scholarly journals Preoperative platelet count, preoperative hemoglobin concentration and deep hypothermic circulatory arrest duration are risk factors for acute kidney injury after pulmonary endarterectomy: a retrospective cohort study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Congya Zhang ◽  
Guyan Wang ◽  
Hui Zhou ◽  
Guiyu Lei ◽  
Lijing Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Platelet Count ◽  
Circulatory Arrest ◽  
Kidney Injury ◽  
Hemoglobin Concentration ◽  
Deep Hypothermic Circulatory Arrest ◽  
Pulmonary Endarterectomy ◽  
Short Term ◽  
Preoperative Hemoglobin ◽  
Postoperative Aki

Abstract Background Acute kidney injury (AKI) is a major postoperative morbidity of patients undergoing cardiac surgery and has a negative effect on prognosis. The kidney outcomes after pulmonary endarterectomy (PEA) have not yet been reported; However, several perioperative characteristics of PEA may induce postoperative AKI. The objective of our study was to identify the incidence and risk factors for postoperative AKI and its association with short-term outcomes. Methods This was a single-center, retrospective, observational, cohort study. Assessments of AKI diagnosis was executed based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results A total of 123 consecutive patients who underwent PEA between 2014 and 2018 were included. The incidence of postoperative AKI was 45% in the study population. Stage 3 AKI was associated with worse short-term outcomes and 90-day mortality (p < 0.001, p = 0.002, respectively). The independent predictors of postoperative AKI were the preoperative platelet count (OR 0.992; 95%CI 0.984–0.999; P = 0.022), preoperative hemoglobin concentration (OR 0.969; 95%CI 0.946–0.993; P = 0.01) and deep hypothermic circulatory arrest (DHCA) time (OR 1.197; 95%CI 1.052–1.362; P = 0.006) in the multivariate analysis. Conclusion The incidence of postoperative AKI was relatively high after PEA compared with other types of cardiothoracic surgeries. The preoperative platelet count, preoperative hemoglobin concentration and DHCA duration were modifiable predictors of AKI, and patients may benefit from some low-risk, low-cost perioperative measures.

Perfusion strategy and mid-term results of 58 consecutive pulmonary endarterectomy

Perfusion ◽  
2019 ◽  
Vol 34 (6) ◽  
pp. 475-481
Author(s):  
Shujie Yan ◽  
Song Lou ◽  
Jiade Zhu ◽  
Sheng Liu ◽  
Yu Zhao ◽  
...  
Keyword(s):  
Neurological Outcome ◽  
Potassium Concentration ◽  
Circulatory Arrest ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Deep Hypothermic Circulatory Arrest ◽  
Good Recovery ◽  
Pulmonary Endarterectomy ◽  
Short Term ◽  
Blood Potassium ◽  
Thromboembolic Pulmonary Hypertension

Objective: The aim of this retrospective study was to review and report short-term and mid-term outcomes of pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension at our institute in the recent 2 years and to describe perfusion strategy. Methods: A total of 58 consecutive patients with chronic thromboembolic pulmonary hypertension underwent pulmonary endarterectomy under deep hypothermia circulatory arrest with an established perfusion practice between November 2015 and December 2017. Peri-operative data and patients’ outcome were retrospectively analyzed. Results: Mean pulmonary artery pressure was decreased (49 (40-56) mmHg vs 27 (20-31) mmHg, p < 0.001), and pulmonary vascular resistance (724 (538-1108) vs 206 (141-284) dyn second cm−5, p < 0.001) improved significantly after surgery. In-hospital mortality was 1.7% and postoperative complication rate was 27.6%. Antipsychotic medication of olanzapine was prescribed for 36 patients (62.1%), which was independently related to total deep hypothermic circulatory arrest time, postoperative blood potassium concentration, and hematocrit. The majority of patients recovered uneventfully with good mid-term cardiac function (New York Heart Association I-II: 98.1%) and neurological outcome (Glasgow Outcome Scale—Extended Upper Good Recovery: 74.1% and Lower Good Recovery: 20.3%). Mid-term neurological outcome was associated with post–pulmonary endarterectomy antipsychotic medication. Conclusion: Short-term and mid-term outcome after pulmonary endarterectomy was comparable to high-volume centers. Incidence of post–pulmonary endarterectomy delirium was relatively high and associated with mid-term neurological outcome. Total deep hypothermic circulatory arrest time, postoperative blood potassium concentration, and hematocrit were independent risk factors of postoperative olanzapine medication. More efforts and further research are required to optimize the neuroprotection of perfusion practice.

scholarly journals Preoperative Albuminuria and Intraoperative Chloride Load: Predictors of Acute Kidney Injury Following Major Abdominal Surgery

