scholarly journals Frequency of renal dysfunction in cardiac surgery patients and its effect on outcome

2018 ◽  
pp. 40-47
Author(s):  
K. Zakon ◽  
V. Romanova ◽  
K. Tverdohlib
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Statistical Analysis ◽  
Hospital Mortality ◽  
Renal Dysfunction ◽  
Postoperative Period ◽  
Significant Risk ◽  
Multiorgan Dysfunction ◽  
Factors Associated ◽  
Multiorgan Dysfunction Syndrome

The purpose of this study was to define the frequency of renal dysfunction, including acute kidney injury (AKI), in cardiac surgery patients and its effect on outcome. Materials and methods. Patients 18 years old or older underwent cardiac surgery were included in the study. AKI and chronic kidney disease (CKD) was defined and staged according KDIGO 2012 guidelines. Glomerular filtration rate (GFR) was calculated with CKD-EPI formula. Clinical, laboratory and instrumental investigations were performed to all patients. As well, continuous hemodynamic monitoring was performed in postoperative period. Statistical analysis was conducted with SPSS for Windows v. 17.0.0. Results. 239 patients (170 (72,8 %) – male, 65 (27,2 %) – female) underwent cardiac surgery in M.M. Amosov National Institute of Cardio-Vascular Surgery between 29.06.16 and 30.10.16 were included in the study.             79 patients had a renal dysfunction before surgery: 19 (7.9%) – CKD and 60 (25.1%) – AKI. Renal replacement therapy (RRT) was used in 7 patients (4 — with CKD and 3 — with AKI). AKI was developed in 38 patients (15.9%) in postoperative period and RRT was started in one case. Statistically significant risk factors associated with AKI development in postoperative period were epinephrine usage (р<0.05) and heart failure development (р<0,001). Hospital mortality was 5.9% - 14 patients (7 (50%) - male, 7 (50 %) - female). All died patients have had renal dysfunction (3 (21.4%) have had AKI on CKD and 11 (78.6%) — AKI). Among them 8 (57.1%) patients have had AKI I, 1 (7.1%) - AKI II and 5 (35.7%) - AKI III. Statistically significant risk factors associated with hospital death were multiorgan dysfunction syndrome (р<0.001), sepsis (р<0.001), epinephrine (р<0.001) and norepinehrine (р<0.001) usage. Dobutamine use was associated with significant improvement in hospital mortality (р<0.05). Conclusions: Near half of cardiac surgery patients had renal dysfunction in perioperative period. RRT was used in 3.4% patients. Because the majority of died patients have had the first stage of AKI, which rather means the risk of renal dysfunction, and statistical analysis reveals no significant association between renal function and outcome, developing of AKI in cardiac surgery patients is an indicator of severity of main disease, but not a cause of death. Renal dysfunction regardless of time of it development in relation to cardiac surgery is not risk factor of death, in contrast to multiorgan dysfunction syndrome and sepsis,  which warrant the use of epinephrine.

scholarly journals Early Postoperative Arrhythmias after Paediatric Cardiac Surgery

2018 ◽  
Vol 6 (1) ◽  
pp. 22-28
Author(s):  
Kazi Zahidul Hoque ◽  
Akhand Tanzih Sultana ◽  
Mamun Mia ◽  
Masumul Gani Chowdhury ◽  
Makbul Hossein
Keyword(s):  
Risk Factors ◽  
Body Weight ◽  
Cardiac Surgery ◽  
Postoperative Period ◽  
Significant Risk ◽  
Radical Change ◽  
Paediatric Cardiac Surgery ◽  
Number Of Patients ◽  
Paediatric Age ◽  
A Prospective Study

Background: The radical change in techniques in paediatric cardiac surgery has dramatically reduced the morbidity and mortality. The different varieties of arrhythmia that are frequently observed in postoperative period in our country are still not well documented.Objectives: To determine the incidence and risk factors of arrhythmia immediately after cardiac surgery in paediatric age group.Materials and method: It was a prospective study. A total of 100 paediatric patients (age <18 years) who underwent cardiac surgery at Dhaka Shishu Hospital between 2013 and 2016 were selected purposivelyResults: Out of 100 patients maximum 41% were from 13-72 months age group. The mean age was 49.73±37.17 months with range of 0.5-231 months, 58% patients were male and rest were female. Postoperatively 31% subjects were arrhythmic and of these the highest number of patients suffered from junctional ectopic tachycardia. Out of these 100 patients, 39% were diagnosed as VSD followed by TOF (35%). Among 31 arrhythmic patients 59.83%, 41.93% and 3.22% manifested onset of arrhythmia at 1st, 1st to 2nd and 2nd to 7th postoperative period respectively. In this study age, body weight, cyanosis, CPB time, postoperative acidosis, ventilation support days, hypertension on arrival in ICU as well as ICU stay days were recognized as significant risk factors (p <0.05).Conclusion: Proper and careful monitoring of younger patient with lower body weight undergoing corrective cardiac surgery with long cardiopulmonary bypass (CPB) time may reduce the episodes of post operative arrhythmia. These patients may require high inotropic support post operatively. So, medical prevention and early diagnosis as well as proper management may improve the operative outcome.Delta Med Col J. Jan 2018 6(1): 22-28

