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Koköfer A, Cozowicz C, Wernly B, Rodemund N. Timing and threshold of high sensitive troponin T measurement for the prediction of mortality after cardiac surgery: a retrospective cohort analysis. Intensive Care Med Exp 2023; 11:58. [PMID: 37656268 PMCID: PMC10473995 DOI: 10.1186/s40635-023-00545-z] [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: 04/03/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND High sensitive cardiac troponin T (hsTnT) is a widely used biomarker of myocardial injury. Along with other high sensitive troponins, HsTnT can predict mortality in both cardiac and non-cardiac surgery. The aim of this study was to determine the association between hsTnT serum elevations in the immediate postoperative period until 120 h after cardiac surgery and the occurrence of in-hospital mortality compared to the Simplified Acute Physiology Score 3 (SAPS3). Additionally, we identified an ideal hsTnT serum threshold to predict in-hospital mortality. METHODS We performed a retrospective single-institutional cohort analysis of 2179 patients undergoing cardiac surgery with cardiopulmonary bypass from 2013 to 2021. Logistic regression analysis was used to investigate an association of hsTnT at various time points and in-hospital mortality. The model was adjusted for relevant covariates including SAPS3, lactate and administered norepinephrine dosage. ROC analysis was performed to estimate the accuracy to predict mortality by serum hsTnT concentrations. This prediction was compared to the SAPS3 score. An ideal cutoff of hsTnT concentration was calculated by means of Youden index. RESULTS In total 7576 troponins were measured at the predefined timepoints. 100 (4.59%) patients died during the hospital stay. The fourth hsTnT on d3 (at 96-120 h postoperatively) showed the highest association with in-hospital death (OR 1.56; 95% CI (1.39-1.76); p < 0.001). This finding persisted after multivariable adjustment (aOR 1.34; 95% CI (1.18-1.53); p < 0.001). In contrast, the third hsTnT on d2 (at 48-72 h postoperatively) showed the best discrimination for in-hospital mortality (AUC 82.75%; 95% CI (0.77-0.89). The prediction by the third hsTnT was comparable to the in-hospital mortality prediction by SAPS3 (AUC 79.36%; 95% CI (0.73-0.85); p = 0.056). The optimal cutoff for the third hsTnT was calculated to be 1264 ng/L (Sensitivity 0.62; Specificity 0.88). CONCLUSION Elevated hsTnT after cardiac surgery was associated with an increased risk of in-hospital mortality. HsTnT measured on postoperative day 2 and 3 were most accurate to predict in-hospital mortality. The prediction of in-hospital mortality using hsTNT is comparable to mortality prediction using the SAPS3 score. HsTnT serum levels currently recommended to establish clinically important periprocedural myocardial injury are lower than thresholds identified in this study.
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Affiliation(s)
- Andreas Koköfer
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria.
| | - Crispiana Cozowicz
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Bernhard Wernly
- Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Niklas Rodemund
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
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Sharma V, Zheng H, Candilio L, Nicholas JM, Clayton T, Yellon DM, Bulluck H, Hausenloy DJ. Defining Peri-Operative Myocardial Injury during Cardiac Surgery Using High-Sensitivity Troponin T. J Clin Med 2023; 12:4291. [PMID: 37445326 PMCID: PMC10342425 DOI: 10.3390/jcm12134291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/11/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE Cut-offs for high-sensitivity troponin (hs-Tn) elevations to define prognostically significant peri-operative myocardial injury (PMI) in cardiac surgery is not well-established. We evaluated the associations between peri-operative high-sensitivity troponin T (hs-TnT) elevations and 1-year all-cause mortality in patients undergoing cardiac surgery. METHODS The prognostic significance of baseline hs-TnT and various thresholds for post-operative hs-TnT elevation at different time-points on 1-year all-cause mortality following cardiac surgery were assessed after adjusting for baseline hs-TnT and EuroSCORE in a post-hoc analysis of the ERICCA trial. RESULTS 1206 patients met the inclusion criteria. Baseline elevation in hs-TnT >x1 99th percentile upper reference limit (URL) was significantly associated with 1-year all-cause mortality (adjusted hazard ratio 1.90, 95% confidence interval 1.15-3.13). In the subgroup with normal baseline hs-TnT (n = 517), elevation in hs-TnT at all post-operative time points was associated with higher 1-year mortality, reaching statistical significance for elevations above: ≥100 × URL at 6 h; ≥50 × URL at 12 and 24 h; ≥35 × URL at 48 h; and ≥30 × URL at 72 h post-surgery. Elevation in hs-TnT at 24 h ≥ 50 × URL had the optimal sensitivity and specificity (73% and 75% respectively). When the whole cohort of patients was analysed, including those with abnormal baseline hs-TnT (up to 10 × URL), the same threshold had optimal sensitivity and specificity (66% and 70%). CONCLUSIONS Both baseline and post-operative hs-TnT elevations are independently associated with 1-year all-cause mortality in patients undergoing cardiac surgery. The optimal threshold to define a prognostically significant PMI in our study was ≥50 × URL elevation in hs-TnT at 24 h.
