PMID- 20172909
OWN - NLM
STAT- MEDLINE
DCOM- 20100811
LR  - 20220310
IS  - 1569-9285 (Electronic)
IS  - 1569-9285 (Linking)
VI  - 10
IP  - 5
DP  - 2010 May
TI  - Effect of mild renal dysfunction (s-crea 1.2-2.2 mg/dl) on presentation 
      characteristics and short- and long-term outcomes of on-pump cardiac surgery 
      patients.
PG  - 777-82
LID - 10.1510/icvts.2009.231068 [doi]
AB  - OBJECTIVES: The objective of this study is to evaluate differences in patient 
      presentation and short- and long-term outcomes between patients dichotomized by 
      the level of preoperative s-creatinine (s-crea) without renal failure and to use 
      EuroSCORE (ES) risk stratification for validating differences and for predictive 
      purposes. METHODS: A thousand consecutive cardiac surgery patients from January 
      1999 through May 2000 were analyzed. Patients with off-pump surgery or s-crea 
      >200 micromol/l (>2.2 mg/dl) were excluded leaving 885 patients for analysis. 
      Group 1 (n=703) had s-crea 0.5-1.2 mg/dl and Group 2 (n=182) had elevated s-crea 
      1.3-2.2 mg/dl but no renal insufficiency. RESULTS: Group 2 patients were older 
      (P<0.0001), had a higher percentage of males (P=0.008), had lower left 
      ventricular ejection fraction (LVEF) (P=0.001), had higher New York Heart 
      Association (NYHA) classification (P<0.0001), had more diabetics (P=0.001) and 
      had more patients with a history of congestive heart failure (CHF) (P<0.0001). 
      Both additive ES (AES) and logistic ES (LES) variables were higher in Group 2 
      patients, AES 8.45+/-4.28% vs. 6.05+/-3.80% (P<0.0001) and LES 17.7+/-19.1% vs. 
      9.57+/-13.3% (P<0.0001). Proportions of emergency operations and use of 
      intra-aortic balloon pulsation (IABP) support did not differ. There were more 
      coronary artery bypass grafting (CABG) with or without concomitant procedures in 
      Group 1 but otherwise the procedures performed were similar. Cardiopulmonary 
      bypass (CPB) times did not differ (P=0.1). Operative mortality was similar 
      (P=0.06) but hospital mortality was higher in Group 2: 19/10.4% vs. 25/3.6% 
      (P<0.0001), odds ratio (OR) 3.16. Total length of stay (LOS) and length of stay 
      in the postoperative intensive care unit (ICU) did not differ. Postoperative 
      renal failure (PORF) (s-crea increase to >2.25 mg/dl or >200 micromol/l) 
      developed in 38/4.5% patients in Group 1 and in 41/22.5% patients in Group 2 
      (P<0.0001), OR=5.08. Follow-up all-cause mortality was higher in Group 2: 
      68/37.4% vs. 167/23.8% (P<0.0001), OR=1.91. Both ES definitions predicted 
      hospital mortality, LOS, ICU, PORF and long-term mortality well, while increased 
      s-crea predicted PORF and long-term mortality in both groups. CONCLUSIONS: Mild 
      increase in s-crea is a marker for patients with increased cardiac risk factors 
      and the risk for poor outcomes. Both ES definitions are highly predictive of the 
      outcomes.
CI  - 2010 Published by European Association for Cardio-Thoracic Surgery. All rights 
      reserved.
FAU - Jyrala, Aarne
AU  - Jyrala A
AD  - Heart Institute at Good Samaritan Hospital, Department of Cardiothoracic Surgery, 
      Los Angeles, USA. lathoracic@hotmail.com
FAU - Weiss, Robert E
AU  - Weiss RE
FAU - Jeffries, Robin A
AU  - Jeffries RA
FAU - Kay, Gregory L
AU  - Kay GL
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20100219
PL  - England
TA  - Interact Cardiovasc Thorac Surg
JT  - Interactive cardiovascular and thoracic surgery
JID - 101158399
RN  - AYI8EX34EU (Creatinine)
SB  - IM
MH  - Acute Kidney Injury/*diagnosis/mortality
MH  - Aged
MH  - Cohort Studies
MH  - Coronary Artery Bypass/methods/*mortality
MH  - Coronary Stenosis/diagnostic imaging/mortality/*surgery
MH  - Creatinine/*blood
MH  - Female
MH  - Follow-Up Studies
MH  - Glomerular Filtration Rate
MH  - Humans
MH  - Kidney Function Tests
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Postoperative Care/methods
MH  - Postoperative Complications/diagnosis/*mortality
MH  - Predictive Value of Tests
MH  - Preoperative Care/methods
MH  - Probability
MH  - Radiography
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Survival Analysis
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2010/02/23 06:00
MHDA- 2010/08/12 06:00
CRDT- 2010/02/23 06:00
PHST- 2010/02/23 06:00 [entrez]
PHST- 2010/02/23 06:00 [pubmed]
PHST- 2010/08/12 06:00 [medline]
AID - icvts.2009.231068 [pii]
AID - 10.1510/icvts.2009.231068 [doi]
PST - ppublish
SO  - Interact Cardiovasc Thorac Surg. 2010 May;10(5):777-82. doi: 
      10.1510/icvts.2009.231068. Epub 2010 Feb 19.