Risk Factors for the Development of Nosocomial Pneumonia and Its Clinical Impact in Cardiac Surgery

2021 ◽  
Author(s):  
Ferdinand Jr Rivera Gerod ◽  
Edgar Ongjoco ◽  
Rod Castro ◽  
Armin Masbang ◽  
Elmer Casley Repotente ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Mortality ◽  
Nosocomial Pneumonia ◽  
Clinical Impact ◽  
Adult Patients ◽  
Mortality And Morbidity ◽  
Factors Associated ◽  
Prolonged Icu Stay

Abstract BackgroundThe development of nosocomial pneumonia after cardiac surgery is a significant post-operative complication that may lead to increased morbidity, mortality, and hospital cost. We aimed to identify risk factors associated with it and to determine its clinical impact in terms of in-hospital mortality and morbidity.MethodsThis is a retrospective cohort study conducted among all adult patients who underwent cardiac surgery from 2014-2019 in St. Luke’s Medical Center, Quezon City, Philippines. Baseline characteristics and possible risk factors for pneumonia were retrieved from medical records. Nosocomial pneumonia was based on the Centers for Disease Control and Prevention criteria. Clinical outcomes include in-hospital mortality and morbidity. Odds ratios from logistic regression was computed to determine risk factors associated with pneumonia using STATA 15.0.ResultsOut of 373 patients included in this study, 104 (28%) patients acquired pneumonia. Most surgeries were coronary artery bypass graft (CABG) (71.58%), followed by valve repair/replacement (29.76%). Neither age, sex, BMI, diabetes, LV dysfunction, renal dysfunction, COPD/asthma, urgency of surgery, surgical time, nor smoking showed association in the development of pneumonia. However, preoperative stay of >2 days was associated with 92.3% (95%CI 18–213%) increased odds of having pneumonia (p=.009). Also, every additional hour on mechanical ventilation conferred 0.8% (95%CI, 0.3–1%) greater odds of acquiring pneumonia (p=.003).Patients who developed pneumonia had 3.9 times odds of mortality (95%CI 1.51–9.89, p=.005), 3.8 times odds of prolonged hospitalization (95%CI 1.81–7.90,p<.001), 6.4 times odds of prolonged ICU stay (95%CI 3.59–11.35,p<.001), and 9.5 times odds of postoperative reintubation (95%CI 3.01–29.76,p<.001). ConclusionAmong adult patients undergoing cardiac surgeries, prolonged preoperative hospital stay and prolonged mechanical ventilation were both associated with an increased risk for nosocomial pneumonia. Those who developed pneumonia had worse outcomes with significantly increased in-hospital mortality, prolonged hospitalization, prolonged ICU stay, and increased postoperative re-intubation. Clinicians should therefore minimize delays in surgery to avoid unnecessary exposure to pathogenic organisms. Also, timely liberation from mechanical ventilation after surgery should be encouraged.

Risk Factors Associated with In-Hospital Mortality for Patients with Acute Abdomen After Cardiac Surgery

2019 ◽  
Vol 44 (1) ◽  
pp. 277-284
Author(s):  
I. Djordjevic ◽  
K. Eghbalzadeh ◽  
S. Heinen ◽  
G. Schlachtenberger ◽  
S. Gerfer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Hospital Mortality ◽  
Acute Abdomen ◽  
Factors Associated

scholarly journals Acute Renal Injury in Cardiac Surgery Patients

2020 ◽  
Vol 9 (3) ◽  
pp. 383-390
Author(s):  
S. I. Rey ◽  
G. A. Berdnikov ◽  
L. N. Zimina ◽  
N. V. Rubtsov ◽  
M. K. Mazanov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Serum Creatinine ◽  
Hospital Mortality ◽  
Replacement Therapy ◽  
Postoperative Period ◽  
Renal Injury ◽  
Acute Renal Injury ◽  
Group 1