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Affiliation(s)
- Vikram Sharma
- Department of Cardiovascular Medicine, University of Iowa, Iowa City, IA 52242, USA;
| | - Huili Zheng
- National Registry of Diseases, Health Promotion Board, Singapore 168937, Singapore;
| | - Luciano Candilio
- Department of Cardiology, Royal Free Hospital, London NW3 2QG, UK;
| | - Jennifer M. Nicholas
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (J.M.N.); (T.C.)
| | - Tim Clayton
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (J.M.N.); (T.C.)
| | - Derek M. Yellon
- The Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK;
| | - Heerajnarain Bulluck
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK;
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - Derek J. Hausenloy
- The Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK;
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore 169609, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore 117597, Singapore
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung 41354, Taiwan
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Denessen EJ, Heuts S, Daemen JH, van Doorn WP, Vroemen WH, Sels JW, Segers P, Van‘t Hof AW, Maessen JG, Bekers O, Van Der Horst IC, Mingels AM. High-Sensitivity Cardiac Troponin I and T Kinetics Differ following Coronary Bypass Surgery: A Systematic Review and Meta-Analysis. Clin Chem 2022; 68:1564-1575. [DOI: 10.1093/clinchem/hvac152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Cardiac troponin I and T are both used for diagnosing myocardial infarction (MI) after coronary artery bypass grafting (CABG), also known as type 5 MI (MI-5). Different MI-5 definitions have been formulated, using multiples of the 99th percentile upper reference limit (10×, 35×, or 70× URL), with or without supporting evidence. These definitions are arbitrarily chosen based on conventional assays and do not differentiate between troponin I and T. We therefore investigated the kinetics of high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) following CABG.
Methods
A systematic search was applied to MEDLINE and EMBASE databases including the search terms “coronary artery bypass grafting” AND “high-sensitivity cardiac troponin.” Studies reporting hs-cTnI or hs-cTnT on at least 2 different time points were included. Troponin concentrations were extracted and normalized to the assay-specific URL.
Results
For hs-cTnI and hs-cTnT, 17 (n = 1661 patients) and 15 studies (n = 2646 patients) were included, respectively. Preoperative hs-cTnI was 6.1× URL (95% confidence intervals: 4.9–7.2) and hs-cTnT 1.2× URL (0.9–1.4). Mean peak was reached 6–8 h postoperatively (126× URL, 99–153 and 45× URL, 29–61, respectively). Subanalysis of hs-cTnI illustrated assay-specific peak heights and kinetics, while subanalysis of surgical strategies revealed 3-fold higher hs-cTnI than hs-cTnT for on-pump CABG and 5-fold for off-pump CABG.
Conclusion
Postoperative hs-cTnI and hs-cTnT following CABG surpass most current diagnostic cutoff values. hs-cTnI was almost 3-fold higher than hs-cTnT, and appeared to be highly dependent on the assay used and surgical strategy. There is a need for assay-specific hs-cTnI and hs-cTnT cutoff values for accurate, timely identification of MI-5.
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Affiliation(s)
- Ellen J Denessen
- Central Diagnostic Laboratory, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Jean H Daemen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center , Heerlen , the Netherlands
| | - William P van Doorn
- Central Diagnostic Laboratory, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
| | - Wim H Vroemen
- Central Diagnostic Laboratory, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Jan-Willem Sels
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Department of Cardiology, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Patrique Segers
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Arnoud W Van‘t Hof
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
- Department of Cardiology, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Department of Cardiology, Zuyderland Medical Center , Heerlen , the Netherlands
| | - Jos G Maessen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Otto Bekers
- Central Diagnostic Laboratory, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
| | - Iwan C Van Der Horst
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center+ , Maastricht , the Netherlands
| | - Alma M Mingels
- Central Diagnostic Laboratory, Maastricht University Medical Center+ , Maastricht , the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , the Netherlands
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Diagnostic significance of highly sensitive troponins in cardiac surgery. КЛИНИЧЕСКАЯ ПРАКТИКА 2022. [DOI: 10.17816/clinpract111002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The level of troponins after cardiac surgery always exceeds the reference values, however, the interpretation of these changes is difficult. Aim: To determine the relationship between the high-sensitivity cardiac troponin I and troponin T levels and the risk of heart failure (HF) development within 24 hours after the heart surgery. Methods: A prospective, observational, single-center study included 70 patients undergoing elective heart surgery. The patients were retrospectively divided into two groups based on the development of HF in the first 12 hours after the surgery. The group without HF included 57 patients, the group with HF included 13 patients. Results: The levels of highly sensitive Troponin I (HsTI) in patients who underwent elective heart surgery without complications were 61 times higher than the upper limit of the normal values, in those with the development of HF they were 111 times higher than the upper limit of the normal values. The levels of highly sensitive Troponin T (HsTT) were 25.5 times and 51 times the upper limit of the normal values, respectively. The level of HsTI at the end of the surgery can be a predictor of the HF development, regardless of the use of cardiac bypass (threshold value =1483 ng/l), as well as a predictor of the need for inotropic support for 2 days or more, regardless of the operation type (threshold value = 1573 ng/l). There was a direct moderate correlation of the HsTI level at the end of the operation and 6 hours after the operation with cumulative hemohydrobalance for 24 hours, which was 60% higher in patients with HF than that in patients without complications. Conclusion: In uncomplicated patients, the level of highly sensitive troponins T and I in the postoperative period is 2561 times higher than the upper limit of the normal values, and with the HF development it is 51111 times higher. Highly sensitive troponins can be considered as predictors of the HF development and the duration of inotropic support. The increase in the level of troponins is influenced by the duration of cardiac bypass and the volume of infusion therapy in the perioperative period.
