EurosSCORE-guided preoperative elective intra-aortic balloon pump implantation in high risk patients does not reduce In-hospital mortality after cardiac surgery

2010 ◽  
Vol 58 (S 01) ◽  
Author(s):  
C Diez ◽  
M Stiller ◽  
D Metz ◽  
RE Silber ◽  
HS Hofmann
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Hospital Mortality ◽  
High Risk Patients ◽  
Intra Aortic Balloon Pump ◽  
Risk Patients ◽  
Pump Implantation

MO410URINARY NGAL:HEPCIDIN-25 RATIO VERSUS URINARY NGAL FOR EARLY IDENTIFICATION OF PATIENTS AT RISK FOR ACUTE RENAL REPLACEMENT THERAPY AND DEATH AFTER CARDIAC SURGERY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Saban Elitok ◽  
Anja Haase-Fielitz ◽  
Martin Ernst ◽  
Michael Haase
Keyword(s):  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
High Risk ◽  
Hospital Mortality ◽  
Replacement Therapy ◽  
Early Identification ◽  
Area Under The Curve ◽  
Discriminatory Power ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background and Aims Acute kidney injury requiring renal replacement therapy (AKI-RRT) is strongly associated with mortality after cardiac surgery, however, options for early identification of patients at high-risk for AKI-RRT are extremely limited. Early after cardiac surgery, the predictive ability for AKI-RRT even of one of the most extensively evaluated novel urinary biomarkers, neutrophil gelatinase-associated lipocalin (NGAL), appears to be only moderate. We aimed to determine whether the discriminatory power and reclassification indices of NGAL:hepcidin-25-ratio (urinary concentrations of NGAL divided by that of hepcidin-25) within 60 min after end of surgery compare favorably to NGAL alone for identification of high-risk patients after cardiac surgery. We also aimed to determine whether an increased NGAL:hepcidin-25-ratio can detect subclinical AKI (no serum creatinine- or urine output-based criteria for AKI). Method This is a prospective substudy of the BICARBONATE trial, a multicenter parallel-randomized controlled trial comparing perioperative bicarbonate infusion for AKI prevention to usual patient care. At a tertiary referral center, 198 patients at increased kidney risk undergoing cardiac surgery with cardiopulmonary bypass were included into the present study. The primary outcome measure was defined as AKI-RRT. Secondary outcomes were in-hospital mortality and ratio-defined subclinical AKI characterized by increased odds for AKI-RRT or in-hospital mortality. We compared biomarkers’ area-under-the-curve of the receiver-operating-characteristic and performed cross-validated reclassification statistics and regression analysis adjusted to Cleveland risk score/EuroScore, cross-clamp time, age and volume of packed red blood cells. Results Patients with AKI-RRT (n=13) had 13.7-times higher NGAL and 3.3-times lower hepcidin-25 concentrations resulting in 46.9-times higher NGAL:hepcidin-25-ratio early after surgery compared to patients without AKI-RRT (Figure 1). The NGAL:hepcidin-25-ratio had higher discriminatory power compared with NGAL for risk of AKI-RRT and in-hospital mortality (area-under-the-curve difference 0.087, 95% CI, 0.036 to 0.138, P<0.001; 0.082, 95% CI, 0.018 to 0.146, P=0.012). The NGAL:hepcidin-25-ratio, but not NGAL, was independently associated with AKI-RRT (adjusted OR per 1-SD higher lnNGAL:hepcidin-25-ratio, 1.524, 95% CI, 1.046 to 2.222, P=0.028). The NGAL:hepcidin-25-ratio increased category-free net-reclassification-improvement for AKI-RRT (0.690, 95% CI, 0.146 to 1.234, P=0.013) and in-hospital mortality (cfNRI 0.744, 95% CI, 0.201 to 1.288, P=0.007). NGAL:hepcidin-25-ratio-positive subclinical AKI was associated with increased AKI-RRT (OR 10.02, 95% CI, 1.59 to 63.39; P<0.001) and in-hospital mortality rates (OR 41.07, 95% CI, 4.31 to 391.40; P<0.001). Conclusion The urinary NGAL:hepcidin-25-ratio appears to early identify high-risk patients and outperform NGAL after cardiac surgery. Also, the urinary NGAL:hepcidin-25 ratio can detect subclinical AKI. Confirmation of our findings in other cardiac surgery centers is now needed.

scholarly journals Intra-aortic balloon pump does not influence cerebral hemodynamics and neurological outcomes in high-risk cardiac patients undergoing cardiac surgery: an analysis of the IABCS trial

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Juliana R. Caldas ◽  
Ronney B. Panerai ◽  
Edson Bor-Seng-Shu ◽  
Graziela S. R. Ferreira ◽  
Ligia Camara ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiac Surgery ◽  
High Risk ◽  
Cognitive Decline ◽  
Neurological Complications ◽  
Cerebral Hemodynamics ◽  
High Risk Patients ◽  
Intra Aortic Balloon Pump ◽  
Risk Patients ◽  
Autoregulation Index

