Impact of Operative Timing in Infective Endocarditis with Cerebral Embolism—The Risk of Intermediate Deterioration

Cerebral embolism due to infective endocarditis (IE) is associated with significant morbidity and mortality. The optimal time-interval between symptomatic stroke and cardiac surgery remains unclear. This study aimed to analyze the patients’ outcomes and define the potential risk factors with regard to surgical timing for IE patients with preoperative symptomatic cerebral embolism (CE). A total of 119 IE patients with CE were identified and analyzed with regard to operative timing: early (1–7 days), intermediate (8–21 days), and late (>22 days). The preoperative patient data, comorbidities and previous cardiac surgical procedures were analyzed to identify potential predictors and independent risk factors for in-hospital mortality using univariate and multivariate regression analysis. Actuarial survival was estimated by the Kaplan-Meier method. In-hospital mortality for the entire study cohort was 15.1% (n = 18), and in comparison, between groups was found to be highest in the intermediate surgical group (25.7%). Univariate analysis identified preoperative mechanical ventilation dependent respiratory insufficiency (p = 0.006), preoperative renal insufficiency (p = 0.019), age (p = 0.002), large vegetations (p = 0.018) as well as intermediate (p = 0.026), and late (p = 0.041) surgery as predictors of in-hospital mortality. The presence of large vegetations (>8 mm) (p = 0.019) and increased age (p = 0.037)—but not operative timing—were identified as independent risk factors for in-hospital mortality. In the presence of large vegetations (>8 mm), cardiac surgery should be performed early and independently from the entity of cerebral embolic stroke. Postponing surgery to achieve clinical stabilization and better postoperative outcomes of IE patients with CE is reasonable, however, worsening of the disease process with deterioration and resulting heart failure during the first 3 weeks after CE results in a significantly higher in-hospital mortality and inferior long-term survival.

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Management of infective endocarditis in patients with post-stroke brain damages

Cardiology and cardiac surgery: continuous professional development ◽

10.30702/ccs.201910.03.004084096 ◽

2019 ◽

pp. 84-96

Author(s):

V. V. Fedko ◽

S. P. Spysarenko ◽

T. O. Malysheva ◽

D. V. Pochynock

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Ischemic Stroke ◽

Cardiopulmonary Bypass ◽

Infective Endocarditis ◽

Hospital Mortality ◽

Neurological Impairment ◽

Neurological Complications ◽

Cerebrovascular Complications ◽

Management Protocol

This study evaluated the effectiveness of anesthesiological management in sur-gical treatment of infective endocarditis with cerebrovascular complications. The aim of the study was to decrease neurological complications and hospital mortality after surgical inter-ventions with the use of cardiopulmonary bypass in patients with infective endocarditis. The main preoperative risk factors of endocardit-associated cerebrovascular complications, which influenced the immediate results of cardiac surgery were: sepsis, systemic inflammatory response, disorders of systemic hemodynamics, high risk of recurrent cerebrovascular events, anemia and carbohydrate disorders. New anesthesiological management protocol was de-veloped and improved. Intraoperative risk factors for hospital mortality were associated with: total protein at the end of surgery less than 49 g/l; maximum blood glucose during surgery more than 10.7 mmol/l; anemia and hemodilution – hemoglobin level less than 58.8 g/l in the period of complete bypass and less than 79.4 g/l at the end of the surgery; positive water balance at the end of the operation. Determination of preoperative blood S100? protein level may be recommended to determine the prognosis of postoperative neurological complications, since the level above 0.13 µg/l was associated with postoperative neurological impairment. The implemented changes in the anesthetic management permitted to decrease neuro-logical complication rate from 22.2% to 9.6% and thirty-day mortality from 19.0% to 2.7% after surgical treatment of infective endocarditis with the use of cardiopulmonary bypass in patients with cerebrovascular complications. In order to achieve maximum effectiveness of anesthesiological management and to re-duce the level of postoperative neurological complications the optimal timing for surgery was 2–3 days after development of cerebrovascular impairment. In case of ischemic stroke in the most acute phase of the course (the first 72 hours), emergency cardiac surgery was advisable (except the cases of brain coma or total volume of myocardial infarction exceeding 31.5 cm3). In the case of ischemic stroke, more than 72 hours after the onset, and in the absence of progression of acute heart failure, the recommended timing for cardiac surgery was 4 weeks after the manifestation of cerebrovascular impairment. In the case of hemorrhagic or mixed type of neurological impairment, cardiac surgery was postponed for 1.4–2 months (since the development of the stroke).

