scholarly journals Effect of the COVID-19 pandemic on complications and mortality of patients with cardiac surgery

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xue Wang ◽  
Heng Gao ◽  
Zhanqin Zhang ◽  
Chao Deng ◽  
Yang Yan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiac Surgery ◽  
Postoperative Complications ◽  
Area Under The Curve ◽  
Admission Rate ◽  
Emergency Admission ◽  
Control Group ◽  
Short Term ◽  
Short Term Mortality ◽  
Complications And Mortality

Abstract Objectives The purpose of this study was to assess changes in cardiovascular disease severity, types, postoperative complications and prognosis during the COVID-19 pandemic and to explore possible influencing factors. Methods A total of 422 patients were enrolled in this study, and hospitalization and short-term follow-up data were retained. The patient population included 273 men and 149 women. Patients had a median (IQR) age of 54 (45–62) years and were divided into an observation group (130) and a control group (292), primarily according to severity of disease, disease types, baseline indexes, biochemical indexes, cardiac function indexes, complications and prognosis. Results During the COVID-19 pandemic, compared with the same period last year, there was a significant increase in patients with aortic dissection (27.69% vs 5.82%), a significant decrease in patients with valvular heart disease (43.08% vs 66.78%), and significantly increased emergency admission (50.00% vs 21.23%) and severity (54.62% vs 27.40%). Family company (76.37% vs 64.62%) was decreased, EuroSCORE [6.5 (2–9) vs 2 (0–5)] score, Pro-BNP [857.50 (241.00–2222.50) vs 542.40 (113.45–1776.75)] ng/L, six months mortality rate (18.46% vs 8.90%), and postoperative complications, including infected patients, atelectasis, pulmonary edema, and so on were increased, with longer length of stay in the ICU and hospital in COVID-19 pandemic. Survival analysis curve further demonstrated that it had an impact on the deaths of patients during the COVID-19 pandemic period. Through ROC analysis of the death factors of patients, it was concluded that Family company affected the death of patients, and the area under the curve was 0.654 (P < 0.05). Conclusions In this study, we found that the admission rate of critically ill patients with cardiovascular disease, complications of cardiac surgery, and short-term mortality of patients all exhibited a short-term increase, family company may be a risk factors for short-term mortality, that may be related to public pressure caused by the COVID-19 pandemic.

scholarly journals Prognostic Value of Neutrophil to Lymphocyte Ratio and Risk Factors for Mortality in Patients with Stanford Type A Aortic Dissection

2017 ◽  
Vol 20 (3) ◽  
pp. 119 ◽  
Author(s):  
Kursad Oz ◽  
Taner Iyigun ◽  
Zeynep Karaman ◽  
Ömer Çelik ◽  
Ertan Akbay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Aortic Dissection ◽  
Neutrophil To Lymphocyte Ratio ◽  
Control Group ◽  
Operating Characteristics ◽  
Short Term ◽  
Lymphocyte Ratio ◽  
Wide Range ◽  
Short Term Mortality

Background: Neutrophil to lymphocyte ratio (NLR) is a prognostic predictor in a wide range of cardiovascular disease. Acute aortic dissection (AD) is an uncommon but fatal cardiovascular disease. In this study, we investigated both prognostic factors in patients with AD and whether NLR can be a predictor for mortality. Methods: We analyzed retrospectively the data of 57 patients with AD who had undergone emergent surgery in our hospital and included 128 consecutive patients with chest pain admitted to the emergency room as a control group. Also, patients who were operated on due to aortic dissection as another subgroup were compared to NLR values. Baseline clinical features, cardiovascular risk factors, and surgical and laboratory parameters were obtained from the hospital database. Results: Patients with AD had higher NLR than the control group (1.7 ± 0.5 versus 7.6 ± 3.3, P < .001). In the AD group, 15 deaths occurred and non-survivors had significantly higher NLR, compared to survivors (11.6 ± 2.4 versus 6.6 ± 2.3, P < .001). In multivariate analysis, high NLR (odds ratio [OR] 1.913, 95% CI 1.030-1.081, P = .04) and cross-clamp time (OR 1.265, 95% CI 1.003-1.596, P = .04) were determined as independent predictors of in-hospital mortality. In receiver operating characteristics curve analyses, the NLR > 9.3 predicted the mortality in AD with a specificity of 91% and a sensitivity of 86% (P < .001).Conclusion: This study shows that high NLR can be used as a marker for prognosis in short-term mortality of patient with AD. Additionally, increased lactate level in perioperative period, prolonged cardiopulmonary bypass time, and additional cardiac procedures are strong independent predictors of short-term mortality in patients with acute AD.

