Effect of goal-directed therapy on post-operative neutrophil gelatinase-associated lipocalin profile in patients undergoing on-pump coronary artery surgery

Kapoor, Poonam Malhotra; Karanjkar, Ameya; Magoon, Rohan; Taneja, Sameer; Das, Sambhunath; Malik, Vishwas; Chowdhury, Ujjwal K.; Ravi, Vadlamani

doi:10.1007/s12055-018-0758-4

Cited by 4 publications

(18 citation statements)

References 24 publications

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“…Five of the selected articles were randomized controlled trials (RCTs) [ 11 , 17 – 20 ], and the remaining were prospective interventional studies ( n = 1) [ 21 ], prospective observational studies ( n = 3) [ 22 – 24 ], retrospective before-and-after cohort studies ( n = 3) [ 25 – 27 ] and a propensity score-matched cohort study [ 28 ]. Of the thirteen included studies, nine studies were performed in surgical patients of which five involved only patients undergoing cardiac surgery.…”

Section: Resultsmentioning

confidence: 99%

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Improvement of composite kidney outcomes by AKI care bundles: a systematic review and meta-analysis

See,

Pan,

Chen

et al. 2023

Crit Care

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Introduction Various approaches have been suggested to identify acute kidney injury (AKI) early and to initiate kidney-protective measures in patients at risk or with AKI. The objective of this study was to evaluate whether care bundles improve kidney outcomes in these patients. Methods We conducted a systematic review of the literature to evaluate the clinical effectiveness of AKI care bundles with or without urinary biomarkers in the recognition and management of AKI. The main outcomes were major adverse kidney events (MAKEs) consisting of moderate-severe AKI, receipt of renal replacement therapy (RRT), and mortality. Results Out of 7434 abstracts screened, 946 published studies were identified. Thirteen studies [five randomized controlled trials (RCTs) and eight non-RCTs] including 16,540 patients were eligible for inclusion in the meta-analysis. Meta-analysis showed a lower incidence of MAKE in the AKI care bundle group [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.66–0.81] with differences in all 3 individual outcomes [moderate–severe AKI (OR 0.65, 95% CI 0.51–0.82), RRT (OR 0.63, 95% CI = 0.46–0.88) and mortality]. Subgroup analysis of the RCTs, all adopted biomarker-based approach, decreased the risk of MAKE (OR 0.55, 95% CI 0.41–0.74). Network meta-analysis could reveal that the incorporation of biomarkers in care bundles carried a significantly lower risk of MAKE when compared to care bundles without biomarkers (OR = 0.693, 95% CI = 0.50–0.96), while the usual care subgroup had a significantly higher risk (OR = 1.29, 95% CI = 1.09–1.52). Conclusion Our meta-analysis demonstrated that care bundles decreased the risk of MAKE, moderate–severe AKI and need for RRT in AKI patients. Moreover, the inclusion of biomarkers in care bundles had a greater impact than care bundles without biomarkers.

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Section: Resultsmentioning

confidence: 99%

“…TIMP-2 and IGFBP7 have been used for enrichment purposes in studies exploring the role of AKI care bundles. Kapoor et al [ 11 ] measured NGAL before and after goal-directed optimization but did not utilize the results to identify high-risk patients or guide management.…”

Section: Introductionmentioning

confidence: 99%

Improvement of composite kidney outcomes by AKI care bundles: a systematic review and meta-analysis

See,

Pan,

Chen

et al. 2023

Crit Care

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“…14 Postoperative AKI was defined by an increase in serum creatinine value to >3 times of baseline, or increase to absolute value of > 4mg/dL or need for renal replacement therapy (according to stage 3 of Acute Kidney Injury Network (AKIN) classification). 15…”

Section: Methodsmentioning

confidence: 99%

Preoperative Combined Adiposity–Nutritional Index Predicts Major aDverse Cardiac and Cerebral Events following Off-pump coRonary Artery Revascularization (PANDORA): A Retrospective Single-Center Study

