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Wang X, Li Y, Ye J, Jiang F, Cheng Y, Chen X. The Prognostic Value of Johns Hopkins Hospital Nutrition Support Score in Older Patients Undergoing Cardiovascular Surgery. J Cardiothorac Vasc Anesth 2023; 37:1959-1966. [PMID: 37516594 DOI: 10.1053/j.jvca.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES Clarify the prognostic value of the Johns Hopkins Hospital Nutrition Support (JHHNS) score on clinical outcomes in older patients undergoing cardiovascular surgery with cardiopulmonary bypass (CPB). DESIGN A retrospective observational study. SETTING A teaching and university hospital and tertiary referral center. PARTICIPANTS The authors analyzed 328 older patients aged ≥65 who underwent cardiovascular surgery with CPB in 2020. INTERVENTIONS Malnutrition risk was identified by the JHHNS score calculated based on specific preoperative and intraoperative objective parameters. Patients were divided into low- and high-JHHNS groups. Early morbidity, including pneumonia, bacteremia, wound infection, cerebrovascular accident, gastrointestinal bleeding, acute kidney injury, delirium, requirement for extracorporeal membrane oxygenation, and readmission to the intensive care unit (ICU), were the primary outcome; whereas in-hospital mortality, length of ICU and hospital stay, duration of mechanical ventilation and short-term mortality were secondary outcomes. The independent risk factors for postoperative complications were analyzed by logistic regression analyses. MEASUREMENTS AND MAIN RESULTS The JHHNS score identified 21.0% of patients at risk for malnutrition. Patients in the high-JHHNS group had prolonged median length hospital stay (21 v 24 days, p = 0.002) and mechanical ventilation (13.0 v 16.0 hours, p = 0.038), and more patients in this subgroup stayed longer than 3 days in ICU (30.1% v 43.5%, p = 0.036). Besides, they experienced more postoperative complications (11.2% v 39.1%, p < 0.001). Furthermore, multivariate logistic regression analysis demonstrated that the JHHNS score independently predicted the risk of postoperative complications. No significant intergroup difference was observed for the short-term mortality. CONCLUSIONS The JHHNS score was an independent predictor for postoperative complications but did not significantly affect short-term mortality in older patients undergoing cardiovascular surgery with CPB.
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Affiliation(s)
- Xiaoqian Wang
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Yuan Li
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Jiaxin Ye
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Fengjuan Jiang
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Yongqing Cheng
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Xiaotian Chen
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
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Carmona-Luque MD, Gonzalez-Alvarez L, Guerrero Orriach JL. Identification of miRNAs as Biomarkers of Cardiac Protection in Non-Genetically Modified Primary Human Cardiomyocytes Exposed to Halogenated Hypnotics in an In Vitro Model of Transfection and Ischemia/Reperfusion: A New Model in Translational Anesthesia. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010064. [PMID: 36676014 PMCID: PMC9865153 DOI: 10.3390/life13010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/11/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Many clinical studies have identified some circulating micro-RNAs (miRNAs) as potential biomarkers with regard to the cardioprotective effects of halogenated agents administered perioperatively during myocardial conditioning procedures. However, there is a major methodological difficulty in identifying these potential miRNA targets in cardiac cells. METHODS We developed an in vitro protocol to analyze the differential expression of target miRNAs at the intracellular level in non-genetically modified primary human cardiomyocytes (HCMs) through their exposure to different hypnotic compounds (i.e., halogenated versus non-halogenated). For this purpose, we performed a validated in vitro model of "ischemia and reperfusion" with the transfection of specific miRNA mimics (MIMICs) designed to simulate naturally occurring mature miRNAs as a functional study. Afterwards, next-generation sequencing (NGS) was used to identify and quantify miRNAs and elucidate their function. The differences in miRNA expression between HCMs exposed to different hypnotic drugs, along with the prediction of functional miRNA targets, were assessed using a meticulous in-house bioinformatics pipeline in order to derive diagnostic biomarkers and possible therapeutic targets. CONCLUSION In brief, this methodological procedure was designed to investigate whether the cardioprotective effects of halogenated agents are a phenomenon mediated by either the activation or the suppression of miRNAs targeted by halogenated anesthetics.