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5
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Pesonen E, Vlasov H, Suojaranta R, Hiippala S, Schramko A, Wilkman E, Eränen T, Arvonen K, Mazanikov M, Salminen US, Meinberg M, Vähäsilta T, Petäjä L, Raivio P, Juvonen T, Pettilä V. Effect of 4% Albumin Solution vs Ringer Acetate on Major Adverse Events in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass: A Randomized Clinical Trial. JAMA 2022; 328:251-258. [PMID: 35852528 PMCID: PMC9297113 DOI: 10.1001/jama.2022.10461] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE In cardiac surgery, albumin solution may maintain hemodynamics better than crystalloids and reduce the decrease in platelet count and excessive fluid balance, but randomized trials are needed to compare the effectiveness of these approaches in reducing surgical complications. OBJECTIVE To assess whether 4% albumin solution compared with Ringer acetate as cardiopulmonary bypass prime and perioperative intravenous volume replacement solution reduces the incidence of major perioperative and postoperative complications in patients undergoing cardiac surgery. DESIGN, SETTING, AND PARTICIPANTS A randomized, double-blind, single-center clinical trial in a tertiary university hospital during 2017-2020 with 90-day follow-up postoperatively involving patients undergoing on-pump coronary artery bypass grafting; aortic, mitral, or tricuspid valve surgery; ascending aorta surgery without hypothermic circulatory arrest; and/or the maze procedure were randomly assigned to 2 study groups (last follow-up was April 13, 2020). INTERVENTIONS The patients received in a 1:1 ratio either 4% albumin solution (n = 693) or Ringer acetate solution (n = 693) as cardiopulmonary bypass priming and intravenous volume replacement intraoperatively and up to 24 hours postoperatively. MAIN OUTCOMES AND MEASURES The primary outcome was the number of patients with at least 1 major adverse event: death, myocardial injury, acute heart failure, resternotomy, stroke, arrhythmia, bleeding, infection, or acute kidney injury. RESULTS Among 1407 patients randomized, 1386 (99%; mean age, 65.4 [SD, 9.9] years; 1091 men [79%]; 295 women [21%]) completed the trial. Patients received a median of 2150 mL (IQR, 1598-2700 mL) of study fluid in the albumin group and 3298 mL (IQR, 2669-3500 mL) in the Ringer group. The number of patients with at least 1 major adverse event was 257 of 693 patients (37.1%) in the albumin group and 234 of 693 patients (33.8%) in the Ringer group (relative risk albumin/Ringer, 1.10; 95% CI, 0.95-1.27; P = .20), an absolute difference of 3.3 percentage points (95% CI, -1.7 to 8.4). The most common serious adverse events were pulmonary embolus (11 [1.6%] in the albumin group vs 8 [1.2%] in the Ringer group), postpericardiotomy syndrome (9 [1.3%] in both groups), and pleural effusion with intensive care unit or hospital readmission (7 [1.0%] in the albumin group vs 9 [1.3%] in the Ringer group). CONCLUSIONS AND RELEVANCE Among patients undergoing cardiac surgery with cardiopulmonary bypass, treatment with 4% albumin solution for priming and perioperative intravenous volume replacement solution compared with Ringer acetate did not significantly reduce the risk of major adverse events over the following 90 days. These findings do not support the use of 4% albumin solution in this setting. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02560519.
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Affiliation(s)
- Eero Pesonen
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Vlasov
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Raili Suojaranta
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seppo Hiippala
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Alexey Schramko
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erika Wilkman
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Eränen
- HUS Pharmacy, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kaapo Arvonen
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maxim Mazanikov
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ulla-Stina Salminen
- Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mihkel Meinberg
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tommi Vähäsilta
- Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Liisa Petäjä
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Peter Raivio
- Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tatu Juvonen
- Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ville Pettilä
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Heuts S, Denessen EJ, Daemen JH, Vroemen WH, Sels JW, Segers P, Bekers O, van ‘t Hof AW, Maessen JG, van der Horst IC, Mingels AM. Meta-Analysis Evaluating High-Sensitivity Cardiac Troponin T Kinetics after Coronary Artery Bypass Grafting in Relation to the Current Definitions of Myocardial Infarction. Am J Cardiol 2022; 163:25-31. [PMID: 34763830 DOI: 10.1016/j.amjcard.2021.09.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 12/29/2022]
Abstract
Various definitions of myocardial infarction type 5 after coronary artery bypass grafting (CABG) have been proposed (myocardial infarction [MI-5], also known as peri-procedural MI), using different biomarkers and different and arbitrary cut-off values. This meta-analysis aims to determine the expected release of high-sensitivity cardiac troponin T (hs-cTnT) after CABG in general and after uncomplicated surgery and off-pump CABG in particular. A systematic search was applied to 3 databases. Studies on CABG as a single intervention and reporting on postoperative hs-cTnT concentrations on at least 2 different time points were included. All data on hs-cTnT concentrations were extracted, and mean concentrations at various points in time were stratified. Eventually, 15 studies were included, encompassing 2,646 patients. Preoperative hs-cTnT was 17 ng/L (95% confidence interval [CI] 13 to 20 ng/L). Hs-cTnT peaked at 6 to 8 hours postoperatively (628 ng/L, 95% CI 400 to 856 ng/L; 45x upper reference limit [URL]) and was still increased after 48 hours. In addition, peak hs-cTnT concentration was 614 ng/L (95% CI 282 to 947 ng/L) in patients with a definite uncomplicated postoperative course (i.e., without MI). For patients after off-pump CABG compared to on-pump CABG, the mean peak hs-cTnT concentration was 186 ng/L (95% CI 172 to 200 ng/L, 13 × URL) versus 629 ng/L (95% CI 529 to 726 ng/L, 45 × URL), respectively. In conclusion, postoperative hs-cTnT concentrations surpass most of the currently defined cut-off values for MI-5, even in perceived uncomplicated surgery, suggesting thorough reassessment. Hs-cTnT release differences following on-pump CABG versus off-pump CABG were observed, implying the need for different cut-off values for different surgical strategies.