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Outcomes and risk factors of septic shock in patients with infective endocarditis: a prospective cohort study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab119 ◽

2021 ◽

Author(s):

Juan M Pericàs ◽

Marta Hernández-Meneses ◽

Patricia Muñoz ◽

Ana Álvarez-Uría ◽

Blanca Pinilla-Llorente ◽

...

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Renal Failure ◽

Acute Renal Failure ◽

Cardiac Surgery ◽

Cohort Study ◽

Liver Disease ◽

Infective Endocarditis ◽

Hospital Mortality ◽

Persistent Bacteremia

Abstract Background Little is known about the characteristics and impact of septic shock (SS) on the outcomes of infective endocarditis (IE). We aimed to investigate the characteristics and outcomes of patients with IE presenting with SS and to compare them to those of IE patients with sepsis (Se) and those with neither Se nor SS (no-Se-SS). Methods Prospective cohort study of 4,864 IE patients from 35 Spanish centers (2008 to 2018). Logistic regression analyses were performed to identify risk factors for SS and mortality. Results SS and Se presented respectively in 597 (12.3%) and 559 (11.5%) patients. Patients with SS were younger and presented significantly higher rates of diabetes, chronic renal and liver disease, transplantation, nosocomial acquisition, S.aureus, IE complications, and in-hospital mortality (62.5%, 37.7% for Se and 18.2% for no-Se-SS,p<.001). S.aureus (OR 1.94, 95%CI 1.34-2.81,p<.001), Gram negative (OR 2.21,95%CI 1.25-3.91,p.006), nosocomial acquisition (OR 1.44,95%CI 1.07-1.94,p.015), persistent bacteremia (OR 1.82, 95%CI 1.24-2.68,p.002), acute renal failure (OR 3.02,95% 2.28-4.01,p<.001), CNS emboli (OR 1.48,1.08-2.01,p.013), and larger vegetation size (OR 1.01,95%CI 1.00-1.02,p.020) were associated with a higher risk of developing SS. Charlson score, heart failure, persistent bacteremia, acute renal failure, mechanical ventilation, worsening of liver disease, S.aureus and receiving aminoglycosides within the first 24h were associated with higher in-hospital mortality, whereas male sex, native valve IE and cardiac surgery were associated with lower mortality. Conclusions SS is frequent and entails dismal prognosis. Early identification of patients at risk of developing SS and early assessment for cardiac surgery appear as key factors to improve outcomes.

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Risk factors for mortality in patients undergoing continuous renal replacement therapy after cardiac surgery

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02324-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chang Liu ◽

