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Kato T, Nakajima T, Fukuda T, Shibasaki I, Hasegawa T, Ogata K, Ogawa H, Hirota S, Ohashi H, Saito S, Takei Y, Tezuka M, Seki M, Kuwata T, Sakuma M, Abe S, Toyoda S, Inoue T, Fukuda H. Preoperative Serum GDF-15, Endothelin-1 Levels, and Intraoperative Factors as Short-Term Operative Risks for Patients Undergoing Cardiovascular Surgery. J Clin Med 2021; 10:jcm10091960. [PMID: 34063283 PMCID: PMC8125127 DOI: 10.3390/jcm10091960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: The Society of Thoracic Surgeons (STS) risk score is widely used for the risk assessment of cardiac surgery. Serum biomarkers such as growth differentiation factor-15 (GDF-15) and endothelin-1 (ET-1) are also used to evaluate risk. We investigated the relationships between preoperative serum GDF-15, ET-1 levels, and intraoperative factors and short-term operative risks including acute kidney injury (AKI) for patients undergoing cardiovascular surgery. Methods: In total, 145 patients were included in this study (92 males and 53 females, age 68.4 ± 13.2 years). The preoperative STS score was determined, and the serum GDF-15 and ET-1 levels were measured by ELISA. These were related to postoperative risks, including AKI, defined according to the Acute Kidney Injury Network (AKIN) classification criteria. Results: AKI developed in 23% of patients. The GDF-15 and ET-1 levels correlated with the STS score. The STS score and GDF-15 and ET-1 levels all correlated with preoperative eGFR, Alb, Hb, and BNP levels; perioperative data (urine output); ICU stay period; and postoperative admission days. Patients with AKI had longer circulatory pulmonary bypass (CPB) time, and male patients with AKI had higher ET-1 levels than those without AKI. In multivariable logistic regression analysis, the preoperative ET-1 level and CPB time were the independent determinants of AKI, even adjusted by age, sex, and BMI. The preoperative GDF-15 level, CPB time, and RCC transfusion were independent determinants of 30-day mortality plus morbidity. Conclusion: Preoperative GDF-15 and ET-1 levels as well as intraoperative factors such as CPB time may be helpful to identify short-term operative risks for patients undergoing cardiovascular surgery.
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Affiliation(s)
- Takashi Kato
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Toshiaki Nakajima
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.S.); (S.A.); (S.T.); (T.I.)
- Department of Medical KAATSU Training, Dokkyo Medical University, Tochigi 321-0293, Japan;
- Correspondence:
| | - Taira Fukuda
- Department of Liberal Arts and Human Development, Kanagawa University of Human Services, Kanagawa 238-8522, Japan;
| | - Ikuko Shibasaki
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Takaaki Hasegawa
- Department of Medical KAATSU Training, Dokkyo Medical University, Tochigi 321-0293, Japan;
| | - Koji Ogata
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Hironaga Ogawa
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Shotaro Hirota
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Hirotaka Ohashi
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Shunsuke Saito
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Yusuke Takei
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Masahiro Tezuka
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Masahiro Seki
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Toshiyuki Kuwata
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
| | - Masashi Sakuma
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.S.); (S.A.); (S.T.); (T.I.)
| | - Shichiro Abe
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.S.); (S.A.); (S.T.); (T.I.)
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.S.); (S.A.); (S.T.); (T.I.)
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.S.); (S.A.); (S.T.); (T.I.)
| | - Hirotsugu Fukuda
- Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.K.); (I.S.); (K.O.); (H.O.); (S.H.); (H.O.); (S.S.); (Y.T.); (M.T.); (M.S.); (T.K.); (H.F.)