Presepsin and Procalcitonin Levels as Markers of Adverse Postoperative Complications and Mortality in Cardiac Surgery Patients

2018 ◽  
Vol 47 (1-3) ◽  
pp. 140-148 ◽  
Author(s):  
Anna Clementi ◽  
Grazia Maria Virzì ◽  
María-Jimena Muciño-Bermejo ◽  
Federico Nalesso ◽  
Davide Giavarina ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Complications ◽  
Predictive Value ◽  
Renal Outcome ◽  
Positive Trend ◽  
Receiver Operating Characteristic Curves ◽  
Primary Endpoints ◽  
Significant Difference ◽  
Respiratory Outcome ◽  
Complications And Mortality

Backgound: This study was aimed at evaluating the presepsin and procalcitonin levels to predict adverse postoperative complications and mortality in cardiac surgery patients. Methods: A total of 122 cardiac surgery patients were enrolled for the study. Presepsin and procalcitonin levels were measured 48 h after the procedure. The primary endpoints were adverse renal, respiratory, and cardiovascular outcomes and mortality. Results: Presepsin and procalcitonin levels were significantly higher in patients with adverse renal and respiratory outcome (p < 0.001 and 0.0081). The presepsin levels were significantly higher in patients with adverse cardiovascular outcome (p = 0.023) and the procalcitonin values in patients with sepsis (p = 0.0013). Presepsin levels were significantly higher in patients who died during hospitalization (382 pg/mL, interquartile range [IQR] 243–717.5 vs. 1,848 pg/mL, IQR 998–5,451.5, p = 0.049). In addition, the predictive value for in-hospital, 30-days, and 6-months mortality was higher for presepsin, with a significant difference between the 2 biomarkers (p = 0.025, p = 0.035, p = 0.003; respectively). Presepsin and procalcitonin seem to have comparable predictive value for adverse renal, cardiovascular, and respiratory outcome in cardiac surgery patients. Although a positive trend was notable for presepsin and adverse renal outcome (area under the ROC [receiver operating characteristic] curves [AUC] of 0.760, 95% CI 0.673–0.833 versus procalcitonin: AUC 0.692; 95% CI 0.601–0.773): no statistically significant difference was evident between the AUC of the 2 biomarkers (p = 0.25). Conclusions: Presepsin and ­procalcitonin seem to have comparable predictive value for ­adverse renal, cardiovascular, and respiratory outcome in cardiac surgery patients. Also, presepsin possesses a better predictive value for in-hospital, 30-days, and 6-months mortality.

Prevalence of Culture-Negative Fever in Infants With Down Syndrome Undergoing Cardiac Surgery

2019 ◽  
Vol 10 (5) ◽  
pp. 599-603
Author(s):  
Jeffrey Vergales ◽  
Michael D. Seckeler ◽  
Joshua Chew ◽  
James Gangemi
Keyword(s):  
Down Syndrome ◽  
Cardiac Surgery ◽  
Septal Defect ◽  
Surgical Repair ◽  
Area Under The Curve ◽  
Control Group ◽  
Chromosomal Anomalies ◽  
Retrospective Case ◽  
Postoperative Fever ◽  
Culture Negative

Background: Children with Down syndrome (DS) often have congenital heart disease that requires surgical repair in the first year. Anecdotally, we have noted that patients with DS seem to have a higher rate of culture-negative postoperative fever. The objective was to evaluate the prevalence of postoperative fever and recovery among patients with DS undergoing cardiac surgery. Methods: We conducted a retrospective, case–control study of all patients at our institution less than one year of age with DS undergoing surgical repair of an atrioventricular septal defect or ventricular septal defect between 2010 and 2016. The control group was patients with no chromosomal anomalies who were age and surgery matched to the DS group. Temperatures were recorded for the first 72 hours postoperatively, with duration and degree of fever being assessed using the area under the curve. Results: Patients with DS (n = 34) had a significantly higher prevalence of fever than the control group (59% vs 24%, P = .003), longer ventilator time, and longer length of stay. Among the DS group, those who developed fever tended to be older at the time of surgery (146 ± 63 vs 103 ± 45 days, P = .04). The DS group with fever had similar cardiopulmonary bypass times, intensive care unit and total lengths of stay, ventilator days, and hospital costs compared to patients with DS without fever. Conclusions: Patients with DS have a higher incidence of culture-negative fever within the first 72 hours. The presence of fever in these patients, however, does not affect their overall postoperative course.

