scholarly journals Hemodilution is Associated with Underestimation of Serum Creatinine in Cardiac Surgery Patients: A retrospective analysis

2020 ◽  
Author(s):  
Jifu Jin ◽  
Jiarui Xu ◽  
Sujuan Xu ◽  
Jiachang Hu ◽  
Wuhua Jiang ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Serum Creatinine ◽  
Fluid Balance ◽  
Left Ventricular ◽  
Normal Group ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Elective Cardiac Surgery ◽  
Prolonged Length ◽  
Cumulative Fluid Balance

Abstract Background: Fluid overload is related to the development and prognosis of cardiac surgery-associated acute kidney injury (CSA-AKI). The study is to investigate the influence of serum creatinine (SCr) corrected by fluid balance on the prognosis of patients with cardiac surgery.Methods: A retrospective study was conducted in 1334 patients who underwent elective cardiac surgery from January 1 to December 31, 2015. Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI were applied to identify CSA-AKI. SCr was measured every 24 hours during ICU period and was accordingly adjusted for cumulative fluid balance. Changes in SCr, defined as ∆Crea, were determined by difference between before and after adjustment for cumulative fluid balance. All patients were then divided into three groups: underestimation group (∆Crea ≥ P75), normal group (P25 < ∆Crea < P75) and overestimation group (∆Crea ≤ P25).Results: The incidence of AKI increased from 29.5% to 31.8% after adjustment for fluid balance. Patients in underestimation group showed prolonged length of ICU stay compared with normal group and overestimation group (3.2[1.0-4.0] vs 2.1[1.0-3.0] d, P < 0.001; 3.2[1.0-4.0] vs 2.3[1.0-3.0] d, P < 0.001). Length of hospital stay and mechanical ventilation dependent days in underestimation group were significantly longer than normal group (P < 0.001). Multivariate analysis showed age, baseline SCr and left ventricular ejection fraction were independently associated with underestimation of creatinine.Conclusions: Cumulative fluid balance after cardiac surgery disturbs accurate measurement of serum creatinine. Patients with underestimation of SCr were associated with poor prognosis.

scholarly journals Hemodilution is Associated with Underestimation of Serum Creatinine in Cardiac Surgery Patients: A retrospective analysis

2020 ◽  
Author(s):  
Jifu Jin ◽  
Jiarui Xu ◽  
Sujuan Xu ◽  
Jiachang Hu ◽  
Wuhua Jiang ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Serum Creatinine ◽  
Fluid Balance ◽  
Left Ventricular ◽  
Normal Group ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Elective Cardiac Surgery ◽  
Prolonged Length ◽  
Cumulative Fluid Balance

Abstract Background: Fluid overload is related to the development and prognosis of cardiac surgery-associated acute kidney injury (CSA-AKI). The study is to investigate the influence of serum creatinine (SCr) corrected by fluid balance on the prognosis of patients with cardiac surgery.Methods: A retrospective study was conducted in 1334 patients who underwent elective cardiac surgery from January 1 to December 31, 2015. Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI were applied to identify CSA-AKI. SCr was measured every 24 hours during ICU period and was accordingly adjusted for cumulative fluid balance. Changes in SCr, defined as ∆Crea, were determined by difference between before and after adjustment for cumulative fluid balance. All patients were then divided into three groups: underestimation group (∆Crea ≥ P75), normal group (P25 < ∆Crea < P75) and overestimation group (∆Crea ≤ P25).Results: The incidence of AKI increased from 29.5% to 31.8% after adjustment for fluid balance. Patients in underestimation group showed prolonged length of ICU stay compared with normal group and overestimation group (3.2[1.0-3.0] vs 2.1[1.0-3.0] d, P < 0.001; 3.2[1.0-3.0] vs 2.3[1.0-3.0] d, P < 0.001). Length of hospital stay and mechanical ventilation dependent days in underestimation group were significantly longer than normal group (P < 0.001). Multivariate analysis showed age, baseline SCr and left ventricular ejection fraction were independently associated with underestimation of creatinine.Conclusions: Cumulative fluid balance after cardiac surgery disturbs accurate measurement of serum creatinine. Patients with underestimation of SCr were associated with poor prognosis.

scholarly journals Hemodilution is associated with underestimation of serum creatinine in cardiac surgery patients: a retrospective analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jifu Jin ◽  
Jiarui Xu ◽  
Sujuan Xu ◽  
Jiachang Hu ◽  
Wuhua Jiang ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Serum Creatinine ◽  
Fluid Balance ◽  
Left Ventricular ◽  
Normal Group ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Elective Cardiac Surgery ◽  
Prolonged Length ◽  
Cumulative Fluid Balance

