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Nedadur R, Bhatt N, Lui T, Chu MWA, McCarthy PM, Kline A. The Emerging and Important Role of Artificial Intelligence in Cardiac Surgery. Can J Cardiol 2024:S0828-282X(24)00586-5. [PMID: 39098601 DOI: 10.1016/j.cjca.2024.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 07/29/2024] [Accepted: 07/29/2024] [Indexed: 08/06/2024] Open
Abstract
Artificial Intelligence (AI) has greatly affected our everyday lives and holds great promise to change the landscape of medicine. AI is particularly positioned to improve care for the increasingly complex patients undergoing cardiac surgery utilizing immense amount of data generated in the course of their care. When deployed, AI can be used to analyze this information at the patient's bedside more expediently and accurately, all while providing new insights. This review summarizes the current applications of AI in cardiac surgery, from the vantage point of a patient's journey. Applications of AI include pre-operative risk assessment, intraoperative planning, post-operative patient care and out-patient telemonitoring, encompassing the spectrum of cardiac surgical care. Offloading of administrative processes and enhanced experience with information gathering also represent a unique and underrepresented avenue for future utilization of AI. As clinicians, understanding the nomenclature and applications of AI is important to contextualize problems, to ensure problem-driven solutions and for clinical benefit. Precision medicine, and thus clinically relevant AI, remains dependent on data curation and warehousing to gather insights from large multicenter repositories while treating privacy with the utmost importance. AI tasks should not be siloed but rather holistically integrated into clinical workflow to retain context and relevance. As cardiac surgeons, AI allows us to look forward to a bright future of more efficient utilization of our clinical expertise toward high-level decision making and technical prowess.
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Affiliation(s)
- Rashmi Nedadur
- Feinberg School of Medicine, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, United States; Center for Artificial Intelligence, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois, United States
| | - Nitish Bhatt
- Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada
| | - Tom Lui
- Feinberg School of Medicine, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, United States; Center for Artificial Intelligence, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois, United States
| | | | - Patrick M McCarthy
- Feinberg School of Medicine, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, United States; Center for Artificial Intelligence, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois, United States
| | - Adrienne Kline
- Feinberg School of Medicine, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, United States; Center for Artificial Intelligence, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois, United States
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2
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Dinges C, Dienhart C, Gansterer K, Rodemund N, Rezar R, Steindl J, Huttegger R, Kirnbauer M, Kalisnik JM, Kokoefer AS, Demirel O, Seitelberger R, Hoppe UC, Boxhammer E. Beyond the Valve: Incidence, Outcomes, and Modifiable Factors of Acute Kidney Injury in Patients with Infective Endocarditis Undergoing Valve Surgery-A Retrospective, Single-Center Study. J Clin Med 2024; 13:4450. [PMID: 39124718 PMCID: PMC11312431 DOI: 10.3390/jcm13154450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/12/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Infective endocarditis (IE) often requires surgical intervention, with postoperative acute kidney injury (AKI), posing a significant concern. This retrospective study aimed to investigate AKI incidence, its impact on short-term mortality, and identify modifiable factors in patients with IE scheduled for valve surgery. Methods: This single-center study enrolled 130 consecutive IE patients from 2013 to 2021 undergoing valve surgery. The creatinine levels were monitored pre- and postoperatively, and AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patient demographics, comorbidities, procedural details, and complications were recorded. Primary outcomes included AKI incidence; the relevance of creatinine levels for AKI detection; and the association of AKI with 30-, 60-, and 180-day mortality. Modifiable factors contributing to AKI were explored as secondary outcomes. Results: Postoperatively, 35.4% developed AKI. The highest creatinine elevation occurred on the second postoperative day. Best predictive value for AKI was a creatinine level of 1.35 mg/dL on the second day (AUC: 0.901; sensitivity: 0.89, specificity: 0.79). Elevated creatinine levels on the second day were robust predictors for short-term mortality at 30, 60, and 180 days postoperatively (AUC ranging from 0.708 to 0.789). CK-MB levels at 24 h postoperatively and minimum hemoglobin during surgery were identified as independent predictors for AKI in logistic regression. Conclusions: This study highlights the crucial role of creatinine levels in predicting short-term mortality in surgical IE patients. A specific threshold (1.35 mg/dL) provides a practical marker for risk stratification, offering insights for refining perioperative strategies and optimizing outcomes in this challenging patient population.