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Affiliation(s)
- Maria Dolores Carmona-Luque
- Maimonides Institute of Biomedical Research in Cordoba (IMIBIC), 14004 Cordoba, Spain
- Cellular Therapy Unit, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Laura Gonzalez-Alvarez
- Institute of Biomedical Research in Malaga, 29010 Malaga, Spain
- Correspondence: (L.G.-A.); (J.L.G.O.)
| | - José Luis Guerrero Orriach
- Institute of Biomedical Research in Malaga, 29010 Malaga, Spain
- Department of Anesthesiology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain
- Department of Pharmacology and Pediatrics, School of Medicine, University of Malaga, 29010 Malaga, Spain
- Correspondence: (L.G.-A.); (J.L.G.O.)
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Stoppe C, Goetzenich A, Whitman G, Ohkuma R, Brown T, Hatzakorzian R, Kristof A, Meybohm P, Mechanick J, Evans A, Yeh D, McDonald B, Chourdakis M, Jones P, Barton R, Tripathi R, Elke G, Liakopoulos O, Agarwala R, Lomivorotov V, Nesterova E, Marx G, Benstoem C, Lemieux M, Heyland DK. Role of nutrition support in adult cardiac surgery: a consensus statement from an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:131. [PMID: 28583157 PMCID: PMC5460477 DOI: 10.1186/s13054-017-1690-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/02/2017] [Indexed: 12/25/2022]
Abstract
Nutrition support is a necessary therapy for critically ill cardiac surgery patients. However, conclusive evidence for this population, consisting of well-conducted clinical trials is lacking. To clarify optimal strategies to improve outcomes, an international multidisciplinary group of 25 experts from different clinical specialties from Germany, Canada, Greece, USA and Russia discussed potential approaches to identify patients who may benefit from nutrition support, when best to initiate nutrition support, and the potential use of pharmaco-nutrition to modulate the inflammatory response to cardiopulmonary bypass. Despite conspicuous knowledge and evidence gaps, a rational nutritional support therapy is presented to benefit patients undergoing cardiac surgery.
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Affiliation(s)
- Christian Stoppe
- Department of Intensive Care Medicine, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Andreas Goetzenich
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Glenn Whitman
- Cardiac Surgical Intensive Care, Johns Hopkins Hospital Baltimore, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Rika Ohkuma
- Cardiac Surgical Intensive Care, Johns Hopkins Hospital Baltimore, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Trish Brown
- Cardiac Surgical Intensive Care, Johns Hopkins Hospital Baltimore, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Roupen Hatzakorzian
- Department of Anesthesia, Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada
| | - Arnold Kristof
- Department of Microbiology and Immunology, McGill University Health Centre, Montreal, Canada
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Jefferey Mechanick
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adam Evans
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Yeh
- Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Bernard McDonald
- Division of Cardiac Anesthesiology and Critical Care Medicine, University of Ottawa Heart Institute, Ruskin Street H2410, Ottawa, ON, K1Y 4W7, Canada
| | - Michael Chourdakis
- Department of Medicine, Aristotle University of Thessaloniki, University Campus, Thessaloniki, 54124, Greece
| | - Philip Jones
- Departments of Anesthesia & Perioperative Medicine and Epidemiology & Biostatistics, University of Western Ontario, London, Canada
| | - Richard Barton
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ravi Tripathi
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Gunnar Elke
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus 12, 24105, Kiel, Germany
| | - Oliver Liakopoulos
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Ravi Agarwala
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Vladimir Lomivorotov
- Department of Anesthesiology and Intensive Care, Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Ekaterina Nesterova
- Department of Anesthesiology and Intensive Care Medicine, National Pirogov Surgical Medical Center, Moscow, Russia
| | - Gernot Marx
- Department of Intensive Care Medicine, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Carina Benstoem
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Margot Lemieux
- Department of Critical Care Medicine, Queen's University and Clinical Evaluation Research Unit, Angada 4, Kingston General Hospital, Kingston, ON, K7L 2V7, Canada
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen's University and Clinical Evaluation Research Unit, Angada 4, Kingston General Hospital, Kingston, ON, K7L 2V7, Canada
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