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Brown JR, Thiessen-Philbrook H, Goodrich CA, Bohm AR, Alam SS, Coca SG, McArthur E, Garg AX, Parikh CR. Are Urinary Biomarkers Better Than Acute Kidney Injury Duration for Predicting Readmission? Ann Thorac Surg 2019; 107:1699-1705. [PMID: 30880140 PMCID: PMC6743318 DOI: 10.1016/j.athoracsur.2019.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/10/2019] [Accepted: 02/04/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication of cardiac surgery. Postprocedural AKI is a risk factor for 30-day readmission. We sought to examine the association of AKI and kidney injury biomarkers with readmission after cardiac surgery. METHODS Patients alive at discharge who underwent cardiac surgery from the Translational Research Investigating Biomarker Endpoints-AKI cohort were enrolled from six medical centers in the United States and Canada. AKI duration was defined as the total number of days AKI was present during index admission (no AKI, 1-2, 3-6, and 7+ days). Preoperative and postoperative urinary levels were collected for interleukin-18, neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, liver-fatty-acid-binding protein, cystatin C, microalbumin, creatinine, and albumin-to-creatinine ratio. Readmission and death events were identified through US (Medicare) and Canadian administrative databases at 30 days and 365 days after discharge. RESULTS Of 968 patients 15.9% were readmitted or died within 30 days of discharge and 35.9% were readmitted or died within 365 days. AKI duration of 3 to 6 days was significantly associated with 30-day readmission or death (adjusted odds ratio, 1.82%; 95% confidence interval, 1.08-3.05). Patients with AKI duration ≥ 7 days had increased odds of readmission or death at both 30 days (adjusted odds ratio, 2.49%; 95% confidence interval, 1.15-5.43) and 365 days (adjusted odds ratio, 3.67%; 95% confidence interval, 1.73-7.79). Urinary biomarkers had no association with readmission and death. CONCLUSIONS AKI duration ≥ 3 days, and not kidney biomarkers, was strongly associated with readmission or death. These clinical outcomes are potentially due to cardiovascular or hemodynamic causes rather than intrinsic injury to the kidney parenchyma.
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Affiliation(s)
- Jeremiah R Brown
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
| | | | - Christine A Goodrich
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
| | - Andrew R Bohm
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
| | - Shama S Alam
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
| | - Steven G Coca
- Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Amit X Garg
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Chirag R Parikh
- Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Abstract
Acute kidney injury (AKI) is a common and severe complication after cardiac
surgery. Currently, a series of novel biomarkers have favored the assessment of
AKI after cardiac surgery in addition to the conventional indicators. The
biomartkers, such as urinary liver fatty acid binding protein (L-FABP), urinary
neutrophil gelatinase-associated lipocalin (NGAL), serum L-FABP, heart-type
FABP, kidney injury molecule 1 (KIM-1), and interleukin-18 were found to be
significantly higher in patients who developed AKI after cardiac surgery than
those who did not. Apart from urinary interleukin-18, the novel biomarkers have
been recognized as reliable indicators for predicting the diagnosis, adverse
outcome, and even mortality of AKI after cardiac surgery. The timing of the
renal replacement therapy is a significant predictor relating to patients’
prognoses. In patients with AKI after cardiac surgery, renal replacement therapy
should be performed as early as possible in order to achieve promising outcomes.
In children, AKI after cardiac surgery can be managed with peritoneal dialysis.
AKI after cardiac surgery has received extensive attention as it may increase
early mortality and impact long-term survival of patients as well. The purpose
of this article was to analyze the changes of the pertinent biomarkers, to
explore the related risk factors leading to the occurrence of AKI after cardiac
surgery, and to provide a basis for the clinical prevention and reduction of
AKI.
