Risk assessment and outcomes of vasoplegia after cardiac surgery

Tsiouris, Athanasios; Wilson, Lynn; Haddadin, Ala S.; Yun, James; Mangi, Abeel A.

doi:10.1007/s11748-017-0789-6

Cited by 46 publications

(57 citation statements)

References 25 publications

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“…Elderly patients often present with multiples comorbidities that may enhance the IR 20. Despite the absence of association in our study, the p-value is almost significant and it probably requires a larger study to demonstrate this relationship.…”

Section: Discussioncontrasting

confidence: 65%

Evaluation of the delta of immature platelet fraction as a predictive biomarker of inflammatory response after cardiac surgery

et al. 2019

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AimsCardiac surgery (CS) can induce an inflammatory response (IR) that is associated with poorer outcomes. Immature platelets are among the factors that may be associated with IR development. We aimed to evaluate whether immature platelet fraction (IPF) could be a predictive biomarker for IR and whether IPF could improve the prognosis assessment of IR for Acute Physiologic and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) following CS.MethodsThree-hundred and twenty-seven (327) patients who underwent CS were enrolled during the study period. IR was defined according to the need for vasopressor support (>48 hours). Perioperative variables and outcomes were registered in our database. IPF was measured immediately following CS and at 24 hours by Sysmex XN analyzer and the difference between both measurements (ΔIPF) was calculated. To assess the relationship between ΔIPF and IR, univariate and multivariate logistic regression were performed. To analyse the additive value of ΔIPF in APACHE II and SOFA scores in predicting IR, an area under the receiver operating characteristic (AUROC) curve was calculated.ResultsAmong 327 patients included, 60 patients (18.3%) developed IR. Multivariate analysis showed ΔIPF was significantly associated with IR (OR: 1.26; 95% CI: 1.01 to 1.56; p=0.038). The combination of ΔIPF with scores improved the AUROC for IR prediction: 0.629 vs 0.728 (p=0.010) for APACHE II and 0.676 vs 0.715 (p=0.106) for SOFA.ConclusionThese findings suggested that ΔIPF may be a useful and low-cost biomarker for the early identification of patients at risk of IR development.

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Section: Discussioncontrasting

confidence: 65%

Evaluation of the delta of immature platelet fraction as a predictive biomarker of inflammatory response after cardiac surgery

et al. 2019

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“…Although there is an overall agreement regarding the effect of specific risk factors for VS, other factors are more controversial. In recent literature, chronic hemodialysis (HD)-dependent renal failure has been suggested to be a risk factor for VS because of its chronic inflammatory status [10,11]. Repeated dialysis treatments in patients with chronic renal failure (CRF) are considered to promote an inflammatory response [12], although the duration of HD has not yet been examined in detail.…”

Section: Introductionmentioning

confidence: 99%

Longer term hemodialysis-dependent chronic renal failure increases the risk of post-cardiac surgery vasoplegic syndrome

et al. 2020

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Purpose We evaluated whether longer term hemodialysis (HD) is associated with a higher incidence of vasoplegic syndrome (VS) after cardiac surgery. Methods This retrospective, single-center cohort study included 562 consecutive patients who underwent cardiac surgery in a tertiary hospital from January 2015 to December 2016. We assessed VS occurrence and its relationship with HD duration and other risk factors. To assess the effect of the HD duration on VS occurrence, we constructed ordinal variables: HD = 0 (non-HD), 0 < HD ≤ 5 (HD ≤ 5 years), 5 < HD ≤ 10, and 10 < HD. Results The overall mean (± standard deviation) age of patients was (73 ± 11) years, and there were 60.9% men. Forty-one patients (7.3%) were HD dependent. Cardiac surgeries included all coronary artery bypass graft procedures, all valvular procedures, and aortic surgery involving cardiopulmonary bypass (CPB). Sixty-six patients (10%) developed VS. Most preoperative patient characteristics were comparable between the VS and no-VS groups; a chronic HD status and a total CPB time of > 180 min were significantly more common in the VS group (P < 0.0001 and P = 0.02, respectively). Longer term HD significantly correlated with VS incidence (P < 0.0001). Ordinal variables for the HD duration and age and known risk factors for VS (preoperative use of angiotensin-converting enzyme inhibitors and beta-blockers, low left-ventricular ejection fraction, and CPB time > 180 min) were subjected to multivariate regression analysis. Long-term HD was identified as an independent predictor of VS (odds ratio, 2.29, 95% confidence interval, 1.66-3.18). Conclusions Longer term HD may be associated with a higher VS incidence after cardiac surgery. VS should be given attention after cardiac surgery in chronic HD-dependent patients.

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“…2,5 Commonly used treatments include fluid resuscitation, vasopressors, and methylene blue. One study 6 suggested that diuretics increase the risk of vasoplegia because diuretics-induced hyponatremia can blunt the arginine vasopressin response.…”

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confidence: 99%

“…The authors reported that the use of continuous-flow ventricular assist device support was associated with a higher incidence of vasoplegia and that no other variables were related to the incidence of vasoplegia. Tsiouris et al 6 investigated the risk factors, vulnerable patient populations, and the cost of postoperative vasoplegia. They demonstrated that vasoplegia is associated with worse survival postoperatively and is commonly seen in patients with heart failure.…”

mentioning

confidence: 99%

“…Beta-blockade has been reported to be protective against postoperative vasoplegia. Tsiouris et al 6 also reported that vasoplegia is associated with a prolongation of intensive care unit stay by 1.17 days, and the estimated cost was calculated to be $3,738 per patient ($1.4 billion annually in the United States). According to another retrospective study investigating patients undergoing orthotropic heart transplantation, 8 the preoperative use of angiotensin-converting enzyme inhibitors was not associated with an increased risk of vasoplegia, contrary to previous beliefs, and preoperative use of inotropic support conferred protection against it.…”

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confidence: 99%

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