Bilirubin adsorption for the treatment of severe hyperbilirubinemia after cardiac surgery: A retrospective cohort study

2021 ◽  
pp. 039139882199784
Author(s):  
Xiaolan Chen ◽  
Lu Li ◽  
Ming Bai ◽  
Shiren Sun ◽  
Xiangmei Chen
Keyword(s):  
Cardiac Surgery ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Multivariate Analyses ◽  
Reduction Rate ◽  
Mortality Rates ◽  
Increased Risk ◽  
Bilirubin Adsorption ◽  
Severe Hyperbilirubinemia ◽  
Post Cardiac Surgery

Objective: Severe hyperbilirubinemia after cardiac surgery increases in-hospital and 1-year mortality. Our present study aimed to analyze the safety and efficacy of bilirubin adsorption (BA) in patients with post-cardiac-surgery severe hyperbilirubinemia. Methods: We retrospectively included patients who underwent BA due to severe hyperbilirubinemia after cardiac surgery in our center between January 2015 and December 2018. The change of serum bilirubin, alanine aminotransferase, aspartate aminotransferase, and 30-day and 1-year mortality were assessed as endpoints. Univariate and multivariate analyses were employed to identify the risk factors of patient 30-day mortality. Result: A total of 25 patients with 44 BA treatments were included. One BA treatment reduced total bilirubin (TB) concentration from 431.65 ± 136.34 to 324.83 ± 129.44 µmol/L ( p < 0.001), with a reduction rate of 24.8%. No clinically relevant thrombosis of the extracorporeal circuit occurred during the BA treatment. The 30-day and 1-year mortality rates were 68% ( n = 18) and 84% ( n = 21), respectively. Multivariate analysis identified that TB level before BA treatment (odds ratio [OR] 1.010, 95% confidence interval [CI] 1.000–1.019; p = 0.043) was an independent risk factor of 30-day mortality. Conclusions: BA treatment should be considered as an effective and safe method for the reduction of serum bilirubin in patients with post-cardiac-surgery severe hyperbilirubinemia. Patients with higher TB level before BA treatment had a relatively increased risk of 30-day mortality. Further studies are needed to evaluate the timing of BA for severe hyperbilirubinemia after cardiac surgery.

scholarly journals Comparison of results on the use of extended criteria liver doners for transplants in Espírito Santo

2021 ◽  
Vol 48 ◽  
Author(s):  
ANTONIO CARLOS LUGON FERREIRA-JR ◽  
GUSTAVO PEIXOTO SOARES MIGUEL ◽  
IARA MOSCON ◽  
ISAAC WALKER ABREU ◽  
JULIETE BOREL DE OLIVEIRA SILVA AGUIAR ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Medical Records ◽  
Liver Diseases ◽  
Statistical Difference ◽  
Total Bilirubin ◽  
Mortality Rates ◽  
Cardiorespiratory Arrest ◽  
Increased Risk ◽  
Expanded Criteria ◽  
Early Late

ABSTRACT Introduction: liver Transplantation is currently the treatment of choice for several terminal liver diseases. Despite the increase in performed transplants, the waiting lists continue to increase. In order to expand the supply of organs, transplantation teams have started to use previously rejected livers for transplants because of an increased risk of unfavorable outcomes. Objective: to evaluate the use of livers of expanded criterion donators. Methods: retrospective study of medical records. The livers were classified as normal or expanded criteria. The groups were divided in low and high MELD. A multivariate analysis was performed through logistic regression. Results: there was no statistical difference regarding early, late and global mortality between the groups. Decreased survival was observed in patients with high MELD (higher or equal to 20) when they received grafts from expanded criterion donators. The association between the occurrence of cardiorespiratory arrest and presence of elevated total bilirubin in donators was associated with higher mortality rates in expanded criterion livers. Conclusion: the overall results are similar, but expanded criteria liver donators was associated with higher mortality in patients with high MELD.

scholarly journals Prophylactic use of proton pump inhibitors post-cardiac surgery

2021 ◽  
pp. 1-7
Author(s):  
Matthew Azzopardi ◽  
Jean-Luc Paris ◽  
David Sladden
Keyword(s):  
Cardiac Surgery ◽  
Gastrointestinal Bleeding ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Statistical Significance ◽  
Mortality Rates ◽  
Prophylactic Use ◽  
New Treatment ◽  
Post Cardiac Surgery ◽  
Discharge Summaries