Abstract Background Fluid overload is related to the development and prognosis of cardiac surgery-associated acute kidney injury (CSA-AKI). The study is to investigate the influence of serum creatinine (SCr) corrected by fluid balance on the prognosis of patients with cardiac surgery. Methods A retrospective study was conducted in 1334 patients who underwent elective cardiac surgery from January 1 to December 31, 2015. Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI were applied to identify CSA-AKI. SCr was measured every 24 h during ICU period and was accordingly adjusted for cumulative fluid balance. Changes in SCr, defined as ∆Crea, were determined by difference between before and after adjustment for cumulative fluid balance. All patients were then divided into three groups: underestimation group (∆Crea ≥ P75), normal group (P25 < ∆Crea < P75) and overestimation group (∆Crea ≤ P25). Results The incidence of AKI increased from 29.5% to 31.8% after adjustment for fluid balance. Patients in underestimation group showed prolonged length of ICU stay compared with normal group and overestimation group (3.2 [1.0–4.0] vs 2.1 [1.0–3.0] d, P < 0.001; 3.2  [1.0–4.0] vs 2.3 [1.0–3.0] d, P < 0.001). Length of hospital stay and mechanical ventilation dependent days in underestimation group were significantly longer than normal group (P < 0.001). Multivariate analysis showed age, baseline SCr and left ventricular ejection fraction were independently associated with underestimation of creatinine. Conclusions Cumulative fluid balance after cardiac surgery disturbs accurate measurement of serum creatinine. Patients with underestimation of SCr were associated with poor prognosis.

scholarly journals Fluid Overload is Associated with Underestimation of Serum Creatinine in Cardiac Surgery Patients: A Retrospective Analysis

2020 ◽  
Author(s):  
Jifu Jin ◽  
Jiarui Xu ◽  
Sujuan Xu ◽  
Jiachang Hu ◽  
Wuhua Jiang ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Serum Creatinine ◽  
Fluid Balance ◽  
Fluid Overload ◽  
Left Ventricular ◽  
Normal Group ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
P 75 ◽  
Cumulative Fluid Balance

Abstract Background: Fluid overload is related to the development and prognosis of cardiac surgery-associated acute kidney injury (CSA-AKI). The study is to investigate the influence of serum creatinine (SCr) corrected by fluid balance on the prognosis of patients with cardiac surgery. Methods: A retrospective study was conducted in 1334 patients who underwent elective cardiac surgery from January 1 to December 31, 2015. Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI were applied to identify CSA-AKI. SCr was measured every 24 hours during ICU period and was accordingly adjusted for cumulative fluid balance. Change in SCr, defined as ∆Crea, was determined by difference between before and after adjustment for cumulative fluid balance. All patients were divided as three groups: underestimation group (∆Crea ≥ P 75 ), normal group (P 25 < ∆Crea < P 75 ) and overestimation group (∆Crea ≤ P 25 ). Results: The incidence of AKI increased from 29.5% to 31.8% after adjustment for fluid balance. Patients in underestimation group showed prolonged length of ICU stay compared with normal group and overestimation group (3.2[1.0-3.0] vs 2.1[1.0-3.0] d, P < 0.001; 3.2[1.0-3.0] vs 2.3[1.0-3.0] d, P < 0.001). Length of hospital stay and mechanical ventilation dependent days in underestimation group were significantly longer than normal group ( P < 0.001). Multivariate analysis showed age, baseline SCr and left ventricular ejection fraction were independently associated with underestimation of creatinine. Conclusions: Cumulative fluid balance after cardiac surgery disturbs accurate measurement of serum creatinine. Patients with underestimation of SCr were associated with poor prognosis.

scholarly journals Modified Maze Procedure for Atrial Fibrillation as an Adjunct to Elective Cardiac Surgery: Predictors of Mid-Term Recurrence and Echocardiographic Follow-Up

2015 ◽  
Vol 42 (4) ◽  
pp. 341-347 ◽  
Author(s):  
Claudia Loardi ◽  
Francesco Alamanni ◽  
Fabrizio Veglia ◽  
Claudia Galli ◽  
Alessandro Parolari ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Left Ventricular Ejection Fraction ◽  
Sinus Rhythm ◽  
Left Ventricular ◽  
Maze Procedure ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Elective Cardiac Surgery

