Is preoperative serum creatinine a reliable indicator of outcome in patients undergoing coronary artery bypass surgery?

ObjectiveEvaluating renal function by calculating creatinine clearance as an alternative measure to serum creatinine may give a better estimation of postoperative renal function in patients undergoing coronary artery bypass grafting.MethodsUsing our database, we conducted a retrospective review of the records of all 11,884 patients aged 21 years or older undergoing pure bypass grafting who required cardiopulmonary bypass. Preoperative renal function was categorized as normal renal function (serum creatinine ≤1.1 mg/dL and creatinine clearance > 60 mL/min), occult renal insufficiency (serum creatinine ≤ 1.1 mg/dL and creatinine clearance ≤ 60 mL/min), mild renal insufficiency (1.1 mg/dL < serum creatinine ≤ 1.5 mg/dL and creatinine clearance ≤ 60 mL/min) or moderate renal insufficiency (serum creatinine > 1.5 mg/dL and creatinine clearance ≤ 60 mL/min).ResultsOut of 11,884 patients in the sample, 7856 (66.1%) had normal renal function, and 706 (5.9%) had occult renal insufficiency. The rate of postoperative mortality, renal failure, atrial fibrillation, prolonged ventilation, intra-aortic balloon pump usage, and prolonged hospital stay (>7 days) was higher in patients with occult renal insufficiency than in the normal group in univariable analysis. Multivariable logistic regression analysis demonstrated that patients with occult renal insufficiency compared with the group with normal renal function were at higher risk for mortality (odds ratio = 2.59, 95% confidence interval 1.15–5.86; P = .022) and prolonged hospital stay (>7 d) (odds ratio = 1.30, 95% confidence interval 1.08–1.57; P = .005).ConclusionsTo identify higher-risk patients requiring special intensive care, and in whom new interventions can be performed to improve outcome, we recommend the preoperative calculation of creatinine clearance, especially in older women with a lower body mass index

Behavioral strategies in the students from different countries: literary review and HSEEU „UMSA” experience

Coping strategies in the students are in the focus of the scientists attention in various countries. There are such works in China (about sense of coherence and associated factors) , Pakistan (94% of guys have experienced stress, girls reported more symptoms) , Taiwan (during competitive entrance exam in nursing students) , Hong Kong (in baccalaureate nursing students in clinical practice with emphasizing that senior students possessed higher stress and the ones with no religious belief used avoidance strategies more) , the bachelors in the USA [5, p. 26-30], Iran (with programs creating to medical students coping with stress) and without them , about problem-focused coping in undergraduate interns to achieve satisfaction with their clinical experience about coping strategies in occupational therapy students , coping strategies for avian influenza among the 1st year medical students and interns in Tehran , in nursing students , Internet addiction and coping with it in Guilan medical students in Iran emphasizing that approximately 50% of students in Guilan and Mashhad , 21% in Kerman of the students belong to the problematic users of Internet

Effect of pentoxifylline on preventing acute kidney injury after cardiac surgery by measuring urinary neutrophil gelatinase - associated lipocalin

Abstract Background Based on Acute Kidney Injury Network (AKIN) criteria, we considered acute kidney injury (AKI) as an absolute increase in the serum creatinine (sCr) level of more than or equal to 0.3 mg/dl or 50%. The introduction of Urinary neutrophil gelatinase-associated lipocalin (UNGAL) has conferred earlier diagnosis of AKI. Pentoxifylline (PTX), a non-specific phosphodiesterase inhibitor, can suppress the production of some factors of inflammatory response and presumably prevent AKI. We examined the PTX on the development of AKI in cardiac surgery patients by measuring the levels of UNGAL. Materials and methods We performed a double blind randomized clinical trial, enrolling 28 consecutive patients undergoing elective coronary artery bypass graft (CABG) surgery. Patients were divided into two groups, one to receive PTX 5 mg/kg intravenous bolus injection, followed by 1.5 mg/kg/h continuous intravenous infusion until 3 hours after cessation of CPB and the other group received placebo. UNGAL was measured before, 3 and 24 hours after surgery. In addition serum creatinine was measured before and 24, 48, 72 and 96 hours after surgery and C-reactive protein (CRP) only 24 hours postoperatively. Results Both groups did not differ in demographic and baseline characteristics. 12 patients developed AKI 48 hours after surgery; 5 of them were in the intervention group and 7 in the control group (p= 0.445). There was an increase of UNGAL in both groups postoperatively, although not significant. Mean sCr was significantly increased in the control group at 24 and 48 hours after surgery (24-h mean: 0.79 ± 0.18 mg/dl vs. 1.03 ± 0.43 mg/dl, P value = 0.02; 48-h mean: 1.17 ± 0.24 mg/dl vs. 0.98 ± 0.20 mg/dl, P value = 0.03, respectively). PTX had a positive effect in preventing AKI reflecting in changes in sCr, and the increase of UNGAL was consistent with the emergence of AKI (Pearson's correlation = 0.30). Conclusion Our study demonstrates a weak correlation between UNGAL and sCr after cardiac surgery. The rise of UNGAL in these patients may be reduced by administration of PTX although we did not show significance. PTX could reduce the occurrence of AKI as determined by attenuation of sCr rise without causing hemodynamic instability or increased bleeding. Overall, we suggest future studies with larger sample sizes to elucidate this effect and determine the different aspects of administrating PTX. Trial Registration ISRCTN: IRCT138807302622N1</p