Hai-Tao Zhang ◽

Li-Jun Yue ◽

Ze-Shi Li ◽

Ke Pan ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Cardiac Surgery ◽

Renal Replacement Therapy ◽

Confidence Interval ◽

Hospital Mortality ◽

Odds Ratio ◽

Intraoperative Bleeding ◽

Independent Risk Factors ◽

Mechanical Ventilation Time

Abstract Background To investigate the risk factors for mortality in patients with acute kidney injury requiring continuous renal replacement therapy (AKI-CRRT) after cardiac surgery. Methods In this retrospective study, patients who underwent AKI-CRRT after cardiac surgery in our centre from January 2015 to January 2020 were included. Univariable and multivariable analyses were performed to identify the risk factors for in-hospital mortality. Results A total of 412 patients were included in our study. Of these, 174 died after AKI-CRRT, and the remaining 238 were included in the survival control group. Multivariable logistic regression analysis revealed that EuroSCORE > 7 (odds ratio [OR], 3.72; 95% confidence interval [CI], 1.92–7.24; p < 0.01), intraoperative bleeding > 1 L (OR, 2.14; 95% CI, 1.19–3.86; p = 0.01) and mechanical ventilation time > 70 h (OR, 5.03; 95% CI, 2.40–10.54; p < 0.01) were independent risk factors for in-hospital mortality in patients who had undergone AKI-CRRT. Our study also found that the use of furosemide after surgery was a protective factor for such patients (odds ratio, 0.48; 95% confidence interval, 0.25–0.92; p = 0.03). Conclusions In summary, the mortality of patients with AKI-CRRT after cardiac surgery remains high. The EuroSCORE, intraoperative bleeding and mechanical ventilation time were independent risk factors for in-hospital mortality. Continuous application of furosemide may be associated with a better outcome.

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The impact of the recurrent laryngeal nerve injury on prognosis after McKeown esophagectomy for ESCC

10.21203/rs.3.rs-88872/v1 ◽

2020 ◽

Author(s):

Rirong Qu ◽

Dehao Tu ◽

Wei Ping ◽

Qi Wang ◽

Ni Zhang ◽

...

Keyword(s):

Risk Factors ◽

Recurrent Laryngeal Nerve ◽

Recurrent Laryngeal Nerve Injury ◽

Laryngeal Nerve ◽

Term Survival ◽

Laryngeal Nerve Injury ◽

Independent Risk Factors ◽

Mckeown Esophagectomy ◽

The Impact

Abstract Background: The objective of this study was to assess the impact of the recurrent laryngeal nerve injury (RLNI) after esophagectomy on prognosis.Methods: Retrospectively collected data from 297 patients with esophageal squamous cell carcinoma who underwent McKeown esophagectomy at our department from April 2014 to May 2018, were analyzed.Results: RLNI occurred in 31.9% of the patients. Left-side RLNI occurred 2.8 times more often than right-side RLNI. Among the cases in which assessment of the vocal cords was continued, 8.4% involved permanent injury. There were no significant differences among clinicopathological data between patients with RLNI and without. Compared with patients without RLNI,patients with RNLI have longer operation time,more number of bronchoscopy suctions, longer postoperation hospital stay, and higher incidence of postoperative complications. T stage, N stage, RLN LN metastasis were independent risk factors for the prognosis, but RLNI is not independent risk factors for long-term survival. Conclusion: RLNI is a serious complication that will affect the short-term prognosis of patients and reduce the quality of life of patients. It should be avoided as much as possible during surgery, but it may not have negative impact on the long-term survival.

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Independent Risk Factors for Fast-Track Failure Using a Predefined Fast-Track Protocol in Preselected Cardiac Surgery Patients

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2015.05.193 ◽

2015 ◽

Vol 29 (6) ◽

pp. 1461-1465 ◽

Cited By ~ 14

Author(s):

Waseem Zakhary ◽

Jacob Lindner ◽

Sophia Sgouropoulou ◽

Sarah Eibel ◽

Stefan Probst ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Fast Track ◽

Independent Risk Factors

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Respiratory morbidity of preterm infants of less than 33 weeks gestation without bronchopulmonary dysplasia: a 12-month follow-up of the CASTOR study cohort

Epidemiology and Infection ◽

10.1017/s0950268813001738 ◽

2013 ◽

Vol 142 (7) ◽

pp. 1362-1374 ◽

Cited By ~ 17

Author(s):

B. FAUROUX ◽

J.-B. GOUYON ◽

J.-C. ROZE ◽

C. GUILLERMET-FROMENTIN ◽

I. GLORIEUX ◽

...