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Li Y, Li Y, Hu Q, Zheng S, Tian B, Meng F, Chen Z, Han J, Wang S, Zhang H, Xu C, Jia Y, Jiao Y, Fu J, Meng X. Association of early elevated cardiac troponin I concentration and longitudinal change after off-pump coronary artery bypass grafting and adverse events: a prospective cohort study. J Thorac Dis 2020; 12:6542-6551. [PMID: 33282356 PMCID: PMC7711399 DOI: 10.21037/jtd-20-1691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/17/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The elevation of troponin after coronary artery bypass grafting (CABG) is common This study aimed to investigate the association between very early cardiac troponin I (cTnI) concentration and its longitudinal change within 24 hours after CABG and 30-day adverse events. METHODS This study prospectively enrolled 633 patients who underwent isolated off-pump CABG from January 2019 to May 2019. Serum cTnI levels were measured in all patients at two examinations within 24 hours postoperatively (1 hour and 12-18 hours), and a proportional hazards model was used to determine the association between cTnI levels and their change with adverse events, which were defined as a composite of 30-day mortality, stroke, heart failure, myocardial infarction (MI), and ventricular fibrillation. RESULTS cTnI levels of the two examinations and absolute change of cTnI levels were significantly higher in the event group than in the non-event group (P<0.01, both). Earlier and later cTnI concentrations were associated with 30-day complications [adjusted hazard ration (HR) 1.598, 95% confidence interval (CI), 1.158-2.204 and HR 1.499, 95% CI, 1.228-1.831, respectively]. With regard to longitudinal change in cTnI levels, participants with persistently high levels of cTnI and those with progression from a low level to high level concentration experienced a significantly increased risk of adverse events than did participants who had a trend of persistently low cTnI levels (HR 3.105, 95% CI, 1.748-5.517 versus HR 2.944, 95% CI, 1.488-5.824). CONCLUSIONS Longitudinal change in cTnI levels within 24 hours and early cTnI concentrations, even less than 1 hour after CABG, are associated with adverse events. These data will be useful in identifying patients at an increased risk of complications.
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Affiliation(s)
- Yan Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuqi Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qiuming Hu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuai Zheng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Baiyu Tian
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fei Meng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zonghao Chen
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Han
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shengyu Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haibo Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chunlei Xu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yixin Jia
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuqing Jiao
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jintao Fu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Meng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Li X, Shan L, Lv M, Li Z, Han C, Liu B, Ge W, Zhang Y. Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG. BMC Cardiovasc Disord 2020; 20:463. [PMID: 33115418 PMCID: PMC7594339 DOI: 10.1186/s12872-020-01745-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/18/2020] [Indexed: 12/14/2022] Open
Abstract
Background Preoperative risk evaluation systems are significant and important to the allocation of medical resources and the communication between doctors and patients. The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is widely used in clinical practice. Cardiac troponin T (cTnT) can specifically and accurately reflect myocardial injury. Whether EuroSCORE II can improve the predictive power after integrating with cTnT is still unclear. This study was a retrospective single center study designed to assess the predictive ability of EuroSCORE II integrated with cTnT for patients undergoing isolated off-pump coronary artery bypass grafting (OPCABG). Methods This retrospective and observational cohort study included 1887 patients who underwent first isolated OPCABG. cTnT was detected within 48 h before operation in each patient. According to myocardial injury, patients were divided by cTnT into 4 stages. A new risk evaluation system was created through logistic regression with EuroSCORE II and myocardial injury classification as covariates. Then the two risk evaluation systems were comparatively assessed by regression analysis, receiver operator characteristic curves, net reclassification index, Bland–Altman plots and decision curve analysis. Results There were 43 in-hospital deaths, with a mortality of 2.30% (43/1887). The logistic regression analysis showed that preoperative myocardial injury classification was a significant risk factor for in-hospital mortality in both total cohort (OR 1.491, 95%CI 1.049–2.119) and subsets (OR 1.761, 95%CI 1.102–2.814). The new risk evaluation system has higher calibration and discrimination power than EuroSCORE II, both for overall cohort and subsets. Especially, the new system has obvious advantages in discrimination power in the subset of acute myocardial infarction (AUC 0.813 vs. 0.772, 0.906 vs. 0.841, and 0.715 vs. 0.646, respectively). Conclusions Both myocardial injury classification and EuroSCORE II are independent risk factors of in-hospital mortality in OPCABG patients. The new risk evaluation system has higher predictive ability than EuroSCORE II, especially in patients with a recent history of AMI.
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Affiliation(s)
- Xiang Li
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, People's Republic of China
| | - Lingtong Shan
- Department of Thoracic Surgery, Sheyang County People's Hospital, Yancheng, Jiangsu, People's Republic of China.,Department of Thoracic Surgery, Yancheng Third People's Hospital, The Affiliated Yancheng Hospital of Southeast University Medical College, Yancheng, Jiangsu, People's Republic of China
| | - Mengwei Lv
- Shanghai East Hospital of Clinical Medical College, Nanjing Medical University, Shanghai, People's Republic of China.,Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, People's Republic of China
| | - Zhi Li
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital With Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Chunyan Han
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No.301 Central Yanchang Road, Shanghai, 200072, People's Republic of China
| | - Ban Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No.301 Central Yanchang Road, Shanghai, 200072, People's Republic of China.
| | - Wen Ge
- Department of Cardiothoracic Surgery, Shuguang Hospital, Affiliated to Shanghai University of TCM, Shanghai, People's Republic of China.
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, People's Republic of China.