The radiofrequency maze procedure achieves sinus rhythm in 45%–95% of patients treated for atrial fibrillation. This retrospective study evaluates mid-term results of the radiofrequency maze—performed concomitant to elective cardiac surgery—to determine sinus-rhythm predictive factors, and describes the evolution of patients' echocardiographic variables. From 2003 through 2011, 247 patients (mean age, 64 ± 9.5 yr) with structural heart disease (79.3% mitral disease) and atrial fibrillation underwent a concomitant radiofrequency modified maze procedure. Patients were monitored by 24-hour Holter at 3, 6, 12, and 24 months, then annually. Eighty-four mitral-valve patients underwent regular echocardiographic follow-up. Univariate and multivariate analysis for risk factors of maze failure were identified. The in-hospital mortality rate was 1.2%. During a median follow-up of 39.4 months, the late mortality rate was 3.6%, and pacemaker insertion was necessary in 26 patients (9.4%). Sinus rhythm was present in 63% of patients at the latest follow-up. Predictive factors for atrial fibrillation recurrence were arrhythmia duration (hazard ratio [HR]=1.296, P=0.045) and atrial fibrillation at hospital discharge (HR=2.03, P=0.019). The monopolar device favored maze success (HR=0.191, P &lt;0.0001). Left atrial area and indexed left ventricular end-diastolic volume showed significant decrease both in sinus rhythm and atrial fibrillation patients. Early sinus rhythm conversion was associated with improved left ventricular ejection fraction. Concomitant radiofrequency maze procedure provided remarkable outcomes. Shorter preoperative atrial fibrillation duration, monopolar device use, and prompt treatment of arrhythmia recurrences increase the midterm success rate. Early sinus rhythm restoration seems to result in better left ventricular ejection fraction recovery.

scholarly journals Nomogram Models to Predict Postoperative Hyperlactatemia in Patients Undergoing Elective Cardiac Surgery

2021 ◽  
Vol 8 ◽  
Author(s):  
Dashuai Wang ◽  
Su Wang ◽  
Jia Wu ◽  
Sheng Le ◽  
Fei Xie ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Clinical Utility ◽  
Risk Groups ◽  
Left Ventricular ◽  
Low Risk ◽  
Red Blood Cell Transfusion ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Elective Cardiac Surgery ◽  
Targeted Interventions

Objectives: Postoperative hyperlactatemia (POHL) is common in patients undergoing cardiac surgery and is associated with poor outcomes. The purpose of this study was to develop and validate two predictive models for POHL in patients undergoing elective cardiac surgery (ECS).Methods: We conducted a multicenter retrospective study enrolling 13,454 adult patients who underwent ECS. All patients involved in the analysis were randomly assigned to a training set and a validation set. Univariate and multivariate analyses were performed to identify risk factors for POHL in the training cohort. Based on these independent predictors, the nomograms were constructed to predict the probability of POHL and were validated in the validation cohort.Results: A total of 1,430 patients (10.6%) developed POHL after ECS. Age, preoperative left ventricular ejection fraction, renal insufficiency, cardiac surgery history, intraoperative red blood cell transfusion, and cardiopulmonary bypass time were independent predictors and were used to construct a full nomogram. The second nomogram was constructed comprising only the preoperative factors. Both models showed good predictive ability, calibration, and clinical utility. According to the predicted probabilities, four risk groups were defined as very low risk (&lt;0.05), low risk (0.05–0.1), medium risk (0.1–0.3), and high risk groups (&gt;0.3), corresponding to scores of ≤ 180 points, 181–202 points, 203–239 points, and &gt;239 points on the full nomogram, respectively.Conclusions: We developed and validated two nomogram models to predict POHL in patients undergoing ECS. The nomograms may have clinical utility in risk estimation, risk stratification, and targeted interventions.

Abstract 16457: Markers of Diabetes and Renal Function Extend Sudden Death Risk Assessment Beyond the Ejection Fraction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kumar Narayanan ◽  
Audrey Uy-Evanado ◽  
Carmen Teodorescu ◽  
Kyndaron Reinier ◽  
Karen Gunson ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Risk Stratification ◽  
Serum Creatinine ◽  
Glycosylated Hemoglobin ◽  
Left Ventricular ◽  
Metropolitan Region ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Catchment Population ◽  
Risk Stratification Model