Bansal

Magoon

Dey

et al. 2021

Journal of Cardiac Critical Care TSS

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Background The metabolic–nutritional profile of coronary artery disease (CAD) patients can be an important outcome determinant. A high visceral adiposity index (VAI) and a low prognostic nutritional index (PNI) have been described to predict major adverse cardiac and cerebral events (MACCE) in nonoperative settings and poor cardiac-surgical outcomes, respectively. The present study evaluated the MACCE-predictive value of the two indices, in isolation and as a combined adiposity–nutritional index (CANI = VAI/PNI) in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods The retrospective study was conducted in 1207 OPCABG patients at a tertiary cardiac care center. Thirty-day postoperative data was evaluated for the development of MACCE, defined by any of the following: cardiac arrest, ST-segment elevation myocardial ischemia (STEMI), repeat coronary revascularization, or stroke. The perioperative characteristics of the MACCE and no-MACCE groups were analyzed for the predictors of postoperative MACCE. Results One-hundred thirty-two patients (10.93%) developed MACCE postoperatively. On univariate analysis, age, EuroSCORE II, ejection fraction, diabetes mellitus, asymptomatic carotid artery disease, left main (LM) disease, PNI, and VAI predicted MACCE. Subsequent to multivariate analysis, age, EuroSCORE II, and CANI were the independent predictors. The MACCE predictive cutoffs of VAI, PNI, and CANI were 3.2, 38.46, and 0.075 (area under the curve [AUC]; sensitivity; specificity: 0.64; 77%; 81.3%, 0.77; 92.6%, 65%, 0.78; 64.5%; 80.2%, respectively). CANI correlated positively with duration of mechanical ventilation, length of intensive care unit (ICU) stay, and mean postoperative vasoactive inotropic scores (VIS). CANI ≥ 0.075 was also associated with a higher incidence of postoperative atrial fibrillation, low cardiac output syndrome, and acute kidney injury. Conclusions CANI emerged as an independent predictor of MACCE following OPCABG.

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“…35 This is particularly pertinent in the context of CSA-AKI which is essentially multifactorial. 33 34 Second, the lack of availability of the renal oxygenation monitoring trends (near-infrared spectroscopy based) for all the included cases, is an additional limitation. 36 Third, the inclusion of other markers of malnutrition, frailty, and/or inflammation could have enhanced the lucidity of the study findings.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…The isolated evaluation of OPCABG patients additionally obviates the possible deleterious renal effects of extracorporeal circulatory conduct. 33,34 However, the study had a few limitations. First, the retrospective study design is prone to residual confounding.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Malnutrition-Inflammation Liaison in Predicting AKI following OPCABG in Diabetics: Role of a Novel Monocyte/High-Density Lipoprotein × Albumin Ratio

Singh

Magoon

Dey

et al. 2022

Journal of Cardiac Critical Care TSS

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Background Monocyte/high-density lipoprotein ratio (MHR) has been recently proposed as a parsimonious inflammatory marker. Akin to MHR, hypoalbuminemia (a malnutrition marker) has a considerable proinflammatory potential and confers an accentuated risk of postcardiac surgery complications, like acute kidney injury (AKI). The present study evaluated the AKI-predictive value of the preoperative monocyte/high-density lipoprotein × albumin ratio (MHAR) in diabetic patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods The retrospective study conducted at our tertiary cardiac care center included 687 diabetic OPCABG patients. Forty-eight hours postoperative data was evaluated for the occurrence of AKI, as defined by the Acute Kidney Injury Network criteria. The perioperative attributes of the AKI and non-AKI groups were compared to evaluate the predictors of AKI, by employing a regression analysis. Results A total of 109 patients (15.87%) developed AKI postoperatively. On univariate analysis: age, EuroSCORE II, preoperative congestive heart failure, systemic hypertension, serum albumin, MHR, MHAR, intraoperative packed red blood cell transfusion, postoperative low cardiac output syndrome, and vasoactive-inotropic score (VIS) predicted AKI. AKI subsequent to multivariate analysis, age (odds ratio [OR]: 1.029), EuroSCORE II (OR: 1.264), MHAR (OR: 1.403), and VIS (OR: 1.07) were the independent predictors (p-values: 0.020, < 0.001, 0.013, 0.002, respectively). The AKI predictive cutoffs of albumin, MHR, and MHAR were ≤ 2.95, ≥ 15.25, and ≥ 4.08 (area under the curve:sensitivity:specificity of 0.761:84.86%:89.62%; 0.754:93.12%:86.68%; 0.798:89.63%:88.34%, respectively). MHAR ≥ 4.08 was also associated with a higher incidence of postoperative atrial fibrillation and major adverse cardiac events. Conclusion Preoperative elevated MHAR independently predicts AKI following OPCABG in diabetics, implying a malnutrition-inflammation liaison at heart of the matter.

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Effect of goal-directed therapy on post-operative neutrophil gelatinase-associated lipocalin profile in patients undergoing on-pump coronary artery surgery

Cited by 4 publications

References 24 publications

Improvement of composite kidney outcomes by AKI care bundles: a systematic review and meta-analysis

Improvement of composite kidney outcomes by AKI care bundles: a systematic review and meta-analysis

Preoperative Combined Adiposity–Nutritional Index Predicts Major aDverse Cardiac and Cerebral Events following Off-pump coRonary Artery Revascularization (PANDORA): A Retrospective Single-Center Study

Malnutrition-Inflammation Liaison in Predicting AKI following OPCABG in Diabetics: Role of a Novel Monocyte/High-Density Lipoprotein × Albumin Ratio

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