Precision Cardiac Anesthesia: Welcome Aboard!

Magoon, Rohan

doi:10.1053/j.jvca.2020.02.029

Cited by 11 publications

(9 citation statements)

References 14 publications

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“…Preoperative elevation of MHAR independently predicted postoperative AKI in the retrospective evaluation of our diabetic patients undergoing OPCABG. While the novel ratio concocts the nutritional and inflammatory predisposition and can potentially assist risk stratification and individualization 37,38 of targeted therapy, future prospective studies are warranted to validate the initial encouraging findings across diverse clinical settings.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Nevertheless, the research community is not new to such examples (premature embracement of recombinant human activated protein-C, etc.) with these previous experiences only highlighting the need of maintaining a high quality standard of evidence for moving practice forward [4] , [5] , [6] . In this context, the FDA has recently outlined a regulatory document of guidance on the conduct of clinical trials related to the public health emergency of COVID-19 [7] .…”

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confidence: 97%

Compounded research challenges amid the COVID-19 pandemic

Magoon

Ohri

2020

Anaesthesia Critical Care & Pain Medicine

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“…The precision medicine slogan: “ One-size-does-not-fit-all ” embraces the commonplace heterogeneity observed in the treatment effects, perioperative complications and associated outcomes. [ 8 9 ] The proponents of the notion opine that EBM by nature regards treatment at a population level with minimal individualistic considerations and highlight the importance of personalizing clinical medicine. Nevertheless, the overarching premise to make precision medicine evidence-based is substantially challenging given a patient is much more than a set of covariates and incurs multipronged difficulties in the terms of investigation, knowledge-acquisition, education, interpretation, and dissemination of multilevel data, from cellular level to environment and lifestyle, for the ever-diversifying patient population.…”

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confidence: 99%

“…To conclude, much or most of the practice variability in clinical medicine stems from the subtle differences among the patients. [ 7 8 9 ] Therefore, personalized management is appreciated well even in the era of EBM aimed at improving patient outcomes as it does not annihilate intuition, clinical expertise, and reasoning physiology as the ground for decision-making while accounting for the systematic evaluation of the evidence. In fact, distant from the dogma of EBM and precision medicine being dichotomous, an intuitive “open-mind” can complement both to practice evidence-based precision medicine in a unified pluralistic health care model, particularly relevant in the perioperative management of high-risk surgical cohort.…”

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confidence: 99%