Hemoglobin and Renal Replacement Therapy after Cardiopulmonary Bypass surgery: A predictive score from the Cardiac Surgery Registry of Puglia

Paparella, Domenico; Guida, Pietro; Mazzei, Valerio; Carbone, Carmine; Saglio, Giuseppe; Fanelli, Vitantonio; Zaccaria, Salvatore; Labriola, Cataldo; Scrascia, Giuseppe

doi:10.1016/j.ijcard.2014.08.003

Cited by 10 publications

(19 citation statements)

References 40 publications

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“…Our study provides a more robust confirmation of this finding by demonstrating the additive value of nadir hematocrit in a multivariate prediction model. In contrast to previous studies, 44 , 45 the addition of hematocrit at arrival to the operating room to the CCS did not improve the prediction of AKI in this analysis. This suggests that nadir intraoperative hematocrit is not just a surrogate for preoperative anemia, but adds important new information about AKI risk during the surgical procedure.…”

Section: Discussioncontrasting

confidence: 99%

“…Our main finding that measurement of nadir hematocrit improves the prediction of CSA-AKI is in line with recent reports showing that nadir hemoglobin and anemia are important predictors of CSA-AKI. 18 , 43 , 44 , 45 Prior studies have shown an inverse correlation between nadir intraoperative hematocrit and risk of CSA-AKI in univariate analyses. Our study provides a more robust confirmation of this finding by demonstrating the additive value of nadir hematocrit in a multivariate prediction model.…”

Section: Discussionmentioning

confidence: 98%

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Improving the Prediction of Cardiac Surgery–Associated Acute Kidney Injury

Crosina

Lerner

et al. 2017

Kidney International Reports

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IntroductionAcute kidney injury (AKI) is a potentially fatal complication of cardiac surgery. The inability to predict cardiac surgery-associated AKI is a major barrier to prevention and early treatment. Current clinical risk models for the prediction of cardiac surgery-associated AKI are insufficient, particularly in patients with preexisting kidney dysfunction.MethodsTo identify intraoperative variables that might improve the performance of a validated clinical risk score (Cleveland Clinic Score, CCS) for the prediction of cardiac surgery-associated AKI, we conducted a prospective cohort study in 289 consecutive elective cardiac surgery patients at a tertiary care center. We compared the area under the receiver operator characteristic curve (AUC) of a base model including only the CCS with models containing additional selected intraoperative variables including mean arterial pressure, hematocrit, duration of procedure, blood transfusions, and fluid balance. AKI was defined by the Kidney Disease Improving Global Outcomes 2012 criteria.ResultsThe CCS alone gave an AUC of 0.72 (95% confidence interval, 0.62–0.82) for postoperative AKI. Nadir intraoperative hematocrit was the only variable that improved AUC for postoperative AKI when added to the CCS (AUC = 0.78; 95% confidence interval, 0.70–0.87; P = 0.002). In the subcohort of patients without preexisting chronic kidney disease (n = 214), where the CCS underperformed (AUC, 0.60 [0.43–0.76]), the improvement with the addition of nadir hematocrit was more marked (AUC, 0.74 [0.62–0.86]). Other variables did not improve discrimination.DiscussionNadir intraoperative hematocrit is useful in improving discrimination of clinical risk scores for AKI, and may provide a target for intervention.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 98%

Improving the Prediction of Cardiac Surgery–Associated Acute Kidney Injury

Crosina

Lerner

et al. 2017

Kidney International Reports

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“…Our present study found that age and preoperative Hb were independent risk factors for AKI, which was consistent with previous studies in cardiac surgery patients [25][26][27]. Che et al [28] showed that the incidence risk of postoperative AKI increased by 1.35 times per 10-year increase in the age of patients with CPB surgery [28].…”

Section: Risk Factors For Postoperative Aki and Crrtsupporting

confidence: 92%

Time to peak bilirubin concentration and advanced AKI were associated with increased mortality in rheumatic heart valve replacement surgery patients with severe postoperative hyperbilirubinemia: a retrospective cohort study

