PMID- 21334918
OWN - NLM
STAT- MEDLINE
DCOM- 20120207
LR  - 20110815
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 40
IP  - 3
DP  - 2011 Sep
TI  - Logistic risk model predicting postoperative renal failure requiring dialysis in 
      cardiac surgery patients.
PG  - 701-7
LID - 10.1016/j.ejcts.2010.12.051 [doi]
AB  - OBJECTIVE: Renal failure requiring dialysis represents a serious complication 
      following cardiac surgery. This study was designed to determine the incidence and 
      predictors of renal failure requiring dialysis in a contemporary patient 
      population. We also aimed to create a model based on these risk factors that 
      could serve as a tool for the prediction of renal failure requiring dialysis. 
      METHODS: Between October 2007 and June 2009, 2511 consecutive patients (mean age 
      69 +/- 12 years, 68% male) underwent on-pump cardiac surgery at our institution. 
      The main outcome investigated was postoperative renal failure requiring temporary 
      or permanent dialysis. Other postoperative parameters included in the analysis 
      were hospital mortality, major morbidity, length of hospital stay, and discharge 
      condition. Predictors of renal failure requiring dialysis were determined using 
      multivariate regression models. The discriminatory power was evaluated by 
      calculating the area under the receiver-operating-characteristic (ROC) curves 
      (c-statistic). RESULTS: Renal failure requiring dialysis occurred in 3.9% (n = 
      98) of patients. Hospital mortality among patients with dialysis-dependent renal 
      failure was 37.8% compared with a mortality rate of 1.3% in patients without this 
      complication (p<0.001). Multivariate analysis revealed pulmonary hypertension 
      (odds ratio (OR) = 8.1), preoperative renal dysfunction (creatinine >2.0 mg dl(-)(1)) 
      (OR=4.6), cardiopulmonary bypass (CPB) time >120 min (OR=3.9), peripheral 
      vascular disease (OR = 3.1), previous myocardial infarction (OR=3.0), atrial 
      fibrillation (OR = 2.8), age > 75 years (OR = 2.6), New York Heart Association 
      (NYHA) class IV (OR = 2.5), and diabetes (OR = 2.0) as independent predictors for 
      postoperative renal failure requiring dialysis. A logistic equation including the 
      coefficients of the regression analysis accurately predicted individual patient's 
      risk for the occurrence of renal failure requiring dialysis (area under the ROC 
      curve: 0.829, 95% confidence interval 0.78-0.86). CONCLUSIONS: Renal failure 
      requiring dialysis remains a serious complication, particularly in patients with 
      pulmonary hypertension and previous renal dysfunction. Our logistic risk model 
      allows the prediction of renal failure requiring dialysis, based on the 
      individual presentation of risk factors and, therefore, helps to determine the 
      perioperative risk in cardiac surgery patients.
CI  - Copyright (c) 2011 European Association for Cardio-Thoracic Surgery. Published by 
      Elsevier B.V. All rights reserved.
FAU - Rahmanian, Parwis B
AU  - Rahmanian PB
AD  - Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne, 
      Cologne, Germany. parwis.rahmanian@uk-koeln.de
FAU - Kwiecien, Grzegorz
AU  - Kwiecien G
FAU - Langebartels, Georg
AU  - Langebartels G
FAU - Madershahian, Navid
AU  - Madershahian N
FAU - Wittwer, Thorsten
AU  - Wittwer T
FAU - Wahlers, Thorsten
AU  - Wahlers T
LA  - eng
PT  - Journal Article
DEP - 20110221
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
CIN - Eur J Cardiothorac Surg. 2011 Sep;40(3):708-9. PMID: 21454087
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiac Surgical Procedures/*adverse effects
MH  - Cardiopulmonary Bypass/adverse effects
MH  - Epidemiologic Methods
MH  - Female
MH  - Germany/epidemiology
MH  - Humans
MH  - Hypertension, Pulmonary/complications/epidemiology
MH  - Kidney/physiopathology
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Renal Dialysis
MH  - Renal Insufficiency/epidemiology/*etiology/therapy
MH  - Treatment Outcome
EDAT- 2011/02/22 06:00
MHDA- 2012/02/09 06:00
CRDT- 2011/02/22 06:00
PHST- 2010/08/30 00:00 [received]
PHST- 2010/12/13 00:00 [revised]
PHST- 2010/12/18 00:00 [accepted]
PHST- 2011/02/22 06:00 [entrez]
PHST- 2011/02/22 06:00 [pubmed]
PHST- 2012/02/09 06:00 [medline]
AID - S1010-7940(10)01150-4 [pii]
AID - 10.1016/j.ejcts.2010.12.051 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2011 Sep;40(3):701-7. doi: 10.1016/j.ejcts.2010.12.051. 
      Epub 2011 Feb 21.