Aims/Background Gastrointestinal bleeding significantly increases morbidity and mortality rates postoperatively in patients undergoing cardiac surgery. The prophylactic prescribing of proton pump inhibitors post-cardiac surgery is currently a class IIa recommendation of the European Association of Cardio-Thoracic Surgery. Method A retrospective review of patients who underwent cardiac surgery between July and December 2019 in the authors' hospital was carried out, using discharge summaries. New treatment charts were introduced with a pre-printed proton pump inhibitor included in the ‘regular medication’ section of the treatment chart and two reaudits were performed using the same methodology. Results Before the intervention, 47% were prescribed omeprazole postoperatively, compared to 74% (P<0.001) and 66% (P=0.008) in the first and second reaudits respectively. Gastrointestinal bleeding was more common pre-intervention (4% vs 1% respectively; P=0.10). Conclusions This intervention resulted in a statistically significant improvement in the prescription of postoperative omeprazole and a decrease in gastrointestinal bleeds. However, other risk factors such as diabetes mellitus, arteriosclerosis and procedure urgency may have contributed to the absence of statistical significance in the latter.

scholarly journals Bilirubin adsorption versus plasma exchange for hyperbilirubinemia in patients after cardiac surgery: a retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ke Pan ◽  
He Zhang ◽  
Kai Zhong ◽  
Hai-tao Zhang ◽  
Ze-shi Li ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Treatment Group ◽  
Hospital Mortality ◽  
Plasma Exchange ◽  
Total Bilirubin ◽  
Liver Function Tests ◽  
Direct Bilirubin ◽  
Circulatory Support ◽  
Mortality And Morbidity ◽  
Bilirubin Adsorption

Abstract Objective Hyperbilirubinemia after cardiac surgery increases in-hospital mortality and is associated with poor prognosis. Our present study aimed to compare the efficacy of bilirubin adsorption (BA) and plasma exchange (PEX) in patients with hyperbilirubinemia after cardiac surgery. Methods We retrospectively included patients who underwent BA treatment or PEX treatment due to severe hyperbilirubinemia after cardiac surgery at our center from 2015 to 2020. We collected results from urine and liver function tests before and after treatment and compared the in-hospital mortality and morbidity between the two treatment groups. Results A total of 56 patients were enrolled in this study: 14 patients received BA treatment, and 42 patients received PEX treatment. Compared to the PEX group, the BA group exhibited a statistically significant reduction in total bilirubin (p = 0.016) and direct bilirubin (p = 0.036) levels. The in-hospital mortality was 85.7% (48/56) in the whole group, and the BA group had a lower mortality than the PEX group (71.4% vs. 90.5%, p = 0.078). The BA group showed better circulatory support, including lower risks of IABP (21.4% vs. 52.4%, p = 0.044), ECMO (21.4% vs. 50.0%, p = 0.061), reintubation (64.3% vs. 40.5%, p = 0.122) and ventricular arrhythmias (64.3% vs. 45.2%, p = 0.217). The in-hospital mortality was still lower in the BA treatment group than in the PEX treatment group (71.4% vs. 100%, p = 0.049) in the matched cohort. Conclusions Compared to PEX treatment, BA treatment had a higher bilirubin removal ability in patients with hyperbilirubinemia and could reduce the mortality and risks of poor clinical outcomes. BA treatment should be considered an effective treatment method for patients with higher total bilirubin or direct bilirubin levels.

Prospective assessment of the diagnostic and prognostic utility of rotational thromboelastometry for canine disseminated intravascular coagulation

2018 ◽  
Vol 183 (22) ◽  
pp. 692-692 ◽  
Author(s):  
Anthony Barthélemy ◽  
Céline Pouzot-Nevoret ◽  
Benoît Rannou ◽  
Isabelle Goy-Thollot
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Multivariate Analyses ◽  
Medical Condition ◽  
Mortality Rates ◽  
Intravascular Coagulation ◽  
Risk Of Death ◽  
Diagnosis And Prognosis ◽  
Increased Risk ◽  
Prognostic Utility ◽  
Prospective Assessment

This study compared the haematological, haemostatic and thromboelastometric (TEM) parameters between dogs with and without suspected disseminated intravascular coagulation (DIC). Seventy-six dogs with a medical condition known to predispose to DIC were prospectively included in the study. Thirty-eight dogs (50 per cent) presented with haemorrhagic diatheses. DIC was diagnosed in 32 dogs (42 per cent). Thirty-five dogs (46 per cent) had a normal TEM profile, 25 dogs (33 per cent) had a hypercoagulable profile and 16 dogs (21 per cent) had a hypocoagulable profile. Except for the lysis parameters, all TEM parameters were significantly correlated with the presence of DIC in univariate and multivariate analyses. Mortality rates were significantly higher in dogs with DIC (50 per cent) than in dogs without DIC (27 per cent, P=0.043; OR 2.667, 95 per cent CI 1.049 to 6.701), and mortality rates were significantly higher in dogs with a hypocoagulable profile (69 per cent) than in dogs with a hypercoagulable (24 per cent, P=0.017; OR 4.800, 95 per cent CI 1.241 to 16.220) or a normal profile (31 per cent, P=0.046; OR 3.429; 95 per cent CI 1.006 to 11.470). All TEM parameters were significantly associated with mortality in univariate and multivariate analyses. Thromboelastometry appears to be a valuable tool for the diagnosis and prognosis of dogs with suspected DIC, especially those with a hypocoagulable profile that was associated with increased risk of death and increased risk of haemorrhagic diatheses.

