Do We Need to Personalize Renal Function Assessment in the Stratification of Patients Undergoing Cardiac Surgery?

Abstract

BackgroundRenal dysfunction is an independent predictor of morbidity and mortality in cardiac surgery. For a better assessment of renal function, calculation of creatinine clearance (CC) may be necessary.ObjectiveTo objectively evaluate whether CC is a better risk predictor than serum creatinine (SC) in patients undergoing cardiac surgery.MethodsAnalysis of 3,285 patients registered in a prospective, consecutive and mandatory manner in the Sao Paulo Registry of Cardiovascular Surgery (REPLICCAR) between November 2013 and January 2015. Values of SC, CC (Cockcroft-Gault) and EuroSCORE II were obtained. Association analysis of SC and CC with morbidity and mortality was performed by calibration and discrimination tests. Independent multivariate models with SC and CC were generated by multiple logistic regression to predict morbidity and mortality following cardiac surgery.ResultsDespite the association between SC and mortality, it did not calibrate properly the risk groups. There was an association between CC and mortality with good calibration of risk groups. In mortality risk prediction, SC was uncalibrated with values > 1.35 mg /dL (p < 0.001). The ROC curve showed that CC is better than SC in predicting both morbidity and mortality risk. In the multivariate model without CC, SC was the only predictor of morbidity, whereas in the model without SC, CC was not only a mortality predictor, but also the only morbidity predictor.ConclusionCompared with SC, CC is a better parameter of renal function in risk stratification of patients undergoing cardiac surgery.

Systematic review of the use of big data to improve surgery in low- and middle-income countries

“…). Following assessment, 68 articles, involving 708 032 patients across 71 LMICs, were included in the review ( Tables S1 and S2 , supporting information). Country‐specific patient numbers were reported in 60 studies but were absent from six and two provided total LMIC patient numbers only.…”

“…Outcomes following cancer surgery were common topics, including breast, gastric, colorectal and prostate cancer, and hepatocellular carcinoma. Cardiac surgery, caesarean section and genitourinary fistula were also well represented in included articles, whereas clinical presentations included burn management, trauma, appendicitis, groin hernias and orthopaedic fracture management.…”

Preoperative Creatinine Clearance and Mortality of Elective Cardiac Surgery in Hospitalization: A Secondary Analysis

“…The creatinine clearance rate (Ccr) is a common method of evaluating renal function. Compared with serum creatinine, creatinine clearance is a better indicator of renal function in risk stratification of patients undergoing cardiac surgery (1). The Cockcroft Gault (CG) and the Modification of Diet in Renal Disease (MDRD) formulae are the main formulae used to calculate Ccr (2,3).…”

Estudo de coorte observacional prospectivo multicêntrico internacional para a elaboração e validação de um modelo de predição de risco de mortalidade em pacientes de alto risco submetidos à cirurgia de alto risco submetidos à cirurgia de revascularização miocárdica: Projeto HiriSCORE

“…Não há dúvidas, que a insuficiência renal tem impacto no prognóstico da morbimortalidade após procedimentos cirúrgicos. [101][102][103][104] . Na estratificação de risco de pacientes submetidos à CCV, clearance de creatinina é um parâmetro da função renal mais preciso do que creatinina sérica.…”

“…Na estratificação de risco de pacientes submetidos à CCV, clearance de creatinina é um parâmetro da função renal mais preciso do que creatinina sérica. 103 Importante lembrar que avaliação dos fatores de risco do paciente real deve ter finalidade ao uso das estratégias possíveis de minimização de risco antes de procedimento cirúrgico.…”