Background. Acute kidney injury following cardiac surgery remains a common and serious complication.Aim of study. To identify risk factors for the development and morphological features of acute renal injury, to assess the use of renal replacement therapy in patients after cardiac surgery.Material and methods. The study involved 66 patients who were treated in the Department of Cardiac Resuscitation of the N.V. Sklifosovsky Research Institute for Emergency Medicine from 2009 to 2018. Of these, 45 men (68.2%) and 21 women (31.8%). The mean age of the patients was 56.3±13.2 years. Clinical and anatomical analysis of material from 19 deceased patients was carried out. Depending on the use of methods of renal replacement therapy, patients were divided into two groups: Group 1 included 23 patients with acute renal injury requiring the use of renal replacement therapy; Group 2 included 43 patients where methods of renal replacement therapy were not used.Results. Hospital mortality in Group 1 was lower (34.8 and 41.9%, respectively), however, the differences were statistically insignificant (p=0.372). To identify the factors in the development of acute renal damage, a stepwise regression analysis was performed by constructing a regression model of Cox proportional hazards. Age, history of chronic kidney disease, serum creatinine level on the first day after surgery, severity of the condition according to the APACHE-II scale, increased lactate level on day 2 of the postoperative period, decreased urine output on the first day after surgery were statistically significant.Conclusion. Risk factors for the development of ARI after cardiac surgery under cardiopulmonary bypass are advanced age, CKD in history, the severity of the patient’s condition, assessed by the APACHE-II scale, increased serum creatinine on the first day after surgery, increased lactate on day 2 of the postoperative period, a decreased diuresis on day 1 after surgery. The use of RRT in patients after surgery under the conditions of AC was accompanied by a tendency to improve treatment results: in-hospital mortality in the group of patients who underwent RRT was 34.8% versus 41.9% in the group without RRT methods. Morphological and functional features of renal failure in patients with ARI were preceding chronic renal pathological processes of different etiology, mainly affecting the glomeruli, vessels and stroma, as well as acute pathological processes aggravating ARI (dyscirculatory disorder, degenerative changes, necrosis and necrobiosis tubular epithelium).

scholarly journals Risk Factors Associated with In-hospital Mortality for Patients with Acute Abdomen after Cardiac Surgery

2019 ◽  
Author(s):  
I. Djordjevic ◽  
K. Eghbalzadeh ◽  
S. Heinen ◽  
G. Schlachtenberger ◽  
C. Weber ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Hospital Mortality ◽  
Acute Abdomen ◽  
Factors Associated

Renal Failure after Coronary Bypass Surgery and the Associated Risk Factors

2015 ◽  
Vol 18 (1) ◽  
pp. 006
Author(s):  
Hasan Reyhanoglu ◽  
Kaan Ozcan ◽  
Murat Erturk ◽  
Fatih İslamoglu ◽  
İsa Durmaz
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Renal Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Significant Risk ◽  
High Morbidity ◽  
Factors Associated

<strong>Objective:</strong> We aimed to evaluate the risk factors associated with acute renal failure in patients who underwent coronary artery bypass surgery.<br /><strong>Methods:</strong> One hundred and six patients who developed renal failure after coronary artery bypass grafting (CABG) constituted the study group (RF group), while 110 patients who did not develop renal failure served as a control group <br />(C group). In addition, the RF group was divided into two subgroups: patients that were treated with conservative methods without the need for hemodialysis (NH group) and patients that required hemodialysis (HR group). Risk factors associated with renal failure were investigated.<br /><strong>Results:</strong> Among the 106 patients that developed renal failure (RF), 80 patients were treated with conservative methods without any need for hemodialysis (NH group); while <br />26 patients required hemodialysis in the postoperative period (HR group). The multivariate analysis showed that diabetes mellitus and the postoperative use of positive inotropes and adrenaline were significant risk factors associated with development of renal failure. In addition, carotid stenosis and postoperative use of adrenaline were found to be significant risk factors associated with hemodialysis-dependent renal failure (P &lt; .05). The mortality in the RF group was determined as 13.2%, while the mortality rate in patients who did not require hemodialysis and those who required hemodialysis was 6.2% and 34%, respectively.<br /><strong>Conclusion:</strong> Renal failure requiring hemodialysis after CABG often results in high morbidity and mortality. Factors affecting microcirculation and atherosclerosis, like diabetes mellitus, carotid artery stenosis, and postoperative vasopressor use remain the major risk factors for the development of renal failure.<br /><br />

scholarly journals Does Vancomycin Resistance Increase Mortality? Clinical Outcomes and Predictive Factors for Mortality in Patients with Enterococcus faecium Infections

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 105
Author(s):  
Jatapat Hemapanpairoa ◽  
Dhitiwat Changpradub ◽  
Sudaluck Thunyaharn ◽  
Wichai Santimaleeworagun
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Proportional Hazards Model ◽  
Significant Risk ◽  
Vancomycin Resistance ◽  
Cox Proportional Hazards Model ◽  
Factors Associated ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
The Impact