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Affiliation(s)
- Christian Dinges
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Christiane Dienhart
- Department of Internal Medicine I, Division of Gastroenterology, Hepathology, Nephrology, Metabolism and Diabetology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Katja Gansterer
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Niklas Rodemund
- Department of Anesthesiology, Perioperative Medicine and General Intensive Care Medicine, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (M.K.)
| | - Richard Rezar
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (U.C.H.); (E.B.)
| | - Johannes Steindl
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Raphael Huttegger
- Department of Anesthesiology, Perioperative Medicine and General Intensive Care Medicine, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (M.K.)
| | - Michael Kirnbauer
- Department of Anesthesiology, Perioperative Medicine and General Intensive Care Medicine, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (M.K.)
| | - Jurij M. Kalisnik
- Department of Cardiovascular and Thoracic Surgery, Klinikum Klagenfurt, 9020 Klagenfurt, Austria
| | - Andreas S. Kokoefer
- Department of Anesthesiology, Perioperative Medicine and General Intensive Care Medicine, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (M.K.)
| | - Ozan Demirel
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (U.C.H.); (E.B.)
| | - Rainald Seitelberger
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Uta C. Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (U.C.H.); (E.B.)
| | - Elke Boxhammer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (U.C.H.); (E.B.)
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Gregory A, Ender J, Shaw AD, Denault A, Ibekwe S, Stoppe C, Alli A, Manning MW, Brodt JL, Galhardo C, Sander M, Zarbock A, Fletcher N, Ghadimi K, Grant MC. ERAS/STS 2024 Expert Consensus Statement on Perioperative Care in Cardiac Surgery: Continuing the Evolution of Optimized Patient Care and Recovery. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00399-9. [PMID: 39004570 DOI: 10.1053/j.jvca.2024.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Affiliation(s)
- Alexander Gregory
- Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Joerg Ender
- Department of Anesthesiology and Intensive Care Medicine, Heartcenter Leipzig GmbH, Leipzig, Germany
| | - Andrew D Shaw
- Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, OH
| | - André Denault
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Stephanie Ibekwe
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX
| | - Christian Stoppe
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany
| | - Ahmad Alli
- Department of Anesthesiology & Pain Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Jessica L Brodt
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto CA
| | - Carlos Galhardo
- Department of Anesthesia, McMaster University, Ontario, Canada
| | - Michael Sander
- Anesthesiology and Intensive Care Medicine, Justus Liebig University Giessen, University Hospital Giessen, Giessen, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Nick Fletcher
- Institute of Anaesthesia and Critical Care, Cleveland Clinic London, London, UK
| | | | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Jones C, Taylor M, Sperrin M, Grant SW. A systematic review of cardiac surgery clinical prediction models that include intra-operative variables. Perfusion 2024:2676591241237758. [PMID: 38649154 DOI: 10.1177/02676591241237758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Most cardiac surgery clinical prediction models (CPMs) are developed using pre-operative variables to predict post-operative outcomes. Some CPMs are developed with intra-operative variables, but none are widely used. The objective of this systematic review was to identify CPMs with intra-operative variables that predict short-term outcomes following adult cardiac surgery. METHODS Ovid MEDLINE and EMBASE databases were searched from inception to December 2022, for studies developing a CPM with at least one intra-operative variable. Data were extracted using a critical appraisal framework and bias assessment tool. Model performance was analysed using discrimination and calibration measures. RESULTS A total of 24 models were identified. Frequent predicted outcomes were acute kidney injury (9/24 studies) and peri-operative mortality (6/24 studies). Frequent pre-operative variables were age (18/24 studies) and creatinine/eGFR (18/24 studies). Common intra-operative variables were cardiopulmonary bypass time (16/24 studies) and transfusion (13/24 studies). Model discrimination was acceptable for all internally validated models (AUC 0.69-0.91). Calibration was poor (15/24 studies) or unreported (8/24 studies). Most CPMs were at a high or indeterminate risk of bias (23/24 models). The added value of intra-operative variables was assessed in six studies with statistically significantly improved discrimination demonstrated in two. CONCLUSION Weak reporting and methodological limitations may restrict wider applicability and adoption of existing CPMs that include intra-operative variables. There is some evidence that CPM discrimination is improved with the addition of intra-operative variables. Further work is required to understand the role of intra-operative CPMs in the management of cardiac surgery patients.