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Affiliation(s)
- Shi-Min Yuan
- Fujian Medical University Teaching Hospital The First Hospital of Putian Putian Fujian Province People's Republic of China Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, People's Republic of China
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Liu X, Ye Y, Mi Q, Huang W, He T, Huang P, Xu N, Wu Q, Wang A, Li Y, Yuan H. A Predictive Model for Assessing Surgery-Related Acute Kidney Injury Risk in Hypertensive Patients: A Retrospective Cohort Study. PLoS One 2016; 11:e0165280. [PMID: 27802302 PMCID: PMC5089779 DOI: 10.1371/journal.pone.0165280] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/10/2016] [Indexed: 11/18/2022] Open
Abstract
Background Acute kidney injury (AKI) is a serious post-surgery complication; however, few preoperative risk models for AKI have been developed for hypertensive patients undergoing general surgery. Thus, in this study involving a large Chinese cohort, we developed and validated a risk model for surgery-related AKI using preoperative risk factors. Methods and Findings This retrospective cohort study included 24,451 hypertensive patients aged ≥18 years who underwent general surgery between 2007 and 2015. The endpoints for AKI classification utilized by the KDIGO (Kidney Disease: Improving Global Outcomes) system were assessed. The most discriminative predictor was selected using Fisher scores and was subsequently used to construct a stepwise multivariate logistic regression model, whose performance was evaluated via comparisons with models used in other published works using the net reclassification index (NRI) and integrated discrimination improvement (IDI) index. Results Surgery-related AKI developed in 1994 hospitalized patients (8.2%). The predictors identified by our Xiang-ya Model were age, gender, eGFR, NLR, pulmonary infection, prothrombin time, thrombin time, hemoglobin, uric acid, serum potassium, serum albumin, total cholesterol, and aspartate amino transferase. The area under the receiver-operating characteristic curve (AUC) for the validation set and cross validation set were 0.87 (95% CI 0.86–0.89) and (0.89; 95% CI 0.88–0.90), respectively, and was therefore similar to the AUC for the training set (0.89; 95% CI 0.88–0.90). The optimal cutoff value was 0.09. Our model outperformed that developed by Kate et al., which exhibited an NRI of 31.38% (95% CI 25.7%-37.1%) and an IDI of 8% (95% CI 5.52%-10.50%) for patients who underwent cardiac surgery (n = 2101). Conclusions/Significance We developed an AKI risk model based on preoperative risk factors and biomarkers that demonstrated good performance when predicting events in a large cohort of hypertensive patients who underwent general surgery.
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Affiliation(s)
- Xing Liu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
| | - Yongkai Ye
- School of Computer, National University of Defense Technology, Changsha, 410073, The People’s Republic of China
| | - Qi Mi
- Department of Sports Medicine and Nutrition, University of Pittsburgh, PA, 15260, United States of America
| | - Wei Huang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
| | - Ting He
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
| | - Pin Huang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
| | - Nana Xu
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
| | - Qiaoyu Wu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
| | - Anli Wang
- Information Department, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
| | - Ying Li
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
- * E-mail: (YL); (HY)
| | - Hong Yuan
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, The People’s Republic of China
- * E-mail: (YL); (HY)
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Chen SW, Chang CH, Fan PC, Chen YC, Chu PH, Chen TH, Wu VCC, Chang SW, Lin PJ, Tsai FC. Comparison of contemporary preoperative risk models at predicting acute kidney injury after isolated coronary artery bypass grafting: a retrospective cohort study. BMJ Open 2016; 6:e010176. [PMID: 27354068 PMCID: PMC4932284 DOI: 10.1136/bmjopen-2015-010176] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is associated with short-term and long-term adverse outcomes. The European System for Cardiac Operative Risk Evaluation (EuroSCORE), EuroSCORE II, the Society of Thoracic Surgeons (STS) score and Age, Creatinine and Ejection Fraction (ACEF) score, have been widely used for predicting the operative risk of cardiac surgery. The aim of this study is to investigate the discriminant ability among current available models in predicting postoperative AKI. METHODS From January 2010 to December 2012, 353 patients who underwent isolated CABG were enrolled. The clinical characteristics, outcomes and scores of prognostic models were collected. The primary outcome was postoperative AKI, defined based on the Kidney Disease Improving Global Outcome (KDIGO) Clinical Practice Guideline for AKI, in 2012. RESULTS 102 patients (28.9%) developed postoperative AKI. For AKI prediction, EuroSCORE II, STS score and ACEF score were all good tools for stage-3 AKI. The ACEF score was shown to have satisfied discriminant ability to predict postoperative AKI with area under a receiver operating characteristic curve: 0.781±0.027, (95% CI 0.729 to 0.834, p value <0.001). Multivariate logistic analysis identified that lower ejection fraction and higher serum creatinine were independent risk factors for AKI. CONCLUSIONS The simple and extremely user-friendly ACEF score can accurately identify the risk of postoperative AKI and has shown satisfactory discriminant ability when compared with other systems. The ACEF score might be the easiest tool for predicting postoperative AKI.