Keyword(s):

Risk Factors ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Respiratory Morbidity ◽

Study Cohort ◽

Recurrent Wheezing ◽

Term Infants ◽

Independent Risk Factors ◽

Syncytial Virus

SUMMARYThe aim of this study was to describe the incidence and risk factors for respiratory morbidity during the 12-month period following the first respiratory syncytial virus (RSV) season in 242 preterm infants [<33 weeks gestational age (GA)] without bronchopulmonary dysplasia and 201 full-term infants (39–41 weeks GA) from the French CASTOR study cohort. Preterm infants had increased respiratory morbidity during the follow-up period compared to full-terms; they were more likely to have wheezing (21% vs. 11%, P = 0·007) and recurrent wheezing episodes (4% vs. 1%, P = 0·049). The 17 infants (14 preterms, three full-terms) who had been hospitalized for RSV-confirmed bronchiolitis during their first RSV season had significantly more wheezing episodes during the follow-up period than subjects who had not been hospitalized for RSV-confirmed bronchiolitis (odds ratio 4·72, 95% confidence interval 1·71–13·08, P = 0·003). Male gender, birth weight <3330 g and hospitalization for RSV bronchiolitis during the infant's first RSV season were independent risk factors for the development of wheezing episodes during the subsequent 12-month follow-up period.

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Abstract 19408: Impact of Perioperative Liver Dysfunction on In-hospital Mortality and Long-term Survival in Infective Endocarditis Patients

Circulation ◽

10.1161/circ.132.suppl_3.19408 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Mahmoud Diab ◽

Christoph Sponholz ◽

Michael Bauer ◽

Andreas Kortgen ◽

Philipp Scheffel ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Infective Endocarditis ◽

Hospital Mortality ◽

Organ Failure ◽

Liver Dysfunction ◽

Cox Regression ◽

Term Survival ◽

Long Term Survival ◽

Aureus Infection

Background: Infective endocarditis (IE) is a dangerous disease with high mortality (20-40%). A leading cause of death is multi-organ failure (MODS) with liver dysfunction (LD) as major contributor. Data on LD in IE patients are scarce. We assessed the impact of preoperative - and newly occurring LD on in-hospital mortality and long-term survival in IE patients. Methods: We retrospectively reviewed our database for surgery of left-sided endocarditis between 1/07 and 4/13. We used the hepatic Sepsis-related Organ Failure Assessment (hSOFA) score to assess the degree of LD. We performed Chi-Square, Cox regression and multivariate analyses. Results: The 308 patients had a mean age of 62 ±13.9. Preoperative LD (hSOFA > 0, Bilirubin > 32 μmol/L) was present in 1/4 (n=81) of patients and was associated with severely elevated in-hospital mortality (51.9% vs.14.6% without preoperative LD, p<0.001). Newly-occurring postoperative LD developed in another quarter (n=57 of 227 patients without LD) of patients and was associated with elevated in-hospital mortality (24.6% vs. 11.2%, p<0.001). Kaplan-Meyer 5-year survival was significantly better in patients without LD (51% vs. 19.9%, p<0.01). Survival curves were practically identical after the perioperative phase was over (Fig.). Quality of life in survivors was also the same. Cox regression analysis revealed preoperative LD as independent predictor of long-term survival (adjusted hazard ratio 1.695, 95% confidence interval 1.160-2.477, p=0.009) and duration of cardiopulmonary bypass (CPB) and S. aureus infection as independent predictors of newly-occurring postoperative LD. Conclusions: LD in patients with endocarditis is a significant independent risk factor for in-hospital mortality. A considerable fraction of patients develop LD perioperatively, which is associated with cardiopulmonary bypass-duration and S. aureus infection. However, after surviving surgery, prognosis no longer seems to be predicted by LD.