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High-sensitivity C-reactive protein as a prognostic marker in patients undergoing valve surgery. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 17:15-19. [PMID: 32728357 PMCID: PMC7379212 DOI: 10.5114/kitp.2020.94185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/23/2020] [Indexed: 11/17/2022]
Abstract
Introduction An inflammatory reaction is a local or systemic response of the organs or tissues of the body to many damaging factors. One of the exponents of the inflammatory process is C-reactive protein (CRP). Aim To investigate the prognostic value of C-reactive protein (CRP) in patients undergoing valve surgery. Material and methods A prospective study was conducted on a group of consecutive patients with haemodynamically significant valve defects who underwent elective valve repair or replacement surgery. The primary end-point was in-hospital death from all causes. Patients were followed by direct observation during hospitalization. The risk of surgery using Euro-SCORE II was calculated for each patient. The plasma levels of C-reactive protein were measured by the Cardiac C-Reactive Protein (Latex) High Sensitive Test (Roche, Germany). Results The study group included 562 patients. The mean age in the studied population was 63 (standard deviation (SD) ±12). The mean plasma preoperative CRP level was 0.39 ±0.3 mg/dl. The primary endpoint occurred in 25 patients. At multivariate analysis age (p = 0.01), CRP (p = 0.02) and NT-proBNP (p = 0.03) remained independent predictors of the primary endpoint. A significant correlation was found between the level of CRP and haemoglobin (r = -0.3; p < 0.0001), red cell distribution width (r = 0.22; p < 0.0001), ejection fraction (r = -0.24, p = 0.007), troponin T (r = 0.3; p < 0.0001), creatinine (r = 0.26; p = 0.001) and body mass index (r = -0.29; p = 0.005). The average total time of hospitalization after the operation in patients with occurrence of the primary endpoint was 25 ±13 days. Conclusions Elevated preoperative CRP was associated with a poorer outcome following valve surgery.
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10
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Duchnowski P, Szymański P, Kuśmierczyk M, Hryniewiecki T. Usefulness of FRAIL Scale in Heart Valve Diseases. Clin Interv Aging 2020; 15:1071-1075. [PMID: 32753858 PMCID: PMC7358089 DOI: 10.2147/cia.s239054] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 01/10/2020] [Indexed: 12/25/2022] Open
Abstract
Background The frailty syndrome is a serious health problem for an aging population. The occurrence of frailty in the group of symptomatic patients undergoing heart valve surgery may have additional clinical implications. The predictive ability of the FRAIL scale in patients undergoing heart valve surgery during a 30-day follow-up has not yet been described. Patients and Methods A prospective study was conducted on a group of consecutive patients with hemodynamically significant valve disease (aortic stenosis, aortic regurgitation, mitral stenosis and mitral regurgitation) that underwent elective valve surgery in 2014–2019. The primary endpoint was 30-day mortality. Univariate analysis, followed by multivariate regression analysis, was performed. Results The study group included 672 consecutive patients (aortic valve stenosis, aortic regurgitation, mitral stenosis and mitral regurgitation) who underwent replacement or repair of the valve. Twenty-five patients died during the 30-day follow-up. At multivariate analysis, FRAIL scale result (OR 2.802; 95% CI 1.275–6.157; p=0.01) and red cell distribution width (RDW) (OR 1.810; 95% CI 1.181–2.775; p=0.006) remained independent predictors of the primary endpoint. Conclusion The presented study showed the predictive ability of the FRAIL scale result in patients undergoing heart valve surgery for 30-day mortality.
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Affiliation(s)
- Piotr Duchnowski
- Institute of Cardiology, Department of Acquired Cardiac Defects, Warsaw, Poland
| | - Piotr Szymański
- Institute of Cardiology, Department of Acquired Cardiac Defects, Warsaw, Poland
| | - Mariusz Kuśmierczyk
- Institute of Cardiology, Department of Cardiosurgery and Transplantology, Warsaw, Poland
| | - Tomasz Hryniewiecki
- Institute of Cardiology, Department of Acquired Cardiac Defects, Warsaw, Poland
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11
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Circulating Secretoneurin Concentrations After Cardiac Surgery: Data From the FINNish Acute Kidney Injury Heart Study. Crit Care Med 2020; 47:e412-e419. [PMID: 30730440 DOI: 10.1097/ccm.0000000000003670] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Secretoneurin is associated with cardiomyocyte Ca handling and improves risk prediction in patients with acute myocardial dysfunction. Whether secretoneurin improves risk assessment on top of established cardiac biomarkers and European System for Cardiac Operative Risk Evaluation II in patients undergoing cardiac surgery is not known. DESIGN Prospective, observational, single-center sub-study of a multicenter study. SETTING Prospective observational study of survival in patients undergoing cardiac surgery. PATIENTS A total of 619 patients undergoing cardiac surgery. INTERVENTIONS Patients underwent either isolated coronary artery bypass graft surgery, single noncoronary artery bypass graft surgery, two procedures, or three or more procedures. Procedures other than coronary artery bypass graft were valve surgery, surgery on thoracic aorta, and other cardiac surgery. MEASUREMENTS AND MAIN RESULTS We measured preoperative and postoperative secretoneurin concentrations and adjusted for European System for Cardiac Operative Risk Evaluation II, N-terminal pro-B-type natriuretic peptide, and cardiac troponin T concentrations in multivariate analyses. During 961 days of follow-up, 59 patients died (9.5%). Secretoneurin concentrations were higher among nonsurvivors compared with survivors, both before (168 pmol/L [quartile 1-3, 147-206 pmol/L] vs 160 pmol/L [131-193 pmol/L]; p = 0.039) and after cardiac surgery (173 pmol/L [129-217 pmol/L] vs 143 pmol/L [111-173 pmol/L]; p < 0.001). Secretoneurin concentrations decreased from preoperative to postoperative measurements in survivors, whereas we observed no significant decrease in secretoneurin concentrations among nonsurvivors. Secretoneurin concentrations were weakly correlated with established risk indices. Patients with the highest postoperative secretoneurin concentrations had worse outcome compared with patients with lower secretoneurin concentrations (p < 0.001 by the log-rank test) and postoperative secretoneurin concentrations were associated with time to death in multivariate Cox regression analysis: hazard ratio lnsecretoneurin 2.96 (95% CI, 1.46-5.99; p = 0.003). Adding postoperative secretoneurin concentrations to European System for Cardiac Operative Risk Evaluation II improved patient risk stratification, as assessed by the integrated discrimination index: 0.023 (95% CI, 0.0043-0.041; p = 0.016). CONCLUSIONS Circulating postoperative secretoneurin concentrations provide incremental prognostic information to established risk indices in patients undergoing cardiac surgery.