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Affiliation(s)
- Ceri Jones
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Clinical Perfusion, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
| | - Marcus Taylor
- Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, , Manchester, UK
| | - Matthew Sperrin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Stuart W Grant
- Division of Cardiovascular Sciences, ERC, Manchester University Hospitals Foundation Trust, University of Manchester, Manchester, UK
- South Tees Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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Kamensek T, Kalisnik JM, Ledwon M, Santarpino G, Fittkau M, Vogt FA, Zibert J. Improved early risk stratification of deep sternal wound infection risk after coronary artery bypass grafting. J Cardiothorac Surg 2024; 19:93. [PMID: 38355514 PMCID: PMC10865600 DOI: 10.1186/s13019-024-02570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Deep sternal wound infection (DSWI) following open heart surgery is associated with excessive morbidity and mortality. Contemporary DSWI risk prediction models aim at identifying high-risk patients with varying complexity and performance characteristics. We aimed to optimize the DSWI risk factor set and to identify additional risk factors for early postoperative detection of patients prone to DSWI. METHODS Single-centre retrospective analysis of patients with isolated multivessel coronary artery disease undergoing myocardial revascularization at Paracelsus Medical University Nuremberg between 2007 and 2022 was performed to identify risk factors for DSWI. Three data sets were created to examine preoperative, intraoperative, and early postoperative parameters, constituting the "Baseline", the "Improved Baseline" and the "Extended" models. The "Extended" data set included risk factors that had not been analysed before. Univariable and stepwise forward multiple logistic regression analyses were performed for each respective set of variables. RESULTS From 5221 patients, 179 (3.4%) developed DSWI. The "Extended" model performed best, with the area under the curve (AUC) of 0.80, 95%-CI: [0.76, 0.83]. Pleural effusion requiring intervention, postoperative delirium, preoperative hospital stay > 24 h, and the use of fibrin sealant were new independent predictors of DSWI in addition to age, Diabetes Mellitus on insulin, Body Mass Index, peripheral artery disease, mediastinal re-exploration, bilateral internal mammary harvesting, acute kidney injury and blood transfusions. CONCLUSIONS The "Extended" regression model with the short-term postoperative complications significantly improved DSWI risk discrimination after surgical revascularization. Short preoperative stay, prevention of postoperative delirium, protocols reducing the need for evacuation of effusion and restrictive use of fibrin sealant for sternal closure facilitate DSWI reduction. TRIAL REGISTRATION The registered retrospective study was registered at the study centre and approved by the Institutional Review Board of Paracelsus Medical University Nuremberg (IRB-2019-005).
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Affiliation(s)
- Tina Kamensek
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, Ljubljana, 1000, Slovenia
| | - Jurij Matija Kalisnik
- Department of Cardiac Surgery, Klinikum Nuremberg, Paracelsus Medical University, Breslauer Str. 201, 90471, Nuremberg, Germany.
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, 1000, Slovenia.
- Department of Cardiothoracic and Vascular Surgery, University of Graz affiliated Clinic KABEG, Klagenfurt am Wörthersee, Feschnigstrasse 11, Klagenfurt, 9020, Austria.
| | - Mirek Ledwon
- Department of Cardiac Surgery, Klinikum Nuremberg, Paracelsus Medical University, Breslauer Str. 201, 90471, Nuremberg, Germany
| | - Giuseppe Santarpino
- Paracelsus Medical University, Campus Nuremberg, Ernst Nathan Straße 1, 90419, Nuremberg, Germany
| | - Matthias Fittkau
- Department of Cardiac Surgery, Klinikum Nuremberg, Paracelsus Medical University, Breslauer Str. 201, 90471, Nuremberg, Germany
| | - Ferdinand Aurel Vogt
- Paracelsus Medical University, Campus Nuremberg, Ernst Nathan Straße 1, 90419, Nuremberg, Germany
| | - Janez Zibert
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, Ljubljana, 1000, Slovenia
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6
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Wong DH, Teman NR. Commentary: Variable in disguise: Using graphical modeling in cardiac surgery to stay ahead of the curve. J Thorac Cardiovasc Surg 2023; 166:e463-e464. [PMID: 36192226 DOI: 10.1016/j.jtcvs.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Daniella H Wong
- Division of Cardiac Surgery, University of Virginia Health System, Charlottesville, Va
| | - Nicholas R Teman
- Division of Cardiac Surgery, University of Virginia Health System, Charlottesville, Va.
