PMID- 19660421
OWN - NLM
STAT- MEDLINE
DCOM- 20091027
LR  - 20220318
IS  - 1097-685X (Electronic)
IS  - 0022-5223 (Linking)
VI  - 138
IP  - 4
DP  - 2009 Oct
TI  - Preoperative anemia in patients undergoing coronary artery bypass grafting 
      predicts acute kidney injury.
PG  - 965-70
LID - 10.1016/j.jtcvs.2009.05.013 [doi]
AB  - OBJECTIVES: Recent authoritative studies suggested that low preoperative 
      hemoglobin concentration may affect cardiac surgery outcomes. This study aimed, 
      primarily, to investigate whether preoperative anemia is an independent 
      determinant of adverse events after coronary artery bypass grafting and, 
      secondarily, to evaluate the potential dose responsiveness between anemia 
      severity and primary end points. METHODS: This single-center prospective study 
      investigated 1214 consecutive patients undergoing coronary artery bypass grafting 
      between January 2004 and June 2007, collecting 100 variables per patient. In 1047 
      patients (median age 64 years, 18.8% female, 38.9% diabetic, 31.9% 
      urgent/emergency, 15.3% with low preoperative left ventricular ejection fraction) 
      who underwent on-pump procedures and received no preoperative transfusion, the 
      prevalence of preoperative anemia (according to World Health Organization 
      definition) and its unadjusted and adjusted relationships with in-hospital death, 
      cardiac morbidity, and acute kidney injury (AKI-RIFLE [Risk, Injury, Failure, 
      Loss, End-stage kidney disease] criteria) were obtained. RESULTS: The prevalence 
      of preoperative anemia was 28%. In-hospital death averaged 3.9%, cardiac 
      morbidity 7.3%, and acute kidney injury 4%. Unadjusted odds ratios (Ors) for 
      in-hospital death, cardiac morbidity, and acute kidney injury were 3.8 (95% 
      confidence interval [CI] 2.0-7.3), 1.7 (95% CI 1.1-2.8), and 4.0 (95% CI 
      2.1-7.6), respectively. Adjusting for anemia in confounders proved an independent 
      predictor of acute kidney injury (OR 2.06; 95% CI 1.14-3.70), whereas the cardiac 
      morbidity and in-hospital mortality were independently predicted by kidney 
      function. No dose-response relationship emerged between anemia severity and acute 
      kidney injury. CONCLUSIONS: Preoperative anemia is independently associated with 
      acute kidney injury after coronary artery bypass grafting. Further studies are 
      warranted to determine whether preoperative low hemoglobin concentration is a 
      marker of severity of illness or a modifiable risk factor.
FAU - De Santo, Luca
AU  - De Santo L
AD  - Department of Cardiac Surgery, University of Foggia, Foggia, Italy. 
      luca.desanto@ospedalemonaldi.it
FAU - Romano, Gianpaolo
AU  - Romano G
FAU - Della Corte, Alessandro
AU  - Della Corte A
FAU - de Simone, Vincenzo
AU  - de Simone V
FAU - Grimaldi, Francesco
AU  - Grimaldi F
FAU - Cotrufo, Maurizio
AU  - Cotrufo M
FAU - de Feo, Marisa
AU  - de Feo M
LA  - eng
PT  - Journal Article
DEP - 20090701
PL  - United States
TA  - J Thorac Cardiovasc Surg
JT  - The Journal of thoracic and cardiovascular surgery
JID - 0376343
RN  - 0 (Hemoglobins)
SB  - IM
MH  - Acute Kidney Injury/*etiology/physiopathology
MH  - Aged
MH  - Anemia/blood/*complications
MH  - Blood Transfusion
MH  - Coronary Artery Bypass/*adverse effects
MH  - Female
MH  - Glomerular Filtration Rate
MH  - Hemoglobins/analysis
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Risk Factors
EDAT- 2009/08/08 09:00
MHDA- 2009/10/29 06:00
CRDT- 2009/08/08 09:00
PHST- 2009/01/02 00:00 [received]
PHST- 2009/04/08 00:00 [revised]
PHST- 2009/05/15 00:00 [accepted]
PHST- 2009/08/08 09:00 [entrez]
PHST- 2009/08/08 09:00 [pubmed]
PHST- 2009/10/29 06:00 [medline]
AID - S0022-5223(09)00715-6 [pii]
AID - 10.1016/j.jtcvs.2009.05.013 [doi]
PST - ppublish
SO  - J Thorac Cardiovasc Surg. 2009 Oct;138(4):965-70. doi: 
      10.1016/j.jtcvs.2009.05.013. Epub 2009 Jul 1.