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Affiliation(s)
- Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Pei-Chun Fan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Yung-Chang Chen
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Tien-Hsing Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center, Taoyuan, Taiwan
| | - Pyng-Jing Lin
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
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Golden D, Corbett J, Forni LG. Peri-operative renal dysfunction: prevention and management. Anaesthesia 2016; 71 Suppl 1:51-7. [PMID: 26620147 DOI: 10.1111/anae.13313] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 01/05/2023]
Abstract
Postoperative increases in serum creatinine concentration, by amounts historically viewed as trivial, are associated with increased morbidity and mortality. Acute kidney injury is common, affecting one in five patients admitted with acute medical disease and up to four in five patients admitted to intensive care, of whom one in two have had operations. This review is focused principally on the identification of patients at risk of acute kidney injury and the prevention of injury. In the main, there are no interventions that directly treat the damaged kidney. The management of acute kidney injury is based on correction of dehydration, hypotension, and urinary tract obstruction, stopping nephrotoxic drugs, giving antibiotics for bacterial infection, and commencing renal replacement therapy if necessary.
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Affiliation(s)
- D Golden
- Department of Intensive Care Medicine, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - J Corbett
- Department of Intensive Care Medicine, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - L G Forni
- Department of Intensive Care Medicine, Royal Surrey County Hospital, Guildford, Surrey, UK.,Surrey Peri-operative Anaesthesia and Critical Care Collaborative Research Group and Faculty of Health Care Sciences, University of Surrey, Guildford, Surrey, UK
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Huang PM, Kuo SW, Chen JS, Lee JM. Thoracoscopic Mesh Repair of Diaphragmatic Defects in Hepatic Hydrothorax: A 10-Year Experience. Ann Thorac Surg 2016; 101:1921-7. [PMID: 26897323 DOI: 10.1016/j.athoracsur.2015.11.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 10/05/2015] [Accepted: 11/09/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND The objective was to analyze the outcomes of thoracoscopic mesh repair for hepatic hydrothorax (HH) at our institution during the past 10 years. METHODS A total of 63 patients with refractory HH who underwent thoracoscopic mesh onlay reinforcement to repair diaphragmatic defects from January 2005 to December 2014 were included in the study. Mesh covering alone was used in 47 patients and mesh with suturing was used in 16 patients. Patient demographics, Child-Pugh class, and model for end-stage liver disease (MELD) score were evaluated to predict morbidity and mortality. RESULTS Of the patients (mean age, 60.4 ± 15 years; 31 men and 32 women), 14.3% had concomitant underlying diseases of renal insufficiency, 34.9% had diabetes mellitus, and 4.8% had pneumonia. Diaphragmatic blebs were the most common diaphragmatic defects (29 of 63 [46%]). After a median 20.5 months of follow-up examinations, 4 patients experienced recurrence. The 1-month mortality rate was 9.5% (6 of 63 patients). On multivariable analysis, underlying impaired renal function (p = 0.039) and MELD scores (p = 0.048) were associated with increased 3-month mortality in 16 patients. Contrary to the rising Child-Pugh score (p = 0.058), rising MELD scores represented an increase in kidney or liver failure and mortality. The main causes of 3-month mortality were septic shock (n = 6), acute renal insufficiency (n = 4), gastrointestinal bleeding (n = 4), hepatic encephalopathy (n = 1), and ischemic bowel (n = 1). CONCLUSIONS Thoracoscopic mesh repair for refractory HH improves symptoms and lowers the recurrence rate.