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7
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Takkavatakarn K, Hofer IS. Artificial Intelligence and Machine Learning in Perioperative Acute Kidney Injury. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:53-60. [PMID: 36723283 DOI: 10.1053/j.akdh.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/30/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022]
Abstract
Acute kidney injury (AKI) is a common complication after a surgery, especially in cardiac and aortic procedures, and has a significant impact on morbidity and mortality. Early identification of high-risk patients and providing effective prevention and therapeutic approach are the main strategies for reducing the possibility of perioperative AKI. Consequently, several risk-prediction models and risk assessment scores have been developed for the prediction of perioperative AKI. However, a majority of these risk scores are only derived from preoperative data while the intraoperative time-series monitoring data such as heart rate and blood pressure were not included. Moreover, the complexity of the pathophysiology of AKI, as well as its nonlinear and heterogeneous nature, imposes limitations on the use of linear statistical techniques. The development of clinical medicine's digitization, the widespread availability of electronic medical records, and the increase in the use of continuous monitoring have generated vast quantities of data. Machine learning has recently shown promise as a method for automatically integrating large amounts of data in predicting the risk of perioperative outcomes. In this article, we discussed the development, limitations of existing work, and the potential future direction of models using machine learning techniques to predict AKI after a surgery.
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Affiliation(s)
- Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ira S Hofer
- Department of Anesthesiology, Pain and Perioperative Medicine, Icahn School of Medicine at Mount, Sinai, NY.
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Khanna NN, Maindarkar M, Puvvula A, Paul S, Bhagawati M, Ahluwalia P, Ruzsa Z, Sharma A, Munjral S, Kolluri R, Krishnan PR, Singh IM, Laird JR, Fatemi M, Alizad A, Dhanjil SK, Saba L, Balestrieri A, Faa G, Paraskevas KI, Misra DP, Agarwal V, Sharma A, Teji J, Al-Maini M, Nicolaides A, Rathore V, Naidu S, Liblik K, Johri AM, Turk M, Sobel DW, Pareek G, Miner M, Viskovic K, Tsoulfas G, Protogerou AD, Mavrogeni S, Kitas GD, Fouda MM, Kalra MK, Suri JS. Vascular Implications of COVID-19: Role of Radiological Imaging, Artificial Intelligence, and Tissue Characterization: A Special Report. J Cardiovasc Dev Dis 2022; 9:jcdd9080268. [PMID: 36005433 PMCID: PMC9409845 DOI: 10.3390/jcdd9080268] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/30/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022] Open
Abstract
The SARS-CoV-2 virus has caused a pandemic, infecting nearly 80 million people worldwide, with mortality exceeding six million. The average survival span is just 14 days from the time the symptoms become aggressive. The present study delineates the deep-driven vascular damage in the pulmonary, renal, coronary, and carotid vessels due to SARS-CoV-2. This special report addresses an important gap in the literature in understanding (i) the pathophysiology of vascular damage and the role of medical imaging in the visualization of the damage caused by SARS-CoV-2, and (ii) further understanding the severity of COVID-19 using artificial intelligence (AI)-based tissue characterization (TC). PRISMA was used to select 296 studies for AI-based TC. Radiological imaging techniques such as magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound were selected for imaging of the vasculature infected by COVID-19. Four kinds of hypotheses are presented for showing the vascular damage in radiological images due to COVID-19. Three kinds of AI models, namely, machine learning, deep learning, and transfer learning, are used for TC. Further, the study presents recommendations for improving AI-based architectures for vascular studies. We conclude that the process of vascular damage due to COVID-19 has similarities across vessel types, even though it results in multi-organ dysfunction. Although the mortality rate is ~2% of those infected, the long-term effect of COVID-19 needs monitoring to avoid deaths. AI seems to be penetrating the health care industry at warp speed, and we expect to see an emerging role in patient care, reduce the mortality and morbidity rate.