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12
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Lionaki S, Liapis G, Boletis JN. Pathogenesis and Management of Acute Kidney Injury in Patients with Nephrotic Syndrome Due to Primary Glomerulopathies. ACTA ACUST UNITED AC 2019; 55:medicina55070365. [PMID: 31336742 PMCID: PMC6681356 DOI: 10.3390/medicina55070365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 01/10/2023]
Abstract
Acute kidney injury in the context of nephrotic syndrome is a serious and alarming clinical problem. Largely, acute kidney injury is a relatively frequent complication among patients with comorbidities while it has been independently associated with an increased risk of adverse outcomes, including death and chronic kidney disease. Nephrotic syndrome, without hematuria or with minimal hematuria, includes a list of certain glomerulopathies; minimal change disease, focal segmental glomerulosclerosis and membranous nephropathy. In the light of primary nephrotic syndrome, pathophysiology of acute kidney injury is differentiated by the nature of the primary disease and the severity of the nephrotic state. This review aims to explore the clinical circumstances and pathogenetic mechanisms of acute kidney injury in patients with nephrotic syndrome due to primary glomerulopathies, focusing on newer perceptions regarding the pathogenesis and management of this complicated condition, for the prompt recognition and timely initiation of appropriate treatment in order to restore renal function to its baseline level. Prompt recognition of the precise cause of acute kidney injury is crucial for renal recovery. Clinical characteristics, laboratory and serological findings along with histopathological findings, if required, will reveal the implicated pathway leading to individualized approach and management.
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Affiliation(s)
- Sophia Lionaki
- Nephrology Department & Transplantation Unit, Laiko Hospital, Faculty of Medicine, National & Kapodistrian University of Athens, 11527 Athens, Greece.
| | - George Liapis
- Department of Pathology, Laiko Hospital, Faculty of Medicine, National & Kapodistrian University of Athens, 11527 Athens, Greece
| | - John N Boletis
- Nephrology Department & Transplantation Unit, Laiko Hospital, Faculty of Medicine, National & Kapodistrian University of Athens, 11527 Athens, Greece
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Passov A, Petäjä L, Pihlajoki M, Salminen US, Suojaranta R, Vento A, Andersson S, Pettilä V, Schramko A, Pesonen E. The origin of plasma neutrophil gelatinase-associated lipocalin in cardiac surgery. BMC Nephrol 2019; 20:182. [PMID: 31113394 PMCID: PMC6530061 DOI: 10.1186/s12882-019-1380-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 05/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background Acute kidney injury (AKI) is common after heart surgery. Neutrophil gelatinase-associated lipocalin (NGAL) is produced in injured kidney. NGAL has been used as an early plasma biomarker for AKI in patients undergoing heart surgery. Neutrophils contain all isoforms (25-kDa, 45-kDa and 145-kDa) but the kidney produces almost exclusively the 25-kDa isoform of NGAL. We investigated first, whether there is association between NGAL and neutrophil activation, and second whether activated neutrophils are a significant source of circulating NGAL in plasma in patients undergoing cardiac surgery. Methods Two separate patient cohorts were studied: 1) the “kinetic cohort” (n = 29) and 2) the “FINNAKI cohort” (n = 306). As NGAL is strictly co-localized with lactoferrin in neutrophils, NGAL and lactoferrin were measured with enzyme-linked immunosorbent assay in all patients. In sixty-one patients of the “FINNAKI cohort” Western blot was used to separate NGAL isoforms according to their molecular size. Mann-Whitney U, Kruskal-Wallis H, Pearson’s and Spearman’s tests were used as appropriate. Results There was strong intraoperative association between NGAL and lactoferrin at all four time-points in the “kinetic cohort”. In the “FINNAKI cohort”, NGAL and lactoferrin concentrations correlated preoperatively (R = 0.59, p < 0.001) and at admission to the intensive care unit (R = 0.69, p < 0.001). At admission to intensive care unit, concentrations of NGAL and lactoferrin were higher in AKI than in non-AKI patients (NGAL: p < 0.001; lactoferrin: p < 0.029). In Western blot analyses, neutrophil specific 45-kDa isoform (median 41% [IQR 33.3–53.1]) and mostly neutrophil derived 145-kDa isoform (median 53.5% [IQR 44.0–64.9%]) together represented over 90% of total NGAL in plasma. Potentially kidney derived NGAL isoform (25-kDa) accounted for only 0.9% (IQR 0.3 – 3.0%) of total NGAL in plasma. There were no statistically significant differences in the distribution of NGAL isomers between AKI and non-AKI patients. Conclusions Plasma NGAL during cardiac surgery is associated with neutrophil activation. Based on molecular size, the majority of circulating NGAL is derived from neutrophils. Neutrophil activation is a confounding factor when interpreting increased plasma NGAL in cardiac surgery.