Abstract Background The intra-aortic balloon pump (IABP) is often used in high-risk patients undergoing cardiac surgery to improve coronary perfusion and decrease afterload. The effects of the IABP on cerebral hemodynamics are unknown. We therefore assessed the effect of the IABP on cerebral hemodynamics and on neurological complications in patients undergoing cardiac surgery who were randomized to receive or not receive preoperative IABP in the ‘Intra-aortic Balloon Counterpulsation in Patients Undergoing Cardiac Surgery’ (IABCS) trial. Methods This is a prospectively planned analysis of the previously published IABCS trial. Patients undergoing elective coronary artery bypass surgery with ventricular ejection fraction ≤ 40% or EuroSCORE ≥ 6 received preoperative IABP (n = 90) or no IABP (n = 91). Cerebral blood flow velocity (CBFV) of the middle cerebral artery through transcranial Doppler and blood pressure through Finometer or intra-arterial line were recorded preoperatively (T1) and 24 h (T2) and 7 days after surgery (T3) in patients with preoperative IABP (n = 34) and without IABP (n = 33). Cerebral autoregulation was assessed by the autoregulation index that was estimated from the CBFV response to a step change in blood pressure derived by transfer function analysis. Delirium, stroke and cognitive decline 6 months after surgery were recorded. Results There were no differences between the IABP and control patients in the autoregulation index (T1: 5.5 ± 1.9 vs. 5.7 ± 1.7; T2: 4.0 ± 1.9 vs. 4.1 ± 1.6; T3: 5.7 ± 2.0 vs. 5.7 ± 1.6, p = 0.97) or CBFV (T1: 57.3 ± 19.4 vs. 59.3 ± 11.8; T2: 74.0 ± 21.6 vs. 74.7 ± 17.5; T3: 71.1 ± 21.3 vs. 68.1 ± 15.1 cm/s; p = 0.952) at all time points. Groups were not different regarding postoperative rates of delirium (26.5% vs. 24.2%, p = 0.83), stroke (3.0% vs. 2.9%, p = 1.00) or cognitive decline through analysis of the Mini-Mental State Examination (16.7% vs. 40.7%; p = 0.07) and Montreal Cognitive Assessment (79.16% vs. 81.5%; p = 1.00). Conclusions The preoperative use of the IABP in high-risk patients undergoing cardiac surgery did not affect cerebral hemodynamics and was not associated with a higher incidence of neurological complications. Trial registrationhttp://www.clinicaltrials.gov (NCT02143544).

scholarly journals Determination of comorbidity index for high-risk patients with coronary artery disease before cardiac surgery

2021 ◽  
Vol 23 (4) ◽  
pp. 485-491
Author(s):  
О. К. Gogayeva
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Surgery ◽  
High Risk ◽  
Normal Weight ◽  
High Risk Patients ◽  
Type 2 Dm ◽  
Risk Patients ◽  
Comorbidity Index ◽  
Artery Disease

The aim: to determine the comorbidity index before cardiac surgery in high-risk patients with coronary artery disease (CAD). Materials and methods. A retrospective analysis of data from 354 random high-risk patients who underwent a surgery and were discharged from National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine during the period 2009–2019. The mean age of patients was 61.9 ± 9.6 years. All the patients were examined: ECG, ECHO CG, coronary angiography before the surgery as well as Charlson comorbidity index was calculated and a risk on the scales EuroSCORE I, EuroSCORE II and STS was stratified. Results. I–III degree obesity was revealed in 133 (37.5 %) patients, patients with type 2 diabetes mellitus (DM) were more likely to have BMI >30 kg/m2 (P = 0.017). Patients with normal weight had a carotid artery stenosis >50 % (P = 0.014) and history of stroke (P = 0.043) significantly more frequently. No differences in comorbidity of overweight and normal weight patients were detected (5.73 ± 1.70 vs. 5.9 ± 1.8, P = 0.4638). Type 2 DM was diagnosed in 90 (25.4 %) patients. In the case of normoglycemia, the comorbidity index was significantly lower than in type 2 DM (4.88 ± 1.38 vs. 6.60 ± 2.03, P = 0.0001) and glucose intolerance 5.8 ± 1.5 (P < 0.0001). Chronic kidney disease (CKD) G3a–G4 stages was diagnosed in 132 (37.2 %) patients. Significant higher comorbidity was found in patients with G3a–G4 stages CKD in comparison to those with G1–G2 stages CKD – 6.33 ± 1.78 vs. 5.46 ± 1.60 (P < 0.0001). Among comorbidities in patients with gouty arthritis, type 2 DM (P < 0.0001), obesity (P = 0.0080), CKD G3a–G4 (P = 0.0020) and varicose veins of the lower extremities (P = 0.0214) were significantly more common. Preoperative risk stratification according to the EuroSCORE II scale averaged 8.8 %. Conclusions. Preoperative analysis of baseline status in CAD patients showed the high Charlson comorbidity index, which averaged 5.7 ± 1.7. The weak direct correlation between the comorbidity index and the high predicted cardiac risk on the ES II scale (r = 0.2356, P = 0.00001), length of stay in the intensive care unit (r = 0.1182, P = 0.0262) and discharge after the surgery (r = 0.1134, P = 0.0330) was found.

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