Chronic kidney disease, prevalence of premature cardiovascular disease, and relationship to short-term mortality

2008 ◽  
Vol 156 (2) ◽  
pp. 277-283 ◽  
Author(s):  
Peter A. McCullough ◽  
Suying Li ◽  
Claudine T. Jurkovitz ◽  
Leslie Stevens ◽  
Alan J. Collins ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Disease Prevalence ◽  
Short Term ◽  
Premature Cardiovascular Disease ◽  
Chronic Kidney Disease Prevalence ◽  
Short Term Mortality

scholarly journals Anisocytosis is Associated With Short-Term Mortality in COVID-19 and May Reflect Proinflammatory Signature in Uninfected Ambulatory Adults

2020 ◽  
Vol 5 (1) ◽  
pp. 312
Author(s):  
Andrew Hornick ◽  
Nour Tashtish ◽  
Michael Osnard ◽  
Binita Shah ◽  
Allison Bradigan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Proportional Hazards Model ◽  
Statistical Significance ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Rank Test ◽  
Short Term ◽  
Distribution Width ◽  
Principle Components Analysis ◽  
Short Term Mortality

BackgroundRed cell distribution width (RDW), a measure of anisocytosis, is observed in chronic inflammation and is a prognostic marker in critically ill patients without COVID-19, but data in COVID-19 are limited.MethodsBetween March 12 and April 19, 2020, 282 individuals with confirmed COVID-19 and RDW available within 7 days prior to COVID-19 confirmation were evaluated. Individuals were grouped by quartiles of RDW. Association between quartiles of RDW and mortality was assessed using the Kaplan-Meier method and statistical significance was assessed using the log-rank test. The association between RDW and all-cause mortality was further assessed using a Cox proportional hazards model. Plasma cytokine levels in uninfected ambulatory adults without cardiovascular disease (n=38) were measured and bivariate Spearman correlations and principle components analysis were used to identify relationships between cytokine concentrations with RDW.ResultsAfter adjusting for age, sex, race, cardiovascular disease, and hemoglobin, there was an association between RDW and mortality (Quartile 4 vs Quartile 1: HR 4.04 [1.08-15.07]), with each 1% increment in RDW associated with a 39% increased rate of mortality (HR 1.39 [1.21-1.59]). Remote RDW was also associated with mortality after COVID-19 infection. Among uninfected ambulatory adults without cardiovascular disease, RDW was associated with elevated pro-inflammatory cytokines (TNF-α, IL8, IL6, IL1b), but not regulatory cytokines (TGFb).ConclusionsAnisocytosis predicts short-term mortality in COVID-19 patients, often predates viral exposure, and may be related to a pro-inflammatory phenotype. Additional study of whether the RDW can assist in the early identification of pending cytokine storm is warranted.

Prognostic Indicators and Short Term Outcomes for Operated Patients with Peritonitis: Prospective Cohort Hospital Based Study in Northern Tanzania

2020 ◽  
Author(s):  
Nassib Daud Msuya ◽  
Julius Pius Alloyce ◽  
David Msuya ◽  
Kondo Chilonga ◽  
Ayesiga Herman ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Prospective Cohort ◽  
Prognostic Indicators ◽  
Short Term ◽  
Female Ratio ◽  
Purulent Peritonitis ◽  
Operative Complications ◽  
Duration Of Operation ◽  
Complications And Mortality ◽  
Post Operative Complications

Abstract Background: Peritonitis is one of the most common surgical emergencies all over the world and is associated with significant complications and mortality. The spectrum of aetiology of peritonitis differs between high income countries and low income countries. Majority of the patients present late with purulent peritonitis and septiceamia. Surgical treatment of peritonitis is highly demanding and very complex, however, if the outcome in these patients can be correctly predicted, then better management can be instituted in order to achieve optimal patients’ care and hence improve treatment outcome.Methods: Prospective cohort hospital based study was conducted among patients admitted due to peritonitis at Kilimanjaro Christian medical center (KCMC) from October 2018 to March 2019.Documentary review and interview methods were employed to obtain data using electronic structured questionnaire. Data was summarized using median, Inter-quartile range (IQR), frequency and percentage. Both bivariate and multivariate logistic regression analyses were used to identify prognostic indicators for post-operative complications and mortality. A 95% CI and P <0.05 used for significance test.Results: The study enrolled 70 patients with predominance of male, giving a male to female ratio of 4.1:1. A total number of 33(47.1%) developed complications and 16(22.9%) died. Only 1(1.43%) patient presented to the hospital within 24 hours since the onset of illness. Delay in care, longer duration of operation, and low potassium were the prognostic indicators noted to have influence on short term complications. The major influence for mortality were comorbidity (AOR=3.02; 95%CI: 2.25-42.90) and postoperative complications (dyselectrolaemia) with (AOR=9.27; 95%CI: 1.21-70.83).Conclusion: Mortality and complications resulted from peritonitis is unacceptably high. Delay in care, longer duration of operation and preoperative low serum potassium levels were the prognostic indicators for the post-operative complications. Comorbidity and postoperative complications such as dyselectrolaemia had influence for the mortality. Correct prediction of these adverse outcomes will help to institute better management for the patients with peritonitis.