Analysis of Nosocomial Infections in Post–Cardiac Surgery Extracorporeal Membrane Oxygenation Support Therapy

2018 ◽  
Vol 21 (5) ◽  
pp. E387-E391 ◽  
Author(s):  
Binfei Li ◽  
Geqin Sun ◽  
Zhou Cheng ◽  
Chuangchuang Mei ◽  
Xiaozu Liao ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Stay ◽  
Nosocomial Infections ◽  
Total Hospital ◽  
Secondary Infections ◽  
Total Hospital Stay ◽  
Mechanical Ventilation Time ◽  
Post Cardiac Surgery

Objectives: This study aims to analyze the nosocomial infection factors in post–cardiac surgery extracorporeal membrane oxygenation (ECMO) supportive treatment (pCS-ECMO). Methods: The clinical data of the pCS-ECMO patients who obtained nosocomial infections (NI) were collected and analyzed retrospectively. Among the 74 pCS-ECMO patients, 30 occurred with NI, accounting for 40.5%; a total of 38 pathogens were isolated, including 22 strains of Gram-negative bacteria (57.9%), 15 strains of Gram-positive bacteria (39.5%), and 1 fungus (2.6%). Results: Multidrug-resistant strains were highly concentrated, among which Acinetobacter baumannii and various coagulase-negative staphylococci were the main types; NI was related to mechanical ventilation time, intensive care unit (ICU) residence, ECMO duration, and total hospital stay, and the differences were statistically significant (P < .05). The binary logistic regression analysis indicated that ECMO duration was a potential independent risk factor (OR = 0.992, P = .045, 95.0% CI = 0.984-1.000). Conclusions: There existed significant correlations between the secondary infections of pCS-ECMO and mechanical ventilation time, ICU residence, ECMO duration, and total hospital stay; therefore, hospitals should prepare appropriate preventive measures to reduce the incidence of ECMO secondary infections.

The Role of Revascularisation in Patients Undergoing Non-cardiac Surgery

2010 ◽  
Vol 5 (1) ◽  
pp. 104
Author(s):  
Daniel S Menees ◽  
Eric R Bates ◽  
◽  
Keyword(s):  
Cardiac Surgery ◽  
Prediction Models ◽  
Cardiovascular Complications ◽  
Weight Of Evidence ◽  
Beta Blockade ◽  
Cardiac Morbidity ◽  
Increased Risk ◽  
Reduction Strategies ◽  
Artery Disease ◽  
Risk Reduction Strategies

Coronary artery disease (CAD) affects millions of US citizens. As the population ages, an increasing number of people with CAD are undergoing non-cardiac surgery and face significant peri-operative cardiac morbidity and mortality. Risk-prediction models can be used to help identify those patients at increased risk of peri-operative cardiovascular complications. Risk-reduction strategies utilising pharmacotherapy with beta blockade and statins have shown the most promise. Importantly, the benefit of prophylactic coronary revascularisation has not been demonstrated. The weight of evidence suggests reserving either percutaneous or surgical revascularisation in the pre-operative setting for those patients who would otherwise meet independent revascularisation criteria.

scholarly journals Long Term Renal Outcomes in Children with Acute Kidney Injury Post-Cardiac Surgery

2021 ◽  
Author(s):  
Sidharth Kumar Sethi ◽  
Rajesh Sharma ◽  
Aditi Gupta ◽  
Abhishek Tibrewal ◽  
Romel Akole ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Injury ◽  
Renal Outcomes ◽  
Post Cardiac Surgery

scholarly journals Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative

2021 ◽  
Author(s):  
John R. Prowle ◽  
Lui G. Forni ◽  
Max Bell ◽  
Michelle S. Chew ◽  
Mark Edwards ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Baseline Risk ◽  
Major Surgery ◽  
Increased Risk

AbstractPostoperative acute kidney injury (PO-AKI) is a common complication of major surgery that is strongly associated with short-term surgical complications and long-term adverse outcomes, including increased risk of chronic kidney disease, cardiovascular events and death. Risk factors for PO-AKI include older age and comorbid diseases such as chronic kidney disease and diabetes mellitus. PO-AKI is best defined as AKI occurring within 7 days of an operative intervention using the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI; however, additional prognostic information may be gained from detailed clinical assessment and other diagnostic investigations in the form of a focused kidney health assessment (KHA). Prevention of PO-AKI is largely based on identification of high baseline risk, monitoring and reduction of nephrotoxic insults, whereas treatment involves the application of a bundle of interventions to avoid secondary kidney injury and mitigate the severity of AKI. As PO-AKI is strongly associated with long-term adverse outcomes, some form of follow-up KHA is essential; however, the form and location of this will be dictated by the nature and severity of the AKI. In this Consensus Statement, we provide graded recommendations for AKI after non-cardiac surgery and highlight priorities for future research.

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