Biomarkers and prognosis in cardiac surgery in the ICU

In this thesis the research of the role of new biomarkers in prognostic models in Cardiac surgery patients in the ICU is presented. The conclusion is that biomarkers, and especially nt-Pro-ADM, can improve the accuracy of the EuroScore model and predict mortality equally good as the APACHE-IV model. A critical appraisal compares likewise studies with the studies published in the thesis. Also, the relation between genetic polymorphisms and serum levels of the biomarkers is investigated leading to the conclusion that for procalcitonin (PCT) serum levels depend on the genetic profile. LUMC / Geneeskund

The predictive value of TIMP-2 and IGFBP7 for kidney failure and 30-day mortality after elective cardiac surgery

Acute kidney injury (AKI) is an important risk factor for chronic kidney disease, renal replacement therapy (RRT), and mortality. However, predicting AKI with currently available markers remains problematic. We assessed the predictive value of urinary tissue inhibitor of metalloprotease-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) regarding the need for RRT, and 30-day mortality, in elective cardiac surgery patients. In 344 elective cardiac surgery patients, we measured urinary TIMP-2 and IGFBP7 and serum creatinine at baseline and directly after surgery. Discrimination of both urinary biomarkers was assessed by the C-statistic. Model improvement for each biomarker when added to a basic model containing serum creatinine and duration of surgery was tested by the net-reclassification index (cf-NRI) and integrated discrimination index (IDI). At baseline, mean age was 66 years and 67% were men. Of all patients, 22 required RRT following surgery. IGFBP7 pre- and post-surgery and change in TIMP-2 during surgery predicted RRT with a C-statistic of about 0.80. However, a simple model including baseline serum creatinine and duration of surgery had a C-statistic of 0.92, which was improved to 0.93 upon addition of post-surgery TIMP-2 or IGFBP7, with statistically significant cf-NRIs but non-significant IDIs. Post-surgery TIMP-2 and IGFBP predicted 30-day mortality, with C-statistics of 0.74 and 0.80. In conclusion, in elective cardiac surgery patients, pre- and peri-operative clinical variables were highly discriminating about which patients required RRT after surgery. Nonetheless, in elective cardiac surgery patients, urinary TIMP-2 and IGFBP7 improved prediction of RRT and 30-day mortality post-surgery.Perioperative Medicine: Efficacy, Safety and Outcome (Anesthesiology/Intensive Care

Biomarkers and prognosis in cardiac surgery in the ICU

In this thesis the research of the role of new biomarkers in prognostic models in Cardiac surgery patients in the ICU is presented. The conclusion is that biomarkers, and especially nt-Pro-ADM, can improve the accuracy of the EuroScore model and predict mortality equally good as the APACHE-IV model. A critical appraisal compares likewise studies with the studies published in the thesis. Also, the relation between genetic polymorphisms and serum levels of the biomarkers is investigated leading to the conclusion that for procalcitonin (PCT) serum levels depend on the genetic profile. </p

Blood pressure augmentation to supra normal levels to improve oxygenation in COVID-19

Perioperative Medicine: Efficacy, Safety and Outcome (Anesthesiology/Intensive Care

Calculation of the mechanical power for pressure-controlled ventilation: a response

Perioperative Medicine: Efficacy, Safety and Outcome (Anesthesiology/Intensive Care

Single-Nucleotide Polymorphisms in the CALCA Gene Are Associated with Variation of Procalcitonin Concentration in Patients Undergoing Cardiac Surgery

Cardiolog

Mortality prediction by SOFA score in ICU-patients after cardiac surgery: comparison with traditional prognostic-models

Background There are many prognostic models and scoring systems in use to predict mortality in ICU patients. The only general ICU scoring system developed and validated for patients after cardiac surgery is the APACHE-IV model. This is, however, a labor-intensive scoring system requiring a lot of data and could therefore be prone to error. The SOFA score on the other hand is a simpler system, has been widely used in ICUs and could be a good alternative. The goal of the study was to compare the SOFA score with the APACHE-IV and other ICU prediction models. Methods We investigated, in a large cohort of cardiac surgery patients admitted to Dutch ICUs, how well the SOFA score from the first 24 h after admission, predict hospital and ICU mortality in comparison with other recalibrated general ICU scoring systems. Measures of discrimination, accuracy, and calibration (area under the receiver operating characteristic curve (AUC), Brier score, R-2, C-statistic) were calculated using bootstrapping. The cohort consisted of 36,632 Patients from the Dutch National Intensive Care Evaluation (NICE) registry having had a cardiac surgery procedure for which ICU admission was necessary between January 1st, 2006 and June 31st, 2018. Results Discrimination of the SOFA-, APACHE-IV-, APACHE-II-, SAPS-II-, MPM24-II - models to predict hospital mortality was good with an AUC of respectively: 0.809, 0.851, 0.830, 0.850, 0.801. Discrimination of the SOFA-, APACHE-IV-, APACHE-II-, SAPS-II-, MPM24-II - models to predict ICU mortality was slightly better with AUCs of respectively: 0.809, 0.906, 0.892, 0.919, 0.862. Calibration of the models was generally poor. Conclusion Although the SOFA score had a good discriminatory power for hospital- and ICU mortality the discriminatory power of the APACHE-IV and SAPS-II was better. The SOFA score should not be preferred as mortality prediction model above traditional prognostic ICU-models