Use of cerebral oxygen saturation and hemoglobin concentration to predict acute kidney injury after cardiac surgery

Objective Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with significant morbidity and mortality. Near infrared spectroscopy (NIRS) is a noninvasive technique for real-time measurement of cerebral tissue oxygenation. The purpose of the present study was to evaluate the correlation of AKI with hemoglobin and regional cerebral oxygen saturation (rScO(2)) measured intraoperatively and postoperatively in patients undergoing cardiac surgery

Myocardial protection in adult Bland-White-Garland syndrome

Arsan, Sinan/0000-0002-0890-2506WOS: 000498300900001PubMed: 31765016

Preoperative Urinary Ph Is Associated With Acute Kidney Injury After Cardiac Surgery In Non-Diabetic Patients

Background: Acute kidney injury is a common complication of cardiac surgery that increases morbidity and mortality. The present study aims to analyze the association of pre-operative urinary pH with acute kidney injury after isolated coronary artery bypass graft surgery (CABG). Methods: We retrospectively reviewed the data of 270 adult non-diabetic patients who underwent isolated CABG surgery with normal renal function. The perioperative data of the patients included demographic data, laboratory findings, morbidity, and mortality. The patient population was divided into four groups: Group I, patients with preoperative urinary pH=5; Group II, patients with preoperative urinary pH=5.5; Group III, patients with preoperative urinary pH=6-6.5; and Group IV, patients with preoperative urinary pH >= 7.0. Kidney injury was interpreted according to the Kidney Disease: Improving Global Outcomes (KDIGO). Results: There were 108 patients (40%) in Group I, 44 patients (16.3%) in Group II, 78 patients (28.9%) in Group III, and 40 patients (14.8%) in Group IV. Postoperative acute kidney injury (AKI) occurred in 39 patients (36.1%) in Group I, 4 patients (9.1%) in Group II, and 2 patients (2,5%) in Group III. None of the patients developed AKI in Group IV. Renal replacement therapy was required in 8 patients (2.3%) (6 patients from Group I; 2 patients from Group II; P = .016). Thirty-day mortality occurred in 5 patients (1.9%) (5 patients from Group I; none from other groups; P = .017). All of the patients required renal replacement therapy. Logistic regression analysis revealing the presence of lower pH levels preoperatively was shown to be associated with increased incidence of postoperative AKI (OR: 0.193; 95% CI: 0.103-0.361; P < .001). Conclusion: Low preoperative urinary pH (<= 5.5) results in severe acute kidney injury and increases the rate of morbidity and mortality after isolated CABG.Wo

Preoperative Vitamin D Level is Associated with Postoperative Delirium After Cardiac Surgery in Patients Over 65 Years of Age

WOS: 000531064700002PubMed: 32524976Introduction: Delirium after cardiac surgery is a devastating and important complication. Delirium is defined as "disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment)." In this study, we analyzed the association of preoperative vitamin D levels and postoperative delirium after cardiac surgery in patients over 65 years. Materials and methods: We retrospectively reviewed the data of 212 adult patients above 65 years of age who underwent isolated coronary artery bypass graft surgery from January 2016 to January 2018. The mean age for Group I was 69.7 +/- 7.4 and Group II was 70.6 +/- 4.8 years. There were 112 female patients in Group I and 46 female patients in Group II. The patient population was divided into 2 groups based on preoperative serum vitamin D (25-hydroxyvitamin D [25-OHD]) levels (normal range of 25-75nmol/L). Group I included patients with preoperative serum 25-OHD level= 25nmol/L. Results: The incidence of delirium in this study was 30.2%. In this study, 138 patients (65.1%) had preoperative serum 25-OHD levels = 25 nmol/L. Preoperative serum 25-OHD levels were associated with postoperative delirium after coronary artery bypass graft surgery. Our retrospective study illustrated that a lower preoperative serum level of 25-OHD was associated with postoperative delirium. Our results showed that 65.1% of patients had preoperative serum 25-OHD levels <25 nmol/L, and this was associated with postoperative delirium. Conclusion: Vitamin D deficiency exacerbates delirium after coronary artery bypass surgery with cardiopulmonary bypass. Whether the effects of vitamin D deficiency during this event represent separate or interrelated activities with cardiopulmonary bypass is an important question to address and prospective randomized studies are necessary to confirm these results

