO - 10.1186/s13019-026-04621-9
UR - https://doi.org/10.1186/s13019-026-04621-9
AB - Background: Postoperative atrial fibrillation (POAF) is a frequent complication after esophagectomy. The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) integrates monocyte-related inflammatory burden with HDL-C-related anti-inflammatory and antioxidative capacity. We examined the association between preoperative MHR and POAF after radical esophagectomy for esophageal squamous cell carcinoma (ESCC). Methods: Consecutive patients with pathologically confirmed ESCC who underwent radical esophagectomy from January 2022 to December 2024 were screened, and 413 patients were included. MHR was calculated as monocyte count divided by HDL-C measured within 7 days before surgery. POAF was defined as new-onset atrial fibrillation lasting ≥ 30 s within 7 postoperative days. ROC/Youden analysis was used to derive an exploratory cut-off. Primary propensity score matching (PSM) based on sex, BMI, smoking, drinking, and diabetes mellitus yielded 147 matched pairs. An expanded PSM analysis was performed as a sensitivity analysis. The primary inferential analyses modeled MHR continuously, with additional exploratory categorical, quartile-based, restricted cubic spline, and Firth penalized logistic regression analyses. Results: POAF occurred in 48 of 413 patients (11.6%). ROC analysis showed moderate discrimination for MHR (AUC 0.765). The exploratory Youden-derived cut-off was 0.355, with sensitivity of 0.92 and specificity of 0.53. POAF was more frequent in the high-MHR group than in the low-MHR group before matching (20.3% vs. 2.0%) and after primary PSM (21.1% vs. 2.0%). In age/sex-adjusted models, each 0.1 increase in MHR was associated with higher odds of POAF in the full cohort (OR 3.05, 95% CI 2.10–4.42), the primary PSM cohort (OR 3.01, 95% CI 1.88–4.82), and the expanded PSM cohort (OR 2.52, 95% CI 1.60–3.96; all P < 0.001). Restricted cubic spline analysis showed a significant overall association (P for overall < 0.001), without evidence of non-linearity (P = 0.746). Conclusions: Elevated preoperative MHR was consistently associated with higher odds of POAF after radical esophagectomy for ESCC. Because the cut-off was data-derived and the study was retrospective, MHR should be considered a candidate biomarker requiring prospective multicenter validation before clinical implementation. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s13019-026-04621-9.
SN - 1749-8090
ER -