Mortality across the spectrum of hemoglobin level in patients undergoing surgical coronary revascularization

Khalaji, Amirmohammad; Ajam, Ali; Sheikhy, Ali; Behnoush, Amir Hossein; Fallahzadeh, Aida; Bagheri, Jamshid; Mansourian, Soheil; Momtahen, Shahram; Masoudkabir, Farzad; Hosseini, Kaveh

doi:10.1002/clc.24004

Cited by 3 publications

(1 citation statement)

References 42 publications

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“…The following may be the underlying mechanisms [ 40 ]: (1) reduction in tissue oxygen intake; (2) increased instability of the plaque; and (3) decreased nitric oxide secretion. Past studies have suggested anemia as an independent risk factor for adverse outcomes in elderly individuals [ 41 , 42 ]. Notably, our investigation also identified an intriguing interaction between cardio-cerebrovascular comorbidities and anemia concerning all-cause mortality.…”

Section: Discussionmentioning

confidence: 99%

Ischemic cardio-cerebrovascular disease and all-cause mortality in Chinese elderly patients: a propensity-score matching study

Yang,

Sun,

Cui

et al. 2024

Eur J Med Res

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Background Ischemic cardio-cerebrovascular disease is the leading cause of mortality worldwide. However, studies focusing on elderly and very elderly patients are scarce. Hence, our study aimed to characterize and investigate the long-term prognostic implications of ischemic cardio-cerebrovascular diseases in elderly Chinese patients. Methods This retrospective cohort study included 1026 patients aged ≥ 65 years who were categorized into the mono ischemic cardio-cerebrovascular disease (MICCD) (either coronary artery disease or ischemic stroke/transient ischemic attack) (n = 912) and the comorbidity of ischemic cardio-cerebrovascular disease (CICCD) (diagnosed with both coronary artery disease and ischemic stroke/transient ischemic attack at admission) (n = 114). The primary outcome was all-cause death. The mortality risk was evaluated using the Cox proportional hazards risk model with multiple adjustments by conventional and propensity-score-based approaches. Results Of the 2494 consecutive elderly patients admitted to the hospital, 1026 (median age 83 years [interquartile range]: 76.5–86.4; 94.4% men) met the inclusion criteria. Patients with CICCD consisted mostly of very elderly (79.2% vs. 66.1%, P < 0.001) individuals with a higher burden of comorbidities. Over a median follow-up of 10.4 years, 398 (38.8%) all-cause deaths were identified. Compared with the MICCD group, the CICCD group exhibited a higher adjusted hazard ratio (HR) (95% confidential interval, CI) of 1.71 (1.32–2.39) for long-term mortality after adjusting for potential confounders. The sensitivity analysis results remained robust. After inverse probability of treatment weighting (IPTW) modeling, the CICCD group displayed an even worse mortality risk (IPTW-adjusted HR: 2.07; 95% CI 1.47–2.90). In addition, anemia (adjusted HR: 1.48; 95% CI 1.16–1.89) and malnutrition (adjusted HR: 1.43; 95% CI 1.15–1.78) are also independent risk factors for all-cause mortality among elderly and very elderly patients. Conclusions Our results thus suggest that elderly patients with ischemic cardio-cerebrovascular disease and anemia or malnutrition may have higher mortality, which may be predicted upon admission. These findings, however, warrant further investigation. Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

Ischemic cardio-cerebrovascular disease and all-cause mortality in Chinese elderly patients: a propensity-score matching study

Yang,

Sun,

Cui

et al. 2024

Eur J Med Res

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Mortality across the spectrum of hemoglobin level in patients undergoing surgical coronary revascularization

Khalaji

Ajam

Sheikhy

et al. 2023

Clinical Cardiology

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Background Preoperative hemoglobin (Hb) level is a predictor of in‐hospital and midterm mortality in patients undergoing coronary artery bypass grafting surgery (CABG). However, the debate about the different hazards across Hb levels and sex differences in outcome occurrence is still on the table. Methods This is a registry‐based serial cross‐sectional study at Tehran Heart Center. Nonanemic patients who underwent CABG with complete follow‐up data were included. The Restricted Cubic Splines (RCS) in the Cox model was used to calculate the sex‐specific correlation between in‐hospital, 6‐month, and 1‐year mortalities and normal Hb levels using odds ratio for the in‐hospital and hazard ratios for 6‐month and 1‐year mortality, adjusted for all possible confounders. Results From 2005 to 2016, a total of 13,557 patients were included, of which 134 had in‐hospital mortality as our primary outcome. Preoperative Hb levels were significantly lower in the deceased. Moreover, dead patients had significantly higher rates of diabetes and hypertension, while lower ejection fraction. Cut‐offs for reference Hb level were higher for males compared with females. The correlation between Hb level and in‐hospital mortality was nearly U‐shaped. Quantitatively, Hb of ≥15.62 and ≤13.25 g/dL for men and that of ≥14.92 and ≤13.4 g/dL for women tended to be associated with higher in‐hospital mortality. Conclusions The association between preoperative Hb level and in‐hospital mortality differs in men and women and does not follow a linear correlation among nonanemic patients. Both low and high numbers in the Hb level spectrum are at greater risk.

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The pharmacological and clinical aspects of using gentamicin in cardiac surgery

Mohammed,

Saleh Alkaaby,

Alshawi

2024

PHAR

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Surgical site infection (SSI) is a serious postoperative complication after cardiac surgery. The objective of this research is to examine the efficacy of administering gentamicin in minimizing the incidence of SSI while closely monitoring the therapeutic level of the drug. Prospective research included 50 Iraqi patients divided into two groups, 25 in each: Group 1 received a combination of flucloxacillin and ceftriaxone, while Group 2 received a combination of flucloxacillin and gentamicin 2 mg/kg of ideal body weight given before surgery, then 80 mg*3 for 48 hours after surgery. A total of five patients had an infection at the surgical site, with four patients in Group 1 and one patient in Group 2. Additionally, two patients in each group exhibited increased renal indices. Among the patients in Group 2, the highest concentration of gentamicin in the blood was ≤ 2.5 µg/ml for eight patients, while for 17 patients, the gentamicin concentration in the blood ranged from 3 to 4.4 µg/ml.

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Mortality across the spectrum of hemoglobin level in patients undergoing surgical coronary revascularization

Cited by 3 publications

References 42 publications

Ischemic cardio-cerebrovascular disease and all-cause mortality in Chinese elderly patients: a propensity-score matching study

Ischemic cardio-cerebrovascular disease and all-cause mortality in Chinese elderly patients: a propensity-score matching study

Mortality across the spectrum of hemoglobin level in patients undergoing surgical coronary revascularization

The pharmacological and clinical aspects of using gentamicin in cardiac surgery

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