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Affiliation(s)
- Arie Passov
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, FIN 00029 HUS, Helsinki, Finland.
| | - Liisa Petäjä
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, FIN 00029 HUS, Helsinki, Finland
| | - Marjut Pihlajoki
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, PO BOX 347, FIN 00029 HUS, Helsinki, Finland
| | - Ulla-Stina Salminen
- Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, FIN 00029 HUS, Helsinki, Finland
| | - Raili Suojaranta
- Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, FIN 00029 HUS, Helsinki, Finland
| | - Antti Vento
- Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, FIN 00029 HUS, Helsinki, Finland
| | - Sture Andersson
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, PO BOX 347, FIN 00029 HUS, Helsinki, Finland
| | - Ville Pettilä
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, FIN 00029 HUS, Helsinki, Finland
| | - Alexey Schramko
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, FIN 00029 HUS, Helsinki, Finland
| | - Eero Pesonen
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, FIN 00029 HUS, Helsinki, Finland
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Duchnowski P, Hryniewiecki T, Kuśmierczyk M, Szymanski P. Performance of the EuroSCORE II and the Society of Thoracic Surgeons score in patients undergoing aortic valve replacement for aortic stenosis. J Thorac Dis 2019; 11:2076-2081. [PMID: 31285901 DOI: 10.21037/jtd.2019.04.48] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The aim of the study was to assess the predictive ability of risk calculators of the EuroSCORE II and the Society of Thoracic Surgeons (STS) score in patients undergoing aortic valve replacement (AVR) due to severe aortic valve stenosis (AS) during a 30-day and 1-year follow-up. Methods A prospective study was conducted on a group of consecutive patients with hemodynamically significant aortic valve stenosis that underwent elective valve replacement surgery. The risk of surgery using EuroSCORE II and STS was calculated for each patient. The primary and secondary endpoints were 30-day and 1-year mortality. Results The study group included 428 consecutive patients who underwent replacement of the aortic valve. Thirteen patients died during the 30-day follow-up and 25 patients died during 1-year follow-up. Actual mortality in 30-day observation was 3.0% compared to the predicted 2.9% using EuroSCORE II and 2.1% for STS. The discriminations of ES II and STS score were above 0.8 for mortality prediction during the 30-day and 1-year observation period. Conclusions The EuroSCORE II and STS score showed satisfactory discrimination and calibration for predicting 30-day and 1-year mortality in patients undergoing AVR.
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Affiliation(s)
- Piotr Duchnowski
- Institute of Cardiology, Department of Acquired Cardiac Defects, Warsaw, Poland
| | - Tomasz Hryniewiecki
- Institute of Cardiology, Department of Acquired Cardiac Defects, Warsaw, Poland
| | - Mariusz Kuśmierczyk
- Institute of Cardiology, Department of Cardiosurgery and Transplantology, Warsaw, Poland
| | - Piotr Szymanski
- Institute of Cardiology, Department of Acquired Cardiac Defects, Warsaw, Poland
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Duchnowski P, Hryniewiecki T, Kuśmierczyk M, Szymański P. Postoperative high-sensitivity troponin T as a predictor of sudden cardiac arrest in patients undergoing cardiac surgery. Cardiol J 2019; 26:777-781. [PMID: 30701514 DOI: 10.5603/cj.a2019.0005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/12/2018] [Accepted: 01/21/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The usefulness of high-sensitivity troponin T (hs-TnT) as a predictor of sudden cardiac arrest (SCA) in patients undergoing valve surgery is currently unknown. METHODS A prospective study was conducted on a group of 815 consecutive patients with significant valvular heart disease that underwent elective valve surgery. The primary end-point was postoperative SCA. RESULTS The postoperative SCA occurred in 26 patients. At multivariate analysis of hs-TnT measured immediately after surgery (hs-TnT I) and age remained independent predictors of the primary end-point. CONCLUSIONS Elevated postoperative hs-TnT was associated with a higher risk of postoperative SCA.
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Affiliation(s)
- Piotr Duchnowski
- Department of Acquired Cardiac Defects, Institute of Cardiology, Alpejska 42, Warsaw, Poland.
| | - Tomasz Hryniewiecki
- Department of Acquired Cardiac Defects, Institute of Cardiology, Alpejska 42, Warsaw, Poland
| | - Mariusz Kuśmierczyk
- Department of Acquired Cardiac Defects, Institute of Cardiology, Alpejska 42, Warsaw, Poland
| | - Piotr Szymański
- Department of Acquired Cardiac Defects, Institute of Cardiology, Alpejska 42, Warsaw, Poland
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16
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Duchnowski P, Hryniewiecki T, Kuśmierczyk M, Szymański P. The usefulness of selected biomarkers in patients with valve disease. Biomark Med 2018; 12:1341-1346. [PMID: 30520658 DOI: 10.2217/bmm-2018-0101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AIM The aim of the study was to investigate the prognostic value of selected biomarkers in patients undergoing valve surgery. MATERIALS & METHODS A prospective study was conducted on a group of consecutive patients with hemodynamically significant valve defects that underwent elective valve repair or replacement surgery. The primary end point was any major adverse event including death within 30 days. RESULTS The study group included 416 patients. The composite end point occurred in 81 patients. At multivariate analysis high-sensitivity C-reactive protein (p = 0.03), red cell distribution width (p = 0.0001) and red blood cell count (p = 0.005) remained independent predictors of the primary end point. CONCLUSION Elevated high-sensitivity C-reactive protein, red cell distribution width and red blood cell count were associated with a poorer outcome following valve surgery.