2018 ◽  
Vol 7 (11) ◽  
pp. 431 ◽  
Author(s):  
Diamantina Marouli ◽  
Kostas Stylianou ◽  
Eleftherios Papadakis ◽  
Nikolaos Kroustalakis ◽  
Stavroula Kolyvaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Abdominal Surgery ◽  
Care Center ◽  
Chronic Kidney Disease Stage ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Major Abdominal Surgery ◽  
Disease Stage ◽  
Postoperative Aki

Background: Postoperative Acute Kidney Injury (AKI) is a common and serious complication associated with significant morbidity and mortality. While several pre- and intra-operative risk factors for AKI have been recognized in cardiac surgery patients, relatively few data are available regarding the incidence and risk factors for perioperative AKI in other surgical operations. The aim of the present study was to determine the risk factors for perioperative AKI in patients undergoing major abdominal surgery. Methods: This was a prospective, observational study of patients undergoing major abdominal surgery in a tertiary care center. Postoperative AKI was diagnosed according to the Acute Kidney Injury Network criteria within 48 h after surgery. Patients with chronic kidney disease stage IV or V were excluded. Logistic regression analysis was used to evaluate the association between perioperative factors and the risk of developing postoperative AKI. Results: Eleven out of 61 patients developed postoperative AKI. Four intra-operative variables were identified as predictors of AKI: intra-operative blood loss (p = 0.002), transfusion of fresh frozen plasma (p = 0.004) and red blood cells (p = 0.038), as well as high chloride load (p = 0.033, cut-off value > 500 mEq). Multivariate analysis demonstrated an independent association between AKI development and preoperative albuminuria, defined as a urinary Albumin to Creatinine ratio ≥ 30 mg·g−1 (OR = 6.88, 95% CI: 1.43–33.04, p = 0.016) as well as perioperative chloride load > 500 mEq (OR = 6.87, 95% CI: 1.46–32.4, p = 0.015). Conclusion: Preoperative albuminuria, as well as a high intraoperative chloride load, were identified as predictors of postoperative AKI in patients undergoing major abdominal surgery.

scholarly journals Plasma Hepcidin Correlates Positively With Interleukin-6 in Patients Undergoing Pulmonary Endarterectomy

2011 ◽  
pp. 493-502 ◽  
Author(s):  
P. MARUNA ◽  
M. VOKURKA ◽  
J. LINDNER
Keyword(s):  
Acute Phase ◽  
Iron Metabolism ◽  
Time Course ◽  
Acute Phase Proteins ◽  
Human Subjects ◽  
Circulatory Arrest ◽  
Experimental Studies ◽  
Acute Phase Reactant ◽  
Deep Hypothermic Circulatory Arrest ◽  
Pulmonary Endarterectomy

Hepcidin, a recently discovered antimicrobial peptide synthesized in the liver, was identified to be the key mediator of iron metabolism and distribution. Despite our knowledge of hepcidin increased in recent years, there are only limited data on hepcidin regulation during systemic inflammatory response in human subjects. In a prospective study, the time course of plasma hepcidin was analyzed in relations to six inflammatory parameters – plasma cytokines and acute-phase proteins in patients undergoing uncomplicated pulmonary endarterectomy. Twenty-four patients (males, aged 52.6±10.2 years, treated with pulmonary endarterectomy in a deep hypothermic circulatory arrest) were enrolled into study. Hepcidin, interleukin (IL)-6, IL-8, tumor necrosis factor-α, C-reactive protein, α1-antitrypsin and ceruloplasmin arterial concentrations were measured before surgery and repeatedly within 120 h post-operatively. Hemodynamic parameters, hematocrit and markers of iron metabolism were followed up. In a postoperative period, hepcidin increased from preoperative level 8.9 ng/ml (6.2-10.7) (median and interquartile range) to maximum 16.4 ng/ml (14.1-18.7) measured 72 h after the end of surgery. Maximum post-operative concentrations of hepcidin correlated positively with maximum IL-6 levels. Both hepcidin and IL-6 maximum concentrations correlated positively with extracorporeal circulation time. In conclusions, the study demonstrated that plasma hepcidin is a positive acute-phase reactant in relation to an uncomplicated large cardiac surgery. Hepcidin increase was related to IL-6 concentrations and to the duration of surgical procedure. Our clinical findings are in conformity with recent experimental studies defining hepcidin as a type II acute-phase protein.

scholarly journals Preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in cardiac surgery patients

2020 ◽  
Vol 73 (1-2) ◽  
pp. 5-12
Author(s):  
Miodrag Golubovic ◽  
Andrej Preveden ◽  
Ranko Zdravkovic ◽  
Jelena Vidovic ◽  
Bojan Mihajlovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Uric Acid ◽  
Cardiac Surgery ◽  
Kidney Injury ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Preoperative Hemoglobin ◽  
Significant Difference ◽  
Acute Kidney Injury Development