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Affiliation(s)
- Pei-Ming Huang
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Shuenn-Wen Kuo
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jang-Ming Lee
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Yang CH, Chang CH, Chen TH, Fan PC, Chang SW, Chen CC, Chu PH, Chen YT, Yang HY, Yang CW, Chen YC. Combination of Urinary Biomarkers Improves Early Detection of Acute Kidney Injury in Patients With Heart Failure. Circ J 2016; 80:1017-23. [PMID: 26888148 DOI: 10.1253/circj.cj-15-0886] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is associated with morality and repeated hospitalization, and is frequently encountered in patients with acute decompensated heart failure (ADHF). However, few effective tools exist for early AKI identification and risk stratification. METHODS AND RESULTS This was a prospective observational study conducted in the coronary care unit (CCU) of a tertiary care university hospital. Patients with a diagnosis of ADHF and who were using diuretics were enrolled.Samples collected between December 2013 and February 2015 were tested for serum cystatin C (Cys-C), urinary neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1 (KIM-1). Demographic, clinical, and laboratory data were evaluated. A total of 103 adult patients with a mean age of 68 years were investigated. AKI was diagnosed in 49 patients (47.6%). For predicting intrinsic AKI on the first day of CCU admission, a combination of Cys-C and urine KIM-1 yielded an excellent area under the receiver operating characteristic curve of 0.828, a sensitivity of 71.0%, and specificity of 43.0%, for an overall accuracy of 78%. CONCLUSIONS In this study, we found that combinations of the biomarker (Cys-C and KIM-1) were an effective clinical model for predicting AKI in patients with ADHF. The biomarker was also useful for differentiating subclinical AKI in patients with ADHF.
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Affiliation(s)
- Chia-Hung Yang
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center
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Chang CH, Lee CC, Chen SW, Fan PC, Chen YC, Chang SW, Chen TH, Wu VCC, Lin PJ, Tsai FC. Predicting Acute Kidney Injury Following Mitral Valve Repair. Int J Med Sci 2016; 13:19-24. [PMID: 26816491 PMCID: PMC4716816 DOI: 10.7150/ijms.13253] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/20/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) after cardiac surgery is associated with short-term and long-term adverse outcomes. Novel biomarkers have been identified for the early detection of AKI; however, examining these in every patient who undergoes cardiac surgery is prohibitively expensive. Society of Thoracic Surgeons (STS) and Age, Creatinine, and Ejection Fraction (ACEF) scores have been proven to predict mortality in bypass surgery. The aim of this study was to determine whether these scores can be used to predict AKI after mitral valve repair. MATERIALS AND METHODS Between January 2010 and December 2013, 196 patients who underwent mitral valve repair were enrolled. The clinical characteristics, outcomes, and scores of prognostic models were collected. The primary outcome was postoperative AKI, defined using the Kidney Disease Improving Global Outcome 2012 clinical practice guidelines for AKI. RESULTS A total of 76 patients (38.7%) developed postoperative AKI. The STS renal failure (AUROC: 0.797, P < .001) and ACEF scores (AUROC: 0.758, P < .001) are both satisfactory tools for predicting all AKI. The STS renal failure score exhibited superior accuracy compared with the ACEF score in predicting AKI stage 2 and 3. The overall accuracy of both scores was similar for all AKI and AKI stage 2 and 3 when the cut-off points of the STS renal failure and ACEF scores were 2.2 and 1.1, respectively. CONCLUSION In conclusion, the STS renal failure score can be used to accurately predict stage 2 and 3 AKI after mitral valve repair. The ACEF score is a simple tool with satisfactory power in screening patients at risk of all AKI stages. Additional studies can aim to determine the clinical implications of combining preoperative risk stratification and novel biomarkers.
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Affiliation(s)
- Chih-Hsiang Chang
- 1. Kidney research center, Chang Gung Memorial Hospital, Chang Gung University, College of medicine, Taoyuan, Taiwan; 3. Graduate Institute of Clinical Medical Sciences, College of medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Chia Lee
- 1. Kidney research center, Chang Gung Memorial Hospital, Chang Gung University, College of medicine, Taoyuan, Taiwan; 3. Graduate Institute of Clinical Medical Sciences, College of medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Wei Chen
- 2. Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; 3. Graduate Institute of Clinical Medical Sciences, College of medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Chun Fan
- 1. Kidney research center, Chang Gung Memorial Hospital, Chang Gung University, College of medicine, Taoyuan, Taiwan; 3. Graduate Institute of Clinical Medical Sciences, College of medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Chang Chen
- 1. Kidney research center, Chang Gung Memorial Hospital, Chang Gung University, College of medicine, Taoyuan, Taiwan
| | - Su-Wei Chang
- 3. Graduate Institute of Clinical Medical Sciences, College of medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tien-Hsing Chen
- 4. Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Victor Chien-Chia Wu
- 4. Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Pyng-Jing Lin
- 2. Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- 2. Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
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