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Risk Factors for Postoperative Urinary Tract Infection and Urinary Retention in Patients Undergoing Surgery for Colorectal Cancer

The American Surgeon ◽

10.1177/000313481207801020 ◽

2012 ◽

Vol 78 (10) ◽

pp. 1100-1104 ◽

Cited By ~ 23

Author(s):

Celeste Y. Kang ◽

Obaid O. Chaudhry ◽

Wissam J. Halabi ◽

Vinh Nguyen ◽

Joseph C. Carmichael ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Urinary Tract Infection ◽

Logistic Regression ◽

Urinary Tract ◽

Tract Infection ◽

Hospital Mortality ◽

Urinary Retention ◽

Surgical Patients ◽

Independent Risk Factors

The aim of this study was to analyze risk factors for postoperative urinary tract infection (UTI) and urinary retention (UR) in patients with colorectal cancer. Using Nationwide Inpatient Sample 2006–2009, a retrospective analysis of surgical patients with colorectal cancer was conducted. Patients were stratified into groups, with or without UTI/UR. The LASSO algorithm for logistic regression identified independent risk factors. A total of 93,931 surgical patients with colorectal cancer were identified. The incidences of UTI and UR were 5.91 and 2.52 per cent, respectively. Overall in-hospital mortality was 2.68 per cent. The UTI group demonstrated significantly higher in-hospital mortality rates compared with those without. Both UTI and UR groups were associated with prolonged hospital stay and increased hospital charge. Multivariate logistic regression analysis revealed age older than 60 years, females, anemia, congestive heart failure, coagulopathy, diabetes with chronic complications, fluid and electrolyte, paralysis, pulmonary circulation disorders, renal failure, and weight loss were independent risk factors of UTI. Age older than 60 years, male gender, rectal and rectosigmoid cancers, and postoperative anastomotic leakage and ileus were independent risk factors for UR. Postoperative UTI increases in-house mortality. Postoperative UTI/UR in patients with colorectal cancer increases length of stay and hospital charges. Knowledge of these specific risk factors for UTI and UR is needed to counsel patients and prevent these complications in this high-risk population.

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O30 NON-RADICAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER; A NATIONWIDE STUDY ON INCIDENCE, RISK FACTORS AND OUTCOMES IN SWEDEN

Diseases of the Esophagus ◽

10.1093/dote/doz092.30 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

David Edholm ◽

Petter Hollertz ◽

Per Sandström ◽

Bergthor Björnsson ◽

Dennis Björk ◽

...

Keyword(s):

Risk Factors ◽

Esophageal Cancer ◽

Cox Regression ◽

Regional Lymph Node ◽

Neoadjuvant Treatment ◽

Resected Specimen ◽

Radical Esophagectomy ◽

Term Survival ◽

R1 Resection ◽

Independent Risk Factors

Abstract Aim To identify potential risk factors for a microscopically non-radical esophageal cancer resection (R1) and investigate how such a resection affects long-term survival. Background & Methods Esophageal cancer resections that are considered R1 have been associated with worse survival. The Swedish National Register for Esophageal and Gastric Cancer includes information on all esophageal cancer resections in Sweden. All patients having undergone esophageal resection with curative intent 2006-2017 were included. Risk factors for R1 resection were assessed through logistic regression. Factors predicting five-year survival were assessed through Cox-regression, adjusted for T-stage, N-stage, age and R-status. Results The study included 1,504 patients. The margins were microscopically involved in 146 patients (10%). Of these the circumferential margin was involved in 115 (8%). The proximal margin was involved in 55 patients (4%) and the distal in 30 (2%). In 54 (4%) specimens two margins were involved. Independent risk factors for R1-resection were absence of neoadjuvant treatment and clinical T3 stage or higher. The 5-year survival for the entire cohort was 41%, but only 19% for those with an R1 resection. Independent risk factors for death within 5-year from resection were regional lymph node metastasis (Hazard Ratio (HR) 2.6 (95% CI 2.2-3.1), histopathological stage T3 or higher (HR 1.2 95% CI 1.1-1.5), age above 60 years and R1-resection (HR 1.6 95% CI 1.4-2.0) Conclusion Involved margin in the resected specimen is an independent risk factor predicting worse 5-year survival. Besides striving for adequate surgical margins, the rate of R1-resections could be decreased through neoadjuvant treatment in fit patients.

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