Cardiac Surgery in Systemic Lupus Erythematosus Patients: Clinical Characteristics and Outcomes

Tejeda-Maldonado, Javier; Quintanilla-González, Lauro; Galindo-Uribe, Jaime; Hinojosa‐Azaola, Andrea

doi:10.1016/j.reumae.2017.01.016

Cited by 8 publications

(8 citation statements)

References 19 publications

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“…In a previous study of SLE patients who underwent cardiac surgery at our center, the use of corticosteroids was not associated with postoperative complications either. 17 There was a higher frequency of preoperative use of aspirin and oral anticoagulants in SLE patients, without impact on the amount of bleeding or blood transfusion requirements, similar to previous findings in non-SLE patients undergoing surgery. 18 However, aspirin use was independently associated with the presence of any postoperative complication in our SLE patients.…”

Section: Discussionsupporting

confidence: 84%

“…23 Hypoalbuminemia was identified as a risk factor associated with early complications (infectious and noninfectious) in SLE patients, as opposed to previous studies including SLE patients that have not described this finding. 1,7,17 In studies evaluating patients without connective tissue disease undergoing major surgery, however, hypoalbuminemia has been identified as a risk factor for infectious postoperative complications, longer hospital stay, higher blood transfusion requirements, rehospitalization, second intervention, and mortality. [23][24][25][26][27] Moreover, hypoalbuminemia has been used as a serum marker of malnutrition, and the latter has been related to worse general condition including more comorbidities, older age, lower immune response, muscle wasting, poor cardiac function, low weight and sepsis.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for development of early infectious and noninfectious complications in systemic lupus erythematosus patients undergoing major surgery

Quintanilla-González

Torres‐Villalobos

Hinojosa‐Azaola

2018

Lupus

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Background We aimed to identify risk factors for early complications in systemic lupus erythematosus (SLE) patients undergoing major surgery. Methods We conducted a retrospective comparative cohort study including patients with SLE undergoing major surgery, and non-SLE patients matched 1:1. Main outcomes were development of infectious and noninfectious complications, and 30-day postoperative mortality. Results A total of 382 patients (191 SLE and 191 non-SLE) were included. Postoperative complications occurred in 82 (43%) SLE patients and 58 (30%) without SLE, ( p = 0.01). Variables associated with infectious complications in SLE patients: prednisone use (OR 1.81, 95% CI 1.13-2.90), anemia (OR 2.43, 95% CI 1.45-4.08), hypoalbuminemia (OR 2.58, 95% CI 1.55-4.30) and lymphopenia (OR 2.43, 95% CI 1.52-3.89), p < 0.05. Variables associated with noninfectious complications: anemia (OR, 1.93, 95% CI 1.03-3.64) and hypoalbuminemia (OR 2.11, 95% CI 1.16-3.86), p < 0.05. Variables associated with any complication: SLEDAI-2K (OR 1.1, 95% CI 1.01-1.20), nephritis (OR 10.08, 95% CI 1.21-83.63), aspirin use (OR 2.68, 95% CI 1.19-6.02, p = 0.01), low C3 (OR 2.00, 95% CI 1.06-3.80), anemia (OR 2.68, 95% CI 1.39-5.18), hypoalbuminemia (OR 3.49, 95% CI 1.83-6.66) and lymphopenia (OR 2.36, 95% CI 1.30-4.26), p < 0.05. More patients with SLE died (6% vs 1%, p = 0.02). Conclusions SLE patients present higher frequency of postoperative complications and mortality compared with non-SLE patients. Hypoalbuminemia, anemia, lymphopenia and aspirin use are independent risk factors.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Risk factors for development of early infectious and noninfectious complications in systemic lupus erythematosus patients undergoing major surgery

Quintanilla-González

Torres‐Villalobos

Hinojosa‐Azaola

2018

Lupus

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“…En este contexto múltiples estudios han demostrado un riesgo aumentado, asociándose a mayor mortalidad intrahospitalaria [18], [19], [20] y complicaciones posoperatorias como infecciones, sepsis, falla renal aguda, enfermedad tromboembólica, eventos cardiovasculares, caídas o necesidad de transfusión, especialmente en pacientes inmunosuprimidos, anémicos, usuarios crónicos de corticoides o AAS, con compromiso renal o antecedente de hospitalización reciente por crisis lúpica [5], [18], [19], [20], [21], [22]. En pacientes sometidos a cirugía cardíaca la presencia de infecciones posoperatorias se asoció a mayor estadía hospitalaria, mayor estadía en UCI, mayor duración de ventilación mecánica e hipertensión pulmonar sistólica [23].…”