scholarly journals Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Jing-Yi Duan ◽  
Wen-He Zheng ◽  
Hua Zhou ◽  
Yuan Xu ◽  
Hui-Bin Huang
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Control Group ◽  
Short Term ◽  
Predictive Equations ◽  
Energy Delivery ◽  
Effect Model ◽  
Short Term Mortality

Abstract Background The use of indirect calorimetry (IC) is increasing due to its precision in resting energy expenditure (REE) measurement in critically ill patients. Thus, we aimed to evaluate the clinical outcomes of an IC-guided nutrition therapy compared to predictive equations strategy in such a patient population. Methods We searched PubMed, EMBASE, and Cochrane library databases up to October 25, 2020. Randomized controlled trials (RCTs) were included if they focused on energy delivery guided by either IC or predictive equations in critically ill adults. We used the Cochrane risk-of-bias tool to assess the quality of the included studies. Short-term mortality was the primary outcome. The meta-analysis was performed with the fixed-effect model or random-effect model according to the heterogeneity. Results Eight RCTs with 991 adults met the inclusion criteria. The overall quality of the included studies was moderate. Significantly higher mean energy delivered per day was observed in the IC group, as well as percent delivered energy over REE targets, than the control group. IC-guided energy delivery significantly reduced short-term mortality compared with the control group (risk ratio = 0.77; 95% CI 0.60 to 0.98; I2 = 3%, P = 0.03). IC-guided strategy did not significantly prolong the duration of mechanical ventilation (mean difference [MD] = 0.61 days; 95% CI − 1.08 to 2.29; P = 0.48), length of stay in ICU (MD = 0.32 days; 95% CI − 2.51 to 3.16; P = 0.82) and hospital (MD = 0.30 days; 95% CI − 3.23 to 3.83; P = 0.87). Additionally, adverse events were similar between the two groups. Conclusions This meta-analysis indicates that IC-guided energy delivery significantly reduces short-term mortality in critically ill patients. This finding encourages the use of IC-guided energy delivery during critical nutrition support. But more high-quality studies are still needed to confirm these findings.

scholarly journals A Combination of N-Terminal proB-Type Natriuretic Peptide and Myoglobin Can Predict Severe Complications After Major Non-Cardiac Surgery in Elderly Patients: A Prospective Observational Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Yi Zhao ◽  
Xuechao Hao ◽  
Yihao Zhu ◽  
Mingkai Chen ◽  
Mengchan Ou ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Natriuretic Peptide ◽  
Area Under The Curve ◽  
Clinical Trial Registry ◽  
Major Complications ◽  
Grade 3 ◽  
American Society ◽  
A Prospective Study

Background: Previous studies have demonstrated that serum N-terminal proB-type natriuretic peptide (NT-proBNP) was a predictor of adverse cardiovascular outcomes after surgery. We performed a prospective study to evaluate if NT-proBNP could be a sensitive marker of overall postoperative outcomes in older patients undergoing major elective non-cardiac surgery when combined with myoglobin (MYO).Methods: Two hundred and three adults aged ≥65 years were enrolled in the study. The American Society of Anesthesiologists (ASA) physical status of patients were I to IV. Blood samples would be taken before and 2 h after the surgery for each patients and NT-proBNP and MYO concentrations (NT-proBNP baseline/ 2 h and MYO baseline/ 2 h) of these samples would be measured immediately. The primary outcome was moderate to severe complications, which were based on the Clavien–Dindo Classification (CDC) scheme (≥CDC grade 3), and the secondary outcomes were major complications within 30 days after surgery. This study was registered at China Clinical Trial Registry (ChiCTR1900026223, http://www.chictr.org.cn/).Results: Overall, moderate to severe complications occurred in 15 patients (7.4%) and major complications occurred in 18 patients (8.9%). Both preoperative and postoperative NT-proBNP values were independent predictors of moderate to severe complications (area under the curve (AUC), 0.820; 95% CI: 0.728, 0.912, P &lt; 0.001; AUC, 0.785; 95% CI: 0.685, 0.885, P &lt; 0.001). When NT-proBNP baseline and MYO-2 h were combined (NT-proBNP baseline × MYO-2 h), the predictive power was improved (AUC 0.841, 95% CI: 0.758, 0.923, P &lt; 0.001).Conclusions: A combination of perioperative NT-proBNP and postoperative MYO concentrations was a good predictor of postoperative complications in elderly patients who underwent major non-cardiac surgery. Using fast and dynamic tests provided by point-to-care-testing, NT-proBNP and MYO concentration measurements provided useful guidance for therapy before or soon after surgery, thus helping to reduce postoperative complications in elderly patients.

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