Introduction: Although diabetes and renal dysfunction are known to be associated with SCD risk, the cumulative risk of objective laboratory markers in combination with left ventricular ejection fraction (LVEF) has not been previously evaluated. Hypothesis: Addition of glycosylated hemoglobin (HbA1C) and serum creatinine levels to LVEF can improve the SCD risk stratification model. Methods: As part of a large, prospective, ongoing study of SCD in a Northwestern US metropolitan region (catchment population about 1 million), SCD cases were compared with controls with coronary artery disease (CAD) and no SCD from the same geographic location. HbA1C, serum creatinine levels and LVEF (all prior and unrelated to the SCD event for cases) were obtained for all subjects. Odds ratios for SCD associated with abnormal HbA1C (≥ 7%) and creatinine (≥ 1.5 mg/dL) levels was calculated. Cumulative odds and improvement in model performance on addition of elevated lab markers to low LVEF (≤ 35%) was assessed. Results: 243 SCD cases (68.7 ± 13.2 yrs; 62.1% male) and 159 CAD controls (66.2 ± 9.9 yrs; 65.6% male) with appropriate lab values and LVEF information were evaluated. The mean HbA1C (7.3 ± 2.3 vs. 6.6 ± 1.5%) and creatinine (1.8 ± 1.7 vs. 1.2 ± 0.7 mg/dL) levels were significantly higher in cases. Cases were significantly more likely to have HbA1C ≥ 7% (49.4 vs. 27.7%; p<0.0001) or creatinine ≥ 1.5 mg/dL (39.1% vs. 13.8%) (all p<0.0001). After adjustment for age, sex and low LVEF, high HbA1C (OR 2.3, 95% CI 1.4-3.6; p=0.001) and high creatinine (OR 3.3, 95% CI 1.9-5.7; p<0.0001) were independently associated with SCD; LVEF ≤ 35% was associated as well (OR 1.8, 95% CI 1.1-3.2; p=0.05). As compared to neither lab marker being high, elevation of one marker (OR 2.4, 95% CI 1.5-3.9) or both markers (OR 7.9, 95% CI 3.5-17.6) was associated with progressive increase in SCD odds. Addition of lab markers to a risk stratification model with only LVEF improved model discrimination significantly (AUC 0.613 vs. 0.709; p=0.01). Conclusions: HbA1C and serum creatinine improved the SCD risk stratification model when added to LVEF. Further investigation is warranted before clinical use, including consideration of competing risks that influence overall mortality.

Specific diseases: valvular heart disease

ESC CardioMed ◽  
2018 ◽  
pp. 2666-2667
Author(s):  
Bernard Iung ◽  
Luc A. Pierard
Keyword(s):  
Cardiac Surgery ◽  
Aortic Stenosis ◽  
Perioperative Complications ◽  
Left Ventricular ◽  
Valvular Disease ◽  
Left Ventricular Ejection ◽  
Mechanical Prosthesis ◽  
Ventricular Ejection Fraction ◽  
Asymptomatic Patients ◽  
Mitral Commissurotomy

The evaluation of the risk of non-cardiac surgery in patients with valvular disease should take into account the type, severity, and tolerance of valvular disease, and the risk inherent to non-cardiac surgery. Aortic stenosis carries the highest risk of perioperative complications. Except for emergency non-cardiac surgery, an intervention on the aortic valve is indicated firstly in case of severe symptomatic aortic stenosis. In asymptomatic patients, low- and intermediate-risk non-cardiac surgery can be performed, while the strategy should be individualized for high-risk non-cardiac surgery. Balloon aortic valvuloplasty may be used as a bridge if non-cardiac surgery is urgent. Percutaneous mitral commissurotomy should be considered in symptomatic patients with severe mitral stenosis. In patients with severe aortic or mitral regurgitation, the risk of non-cardiac surgery is low if they are asymptomatic with preserved left ventricular ejection fraction. In patients with a mechanical prosthesis, perioperative anticoagulant therapy should be adapted to the haemorrhagic risk of intervention and to the patient- and prosthesis-related thromboembolic risk.

Nephrocheck after cardiac surgery: Does it play a role in daily practice? A sequel of “Nephrocheck results should be corrected for dilution”

2019 ◽  
Vol 42 (11) ◽  
pp. 665-667 ◽  
Author(s):  
Camilla L’Acqua ◽  
Erminio Sisillo ◽  
Luca Salvi ◽  
Giovanni Introcaso ◽  
Maria Luisa Biondi
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Injury ◽  
Daily Practice ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Inclusion Criteria ◽  
Ventricular Ejection Fraction ◽  
Cycle Arrest ◽  
Urine Creatinine

Acute kidney injury is a well-recognized complication after cardiac surgery and significantly affects morbidity and mortality. Although the mechanisms of acute kidney injury are not fully understood, Nephrocheck (Astute Medical, San Diego, CA, USA) is a meter for early detection of acute kidney injury based on bedside urinalysis of two cell-cycle arrest biomarkers. However, considerable overlap in the AKIRiskTM score of different RIFLE groups makes interpretation of the score uncertain. A possible reason for the overlap in the AKIRisk score between different RIFLE groups could be that the score is not corrected for dilution. We performed a pilot study to explore the applicability of the test in our daily practice. A total of 68 patients electively scheduled for cardiac surgery with at least two of the following inclusion criteria: age > 70 years, glomerular filtration rate <60 mL/min, left ventricular ejection fraction <41%, redo procedure and combined procedures have been enrolled in the study, and 25 of them developed acute kidney injury. We described the correlation between urine creatinine and Nephrocheck, all the samples with low Nephrocheck (<0.2) also have low urine creatinine, less than 50 mg/dL, detecting a potential diluted sample. In conclusion, in our daily practice AKIRisk score, together with an assessment of whether urine is diluted or concentrated can better discriminate between various degrees of acute kidney injury.

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