Preoperative Vitamin D Level Predicts Operative Mortality After Cardiac Surgery

Objectives: The present study aimed to analyze the prognostic value of preoperative serum vitamin D level in patients who underwent coronary artery bypass graft (CABG) surgery. Materials and Methods: The data of 360 adult patients who underwent isolated CABG surgery were retrospectively reviewed. We reached the data of preoperative serum vitamin D [25-hydroxyvitamin D (25-OHD)] values of 305 patients. The patient population was divided into two groups based on preoperative serum 25-OHD levels with a normal range of 25-75 nmol/L (group I: patients with preoperative serum 25-OHD level <25 nmol/L and group II: patients with preoperative serum 25-OHD level ?25 nmol/L). The effect of preoperative 25-OHD level on operative mortality (mortality which occurred during the first 30 days after the operation) was determined using regression analysis and the results were expressed as Odds ratio (OR) with a 95% confidence interval (CI). A p value <0.05 was considered statistically significant. Results: In the present study, operative mortality was 3.93% (n=12). One hundred and fifty seven patients (51.5%) had serum 25-OHD levels <25 nmol/L. The mean serum 25-OHD levels were significantly lower in females than in males (p<0.001). On logistic regression analysis, preoperative serum 25-OHD level was found to be independently associated with operative mortality (OR: 0.201, 95% CI: 0.043- 0.935; p=0.041). Conclusion: The presence of vitamin D deficiency seems to be an independent predictor of operative mortality after cardiac surgery in this retrospective study; however, prospective randomized trials are warranted to clarify the effect of preoperative vitamin D supplementation on postoperative outcomes in cardiac surgical patients

Subclinical Hypothyroidism Increases the Requirement of Renal Replacement Therapy After Cardiac Surgery

WOS:000557211400008PubMed: 32726204Background: Subclinical or biochemically diagnosed hypothyroidism (SCH) is defined as an elevated serum thyroid-stimulating hormone (TSH) with normal free thyroxine (FT4) levels. Thyroid hormones play a major role in the normal function of the heart and vascular physiology. Atherosclerosis, increased systemic vascular resistance, and decreased arterial compliance are common pathophysiological changes that may occur in hypothyroidism. Acute kidney injury (AKI) is one of the devastating complications after cardiac surgery. Age, diabetes mellitus (DM), preexisting renal dysfunction, hypertension, impaired left ventricular function, and severe arteriosclerosis are the major risk factors for the development of AKI. The purpose of the current study was to analyze the influence of SCH on AM and the requirement of renal replacement therapy (RRT) after isolated coronary artery bypass graft surgery (CABG). Methods: We retrospectively reviewed the prospectively collected data of 336 adult patients who underwent isolated CABG surgery with normal renal function (baseline serum creatinine value <1.4 mg/dL) from January 2017 to January 2019. The patients were divided into two groups either having the diagnosis of SCH (Group I, N = 47) or not (Group II, N = 289). SCH was diagnosed based on preoperative serum TSH and FT4 levels. Kidney injury was interpreted, according to RIFLE classification. The effect of SCH on AM and the need for RRT after CABG was determined using logistic regression analysis and the results were expressed as odds ratio (OR) with a 95% confidence interval (CI). A P value < .05 was considered statistically significant. Results: Subclinical hypothyroidism was diagnosed in 14% of all patients. Postoperative AKI occurred in 15 patients (31.9%) in Group I, whereas there were 42 patients (14.5%) in Group II. On logistic regression analysis, the presence of SCH was shown to be associated with an increased incidence of postoperative AKI (OR, 0.363; 95% CI, 0.181-0.727; P = .004). RRT was used in 2.97% of patients (seven patients in Group I and three patients in Group II, P < .001). The 30-day mortality was 2.1%. Conclusion: The presence of SCH seems to be associated with an increased incidence of AKI and increased requirement for RRT after cardiac surgery