The prevalence of enterococcal infection, especially E. faecium, is increasing, and the issue of the impact of vancomycin resistance on clinical outcomes is controversial. This study aimed to investigate the clinical outcomes of infection caused by E. faecium and determine the risk factors associated with mortality. This retrospective study was performed at the Phramongkutklao Hospital during the period from 2014 to 2018. One hundred and forty-five patients with E. faecium infections were enrolled. The 30-day and 90-day mortality rates of patients infected with vancomycin resistant (VR)-E. faecium vs. vancomycin susceptible (VS)-E. faecium were 57.7% vs. 38.7% and 69.2% vs. 47.1%, respectively. The median length of hospitalization was significantly longer in patients with VR-E. faecium infection. In logistic regression analysis, VR-E. faecium, Sequential Organ Failure Assessment (SOFA) scores, and bone and joint infections were significant risk factors associated with both 30-day and 90-day mortality. Moreover, Cox proportional hazards model showed that VR-E. faecium infection (HR 1.91; 95%CI 1.09–3.37), SOFA scores of 6–9 points (HR 2.69; 95%CI 1.15–6.29), SOFA scores ≥ 10 points (HR 3.71; 95%CI 1.70–8.13), and bone and joint infections (HR 0.08; 95%CI 0.01–0.62) were significant risk factors for mortality. In conclusion, the present study confirmed the impact of VR-E. faecium infection on mortality and hospitalization duration. Thus, the appropriate antibiotic regimen for VR-E. faecium infection, especially for severely ill patients, is an effective strategy for improving treatment outcomes.

Risk factors associated with post-operative bleeding in patients undergoing cardiac surgery

2021 ◽  
Vol 23 ◽  
pp. 100158
Author(s):  
Yazmín Guillén Dolores ◽  
Carlos Alberto Delgado Quintana ◽  
Gustavo Lugo Goytia
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Factors Associated

Risk Factors Associated With Dengue Fever Outbreak in Taiz Governorate, Yemen, 2018: Case-control Study

2021 ◽  
Author(s):  
Abdulkareem Ali Hussein Nassar ◽  
Amr Abdulaziz Torbosh ◽  
Yassin Abdulmalik Mahyoub ◽  
Mohammed Abdullah Al Amad
Keyword(s):  
Risk Factors ◽  
Dengue Fever ◽  
Case Control Study ◽  
Significant Risk ◽  
Case Fatality ◽  
Case Control ◽  
Case Definition ◽  
P Value ◽  
Factors Associated ◽  
Control Study

Abstract Background: Dengue Fever (DF) is a significant health problem in Yemen especially in the coastal areas. On November 6, 2018, Taiz governorates surveillance officer notified the Ministry of Public Health and Population on an increase in the number of suspected DF in Al Qahirah and Al Mudhaffar districts, Taiz governorate. On November 7, 2018, Field Epidemiology Training Program sent a team to perform an investigation. The aims were to confirm and describe the outbreak by person, place and time in Taiz governorate, and identify its risk factors.Methodology: Descriptive and case-control study (1:2 ratio) were conducted. WHO case definition was used to identify cases in Al Qahirah or Al Mudhaffar districts during August-November 2018. Control was selected from the same districts who did not suffer from DF. Predesigned questionnaire was used to collect data related to sociodemographic, behavioral and environmental characteristics. Bivariate and multivariate backward stepwise analyses were used. The adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated. A P value < 0.05 was considered as the cut point for statistically significant. Epi info version 7.2 was used.Results: A total of 50 DF cases were found. Almost 52% were males and 76% were <30 years of age. The overall attack rate was 1/10,000 of the population. Case fatality rate was 4%. In multivariate analysis, not working (aOR = 26.6, 95% CI: 6.8–104.7), not using mosquito repellent (aOR = 13.9, 95% CI:1.4–136.8), wearing short sleeves/pants (aOR = 27.3, 95% CI: 4.8–156.8), poor sanitation (aOR = 5.4, 95% CI: 1.4–20.3), presence of outdoor trees (aOR = 13.2, 95% CI: 2.8–63.0) and houses without window nets (aOR = 15.7, 95% CI: 3.9–63.4) were statistically significant risk factors associated with DF outbreak. Eleven 11 (58%) of blood samples were positive for DF IgM.Conclusions: DF outbreak in Al Qahirah and Al Mudhaffar districts, Taiz governorate was confirmed. This study provides evidence-based information regarding the identified risk factors that contributed to the occurrence of this outbreak. Raising community awareness on the importance of personal protection measures and improving the sanitation services are strongly recommended.

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