Chen

Bai

Zhao

et al. 2021

BMC Cardiovasc Disord

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Background Hyperbilirubinemia after heart valve surgery (HVS) with cardiopulmonary bypass is frequently observed and associated with worse outcomes. We investigated the characteristics and prognosis of patients with severe hyperbilirubinemia after HVS for rheumatic heart disease (RHD) to identify the clinical outcomes and potential risk factors. Methods Between 2015 and 2018, patients who underwent HVS in the cardiac surgery intensive care unit of our hospital were retrospectively screened. Risk factors for acute kidney injury (AKI), the requirement for continuous renal replacement therapy (CRRT), and in-hospital and long-term mortality were identified by univariate and multivariate analyses. The patient survival proportion was graphically presented with the Kaplan–Meier method. Results A total of 149 patients who underwent HVS for RHD and had severe postoperative hyperbilirubinemia were included. Of the included patients, 80.5% developed postoperative AKI, and 18.1% required CRRT. The in-hospital mortality was 30.2%. Backward logistic regression analysis showed that the time to peak TB concentration (odds ratio [OR] 1.557, 95% confidence interval [CI] 1.259–1.926; P < 0.001) and advanced AKI (stage 2 and 3 AKI) (OR 19.408, 95% CI 6.553–57.482; P < 0.001) were independent predictors for in-hospital mortality. The cutoff value of the time to peak TB levels for predicting in-hospital mortality was 5 postoperative days. Conclusions Severe postoperative hyperbilirubinemia is a life-threatening complication in patients who undergo HVS for RHD. Patients whose bilirubin levels continued to increase past the 5th postoperative day and who had advanced AKI (stages 2 and 3) were associated with a higher risk of mortality.

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“…Several scoring systems to estimate the risk of postoperative AKI have been developed, such as the AKI following cardiac surgery prognostic score system [13]. Thakar and colleagues [11] also developed a scoring model to predict AKI after cardiac operations by incorporating the effects of all major risk factors for AKI, including gender, congestive heart failure, left ventricular ejection fraction of less than 0.35, comorbidities, type of operation, and preoperative creatinine levels.Postoperative AKI is considered as an independent predictor of short-and long-term death in patients undergoing cardiac operations [15]. Postoperative renal replacement therapy (RRT), which is frequently used to treat AKI, is also associated with an increased death and hospitalization cost [15,16] and requires intensive nursing care and continuous anticoagulation [17,18].…”

mentioning

confidence: 99%

“…Postoperative AKI is considered as an independent predictor of short-and long-term death in patients undergoing cardiac operations [15]. Postoperative renal replacement therapy (RRT), which is frequently used to treat AKI, is also associated with an increased death and hospitalization cost [15,16] and requires intensive nursing care and continuous anticoagulation [17,18]. Thus, reducing the incidence of postoperative AKI and RRT is essential to improve the clinical outcome of patients undergoing CABG.…”

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confidence: 99%

Preoperative Prophylactic Intraaortic Balloon Pump Reduces the Incidence of Postoperative Acute Kidney Injury and Short-Term Death of High-Risk Patients Undergoing Coronary Artery Bypass Grafting: A Meta-Analysis of 17 Studies

Wang

Gao

et al. 2016

The Annals of Thoracic Surgery

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This meta-analysis investigated the effects of preoperative prophylactic intraaortic balloon pump placement on postoperative renal function and short-term death of high-risk patients undergoing coronary artery bypass grafting. We found that preoperative prophylactic intraaortic balloon pump support reduced the incidence of coronary artery bypass grafting-associated acute kidney injury and short-term death and dramatically decreased the incidence of postoperative renal replacement therapy by 82% compared with high-risk patients without the procedure. This is the first meta-analysis to demonstrate significant beneficial effects of preoperative prophylactic intraaortic balloon pump on renal function in high-risk patients undergoing coronary artery bypass grafting.

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Hemoglobin and Renal Replacement Therapy after Cardiopulmonary Bypass surgery: A predictive score from the Cardiac Surgery Registry of Puglia

Cited by 10 publications

References 40 publications

Improving the Prediction of Cardiac Surgery–Associated Acute Kidney Injury

Improving the Prediction of Cardiac Surgery–Associated Acute Kidney Injury

Time to peak bilirubin concentration and advanced AKI were associated with increased mortality in rheumatic heart valve replacement surgery patients with severe postoperative hyperbilirubinemia: a retrospective cohort study

Preoperative Prophylactic Intraaortic Balloon Pump Reduces the Incidence of Postoperative Acute Kidney Injury and Short-Term Death of High-Risk Patients Undergoing Coronary Artery Bypass Grafting: A Meta-Analysis of 17 Studies

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