Introduction. Acute kidney injury associated with cardiac surgery is a common and significant postoperative complication. With a frequency of 9 - 39% according to different studies, it is the second most common cause of acute kidney injury in intensive care units, and an independent predictor of mortality. This study aimed to investigate the importance of preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in the postoperative period in cardiac surgery patients. Material and Methods. The study included a total of 118 patients who were divided into two groups. Each group included 59 patients; the fist group included patients who developed acute kidney injury and required renal replacement therapy, and the second included patients without acute kidney injury. Types of cardiac surgery included coronary, valvular, combined, aortic dissection, and others. All necessary data were collected from patient medical records and the electronic database. Results. A statistically significant difference was found between the groups in preoperative hemoglobin levels (108.0 vs. 143.0 g/l, p = 0.0005); postoperative urea (26.4 vs. 5.8 mmol/l, p = 0.0005) and creatinine (371.0 vs. 95.0 ?mol/l, p = 0.0005), acute phase inflammatory reactants C-reactive protein (119.4 vs. 78.9 mg/l, p = 0.002) and procalcitonin (7.0 vs. 0.2 ng/ml, p = 0.0005), creatine kinase myocardial band isoenzyme (1045.0 vs. 647.0 mg/l, p = 0.014); duration of extracorporeal circulation (103.5 vs. 76.0 min, p = 0.0005) and ascending aortic clamp during cardiac surgery (89.0 vs. 67.0 min, p = 0.0005). The exception was the preoperative uric acid level, where there was no statistically significant difference (382.0 vs. 364.0 ?mol/l, p = 0.068). There was a statistically significant correlation between the use of inotropic agents and acute kidney injury development. Conclusion. There is a correlation between the preoperative low hemoglobin levels and postoperative acute kidney injury. There is no statistically significant correlation between the preoperative levels of uric acid and postoperative acute kidney injury.

scholarly journals Severe acute kidney injury following major liver resection without portal clamping: incidence, risk factors, and impact on short-term outcomes

HPB ◽  
2018 ◽  
Vol 20 (9) ◽  
pp. 865-871 ◽  
Author(s):  
Jonathan Garnier ◽  
Marion Faucher ◽  
Ugo Marchese ◽  
Hélène Meillat ◽  
Djamel Mokart ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Liver Resection ◽  
Kidney Injury ◽  
Major Liver Resection ◽  
Short Term ◽  
Incidence Risk

scholarly journals Incidence, Risk Factors and Short Term Outcome of Acute Kidney Injury among Patients with Acute Coronary Syndrome

2020 ◽  
Vol 08 (05) ◽  
pp. 177-188
Author(s):  
Md. Kabir Hossain ◽  
Muhammad Rafiqul Alam ◽  
Asia Khanam ◽  
A. K. M. Shahidur Rahman ◽  
Rafi Nazrul Islam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Acute Coronary Syndrome ◽  
Kidney Injury ◽  
Short Term ◽  
Term Outcome ◽  
Coronary Syndrome ◽  
Short Term Outcome ◽  
Incidence Risk

scholarly journals Incidence and risk factors of acute kidney injury after femoral neck fracture in elderly patients: a retrospective case-control study

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Sizheng Zhan ◽  
Wenyong Xie ◽  
Ming Yang ◽  
Dianying Zhang ◽  
Baoguo Jiang
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Femoral Neck Fracture ◽  
Kidney Injury ◽  
Intraoperative Hypotension ◽  
Neck Fracture ◽  
Potential Risk Factors ◽  
Independent Risk Factors ◽  
Postoperative Aki

Abstract Background Hip fracture is highly associated with disability and consequently, mortality in the elderly population. Postoperative acute kidney injury (AKI) is not unusual and is associated with considerable morbidity and mortality. We aimed to determine the incidences and potential risk factors for postoperative AKI in elderly patients with femoral neck fracture. Methods We retrospectively evaluated patients over 65 years of age who had been subjected to surgery for femoral neck fracture at Peking University People's Hospital from January 2015 to December 2019. Demographic characteristics and potential risk factors were collected. AKI was defined according to the Kidney Disease Improving Global Outcomes Guidelines (KDIGO). Results A total of 308 elderly patients with femoral neck fracture were included in the study. The overall incidence of postoperative AKI was 12% (37 cases). Through binary logistic regression analysis, adjusted for age, intraoperative blood loss and BMI, we identified that early postoperative albumin levels, hemoglobin changes and intraoperative hypotension are independent risk factors for postoperative AKI. The model considering the three factors can improve accuracy of predicting the possibility of developing AKI. The patients with AKI had a significantly higher mortality of 40.5% than those without AKI (24.0%, p < 0.001) Conclusion The incidence of postoperative AKI in elderly patients with femoral neck fracture was 12%. Independent risk factors for postoperative AKI included hemoglobin changes, early postoperative hypoalbuminemia and intraoperative hypotension. At the same time, postoperative AKI significantly increased mortality in elderly patients with femoral neck fracture. Taking multiple possible factors into consideration can better predict the possibility of elderly patients developing AKI after surgery.

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