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Affiliation(s)
- Narendra N. Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi 110001, India
| | - Mahesh Maindarkar
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India
| | - Anudeep Puvvula
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
- Annu’s Hospitals for Skin and Diabetes, Nellore 524101, India
| | - Sudip Paul
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India
| | - Mrinalini Bhagawati
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India
| | - Puneet Ahluwalia
- Max Institute of Cancer Care, Max Super Specialty Hospital, New Delhi 110017, India
| | - Zoltan Ruzsa
- Invasive Cardiology Division, Faculty of Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Aditya Sharma
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA 22904, USA
| | - Smiksha Munjral
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
| | - Raghu Kolluri
- Ohio Health Heart and Vascular, Columbus, OH 43214, USA
| | | | - Inder M. Singh
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
| | - John R. Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA 94574, USA
| | - Mostafa Fatemi
- Department of Physiology & Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Azra Alizad
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Surinder K. Dhanjil
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, 40138 Cagliari, Italy
| | - Antonella Balestrieri
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National & Kapodistrian University of Athens, 15772 Athens, Greece
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria, 09124 Cagliari, Italy
| | | | - Durga Prasanna Misra
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Vikas Agarwal
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Aman Sharma
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Jagjit Teji
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Mustafa Al-Maini
- Allergy, Clinical Immunology and Rheumatology Institute, Toronto, ON L4Z 4C4, Canada
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre and University of Nicosia Medical School, 2408 Nicosia, Cyprus
| | - Vijay Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA 95119, USA
| | - Subbaram Naidu
- Electrical Engineering Department, University of Minnesota, Duluth, MN 55812, USA
| | - Kiera Liblik
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Amer M. Johri
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Monika Turk
- The Hanse-Wissenschaftskolleg Institute for Advanced Study, 27753 Delmenhorst, Germany
| | - David W. Sobel
- Rheumatology Unit, National Kapodistrian University of Athens, 15772 Athens, Greece
| | - Gyan Pareek
- Minimally Invasive Urology Institute, Brown University, Providence, RI 02912, USA
| | - Martin Miner
- Men’s Health Centre, Miriam Hospital Providence, Providence, RI 02906, USA
| | - Klaudija Viskovic
- Department of Radiology and Ultrasound, University Hospital for Infectious Diseases, 10000 Zagreb, Croatia
| | - George Tsoulfas
- Department of Surgery, Aristoteleion University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Athanasios D. Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National & Kapodistrian University of Athens, 15772 Athens, Greece
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Centre, 17674 Athens, Greece
| | - George D. Kitas
- Academic Affairs, Dudley Group NHS Foundation Trust, Dudley DY1 2HQ, UK
- Arthritis Research UK Epidemiology Unit, Manchester University, Manchester M13 9PL, UK
| | - Mostafa M. Fouda
- Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID 83209, USA
| | - Manudeep K. Kalra
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
| | - Jasjit S. Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
- Correspondence: ; Tel.: +1-916-749-5628
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9
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Kalisnik JM, Steblovnik K, Hrovat E, Jerin A, Skitek M, Dinges C, Fischlein T, Zibert J. Enhanced Detection of Cardiac Surgery-Associated Acute Kidney Injury by a Composite Biomarker Panel in Patients with Normal Preoperative Kidney Function. J Cardiovasc Dev Dis 2022; 9:210. [PMID: 35877572 PMCID: PMC9317610 DOI: 10.3390/jcdd9070210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
We have recently shown that minor subclinical creatinine dynamic changes enable the excellent detection of acute kidney injury (AKI) within 6-12 h after cardiac surgery. The aim of the present study was to examine a combination of neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC) and creatinine for enhanced AKI detection early after cardiac surgery. Elective patients with normal renal function undergoing cardiac surgery using cardiopulmonary bypass were enrolled. Concentrations of plasma NGAL, serum CysC and serum creatinine were determined after the induction of general anesthesia, at the termination of the cardiopulmonary bypass and 2 h thereafter. Out of 119 enrolled patients, 51 (43%) developed AKI. A model utilizing an NGAL, CysC and creatinine triple biomarker panel including sequential relative changes provides a better prediction of cardiac surgery-associated acute kidney injury than any biomarker alone already 2 h after the termination of the cardiopulmonary bypass. The area under the receiver-operator curve was 0.77, sensitivity 77% and specificity 68%.
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Affiliation(s)
- Jurij Matija Kalisnik
- Department of Cardiac Surgery, Paracelsus Medical University, 40791 Nuremberg, Germany;
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Klemen Steblovnik
- Department of Cardiology, University Medical Centre, 1000 Ljubljana, Slovenia;
| | - Eva Hrovat
- Department of Cardiovascular Surgery, University Medical Centre, 1000 Ljubljana, Slovenia;
| | - Ales Jerin
- Institute of Clinical Chemistry and Biochemistry, University Medical Centre, 1000 Ljubljana, Slovenia; (A.J.); (M.S.)
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Milan Skitek
- Institute of Clinical Chemistry and Biochemistry, University Medical Centre, 1000 Ljubljana, Slovenia; (A.J.); (M.S.)
| | - Christian Dinges
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Theodor Fischlein
- Department of Cardiac Surgery, Paracelsus Medical University, 40791 Nuremberg, Germany;
| | - Janez Zibert
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia;
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