Section: Consideraciones Anestésicasunclassified

“…Algunas situaciones particulares de mayor riesgo son pacientes sometidos a cirugía cardiaca. Los procedimientos más frecuentes son el reemplazo valvular, la ventana pericárdica y la cirugía de revascularización coronaria, requiriendo frecuentemente el uso de circulación extracorpórea [15], [23]. Particularmente en los pacientes con anticuerpos antifosfolípidos el manejo es complejo, dado que el cuadro se asocia tanto a un mayor riesgo trombótico como a defectos en la formación de.…”

Section: Consideraciones Anestésicasunclassified

Consideraciones anestésicas en lupus eritematoso sistémico

C.¹,

L.²,

C.³

2021

Rev. chil. anest.

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Introduction: Sistemyc lupus erythematosus (SLE) is an autoinmune disease associated to severe organ damage and mortality. SLE patients have a higher surgical risk. The objective of this article is to review the systemic manifestations of SLE and how they can challenge the anesthetic management, so a safer and more tailored anesthesia can be provided. Methods: A search was made on Pubmed, ProQuest, and EMBASE databases obtaining a total of 2,028 articles. The titles of articles found were reviewed, of which 88 merited greater review. The complete text of each article of this group was reviewed, references that were of greater interest were also reviewed. Finally, a total of 29 works to be included in this review were selected. Results: Musculoskeletal, cardiac, renal and laringeal involvement are the most frequent and important complications to anesthetic management. It´s clinical manifestations must be assess in the preoperative evaluation as well as potential pharmacological interactions with regular medications that the patient might be taking. The need of antibiotic profilaxis and steroidal supplementation has to be addressed. The post operative management should be focused on assessment of frecuent complications as cardiovascular or thrombotic events. Conclusion: SLE is a complex disease that represent a challenge in surgical context. Its complications can affect the airway, ventilatory or hemodinamic management as well as renal function. That is why the multidisciplinary management of these patients and a complete preoperative evaluation are essentials so a risk estratification can be made and anesthesiologists can prepare correctly to handle potential complications.

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“…Clearly in the setting of reversible or treatable cardiac disease, this should be the priority. Thus, SLE-related valvular heart disease should be managed surgically where appropriate 52 ; of note in scleroderma, aortic stenosis often progresses more rapidly 53 than in normal patients and valve replacement significantly reduces left heart filling pressures. Ankylosing spondylitis is another CTD that is frequently associated with aortic regurgitation and may lead to postcapillary PH.…”

Section: Management Of Postcapillary Ctd-phmentioning

confidence: 99%

Pulmonary Hypertension Associated with Connective Tissue Disease

Fayed

Coghlan

2019

Semin Respir Crit Care Med

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Pulmonary hypertension (PH) is common in most forms of connective tissue disease (CTD); the prevalent type of PH depends on the particular CTD. Thus, pulmonary arterial hypertension (PAH) is dominantly associated with scleroderma, while postcapillary PH is most common in rheumatoid arthritis and lung disease-associated PH is typically found in myositis and sarcoidosis.Considerable expertise is required to identify, diagnose, and manage CTD-PH, as the primary physicians providing the majority of care for this population, rheumatologists, need a good working knowledge of CTD-PH, its rather subtle presentation, and how to access the necessary investigations to screen for and identify patients with PH. The role of the rheumatologist does not stop at diagnosis; in some conditions such as lupus, optimizing immunosuppression is key to the management of PH, and unlike simple idiopathic PAH, the natural history of CTD-PH is often punctuated by complications of the CTD rather than just events due to progression of PH or therapy-related adverse events.The aim of this article is to provide an overview of all forms of CTD-PH, and to provide an easy reference source on current best practice.

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Cardiac Surgery in Systemic Lupus Erythematosus Patients: Clinical Characteristics and Outcomes

Cited by 8 publications

References 19 publications

Risk factors for development of early infectious and noninfectious complications in systemic lupus erythematosus patients undergoing major surgery

Risk factors for development of early infectious and noninfectious complications in systemic lupus erythematosus patients undergoing major surgery

Consideraciones anestésicas en lupus eritematoso sistémico

Pulmonary Hypertension Associated with Connective Tissue Disease

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