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Affiliation(s)
- Piotr Duchnowski
- Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland
| | - Tomasz Hryniewiecki
- Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland
| | - Mariusz Kuśmierczyk
- Department of Cardiosurgery & Transplantology, Institute of Cardiology, Warsaw, Poland
| | - Piotr Szymański
- Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland
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17
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Duchnowski P, Hryniewiecki T, Koźma M, Mariusz K, Piotr S. High-sensitivity troponin T is a prognostic marker of hemodynamic instability in patients undergoing valve surgery. Biomark Med 2018; 12:1303-1309. [DOI: 10.2217/bmm-2018-0186] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: The usefulness of high-sensitivity troponin T (hs-TnT) as a predictor of perioperative hemodynamic instability is currently unknown. Methods: A prospective study was conducted on a group of 708 consecutive patients with significant valvular heart disease that underwent elective valve surgery. The primary end point was postoperative hemodynamic instability. The secondary end point was death from all causes in patients with perioperative hemodynamic instability. Results: The postoperative hemodynamic instability occurred in 131 patients. At multivariate analysis hs-TnT measured immediately after surgery and New York Heart Association classes remained independent predictors of the primary end point. Age and hs-TnT measured immediately after surgery were associated with an increased risk of death. Conclusion: Elevated postoperative hs-TnT was associated with a higher risk of postoperative hemodynamic instability and death.
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Affiliation(s)
- Piotr Duchnowski
- Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland
| | - Tomasz Hryniewiecki
- Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland
| | - Małgorzata Koźma
- Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland
| | - Kuśmierczyk Mariusz
- Department of Cardiosurgery & Transplantology, Institute of Cardiology, Warsaw, Poland
| | - Szymański Piotr
- Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland
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18
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Duchnowski P, Hryniewiecki T, Kuśmierczyk M, Szymański P. The usefulness of selected biomarkers in aortic regurgitation. Cardiol J 2018; 26:477-482. [PMID: 30234893 DOI: 10.5603/cj.a2018.0108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/13/2018] [Accepted: 09/01/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The aim of the study was to investigate the prognostic value of selected biomarkers in patients with aortic regurgitation undergoing valve surgery. METHODS A prospective study was conducted on a group of consecutive patients with hemodynamically significant aortic regurgitation that underwent elective aortic valve surgery. The primary endpoint was 30-day mortality and any major adverse event within 30 days. RESULTS The study group included 205 consecutive patients who underwent replacement or repair of the aortic valve. The primary endpoint occurred in 72 patients. At multivariate analysis red cell distribution width (RDW; p = 0.03) and high-sensitivity troponin T (hs-TnT; p = 0.02) remained independent predictors of the major complications including death. CONCLUSIONS Elevated preoperative RDW and hs-TnT were associated with a poorer outcome following aortic valve surgery.
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Affiliation(s)
- Piotr Duchnowski
- Department of Acquired Cardiac Defects, Institute of Cardiology, Alpejska 42, Warsaw, Poland.
| | - Tomasz Hryniewiecki
- Department of Acquired Cardiac Defects, Institute of Cardiology, Alpejska 42, Warsaw, Poland
| | - Mariusz Kuśmierczyk
- Department of Cardiosurgery and Transplantology, Institute of Cardiology, Warsaw, Poland
| | - Piotr Szymański
- Department of Acquired Cardiac Defects, Institute of Cardiology, Alpejska 42, Warsaw, Poland
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Ge W, Gu C, Chen C, Chen W, Cang Z, Wang Y, Shi C, Zhang Y. High-sensitivity troponin T release profile in off-pump coronary artery bypass grafting patients with normal postoperative course. BMC Cardiovasc Disord 2018; 18:157. [PMID: 30064376 PMCID: PMC6069958 DOI: 10.1186/s12872-018-0893-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 07/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to investigate the high-sensitivity troponin T (hs-TnT) release profile in off-pump coronary artery bypass grafting (OPCABG) patients with normal postoperative course. METHODS From January 2015 to October 2016, 398 consecutive OPCABG patients who had normal postoperative courses were enrolled. Blood samples for hs-TnT were collected at several time points and the comparisons among different time points grouped by various factors were further analyzed. RESULTS There were 317 male and 81 female patients, with a median age of 64. For 66.1% of the patients, peak hs-TnT occurred at the 24th hour after OPCABG, regardless of the groups divided by different factors. In total, the hs-TnT values were much higher in male group (P = 0.035), in patients who need 5 or more bypass grafts (P = 0.035) and in patients with high-risk EuroSCORE II assessment (P = 0.013). However, we failed to find any significant differences between different age groups (P = 0.129) or among different coronary heart disease classifications (P = 0.191). CONCLUSIONS The hs-TnT values were affected by various factors and culminated around the first 24 h following OPCABG. It may provide some useful information for future clinical studies of myocardial biomarkers after OPCABG.
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Affiliation(s)
- Wen Ge
- Department of Cardiothoracic Surgery, Shuguang Hospital, affiliated to Shanghai University of TCM, Shanghai, 200021, China
| | - Chang Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Chao Chen
- The First Clinical Medical College of Nanjing Medical University, Nanjing, 210029, China
| | - Wangwang Chen
- The First Clinical Medical College of Nanjing Medical University, Nanjing, 210029, China
| | - Zhengqiang Cang
- The First Clinical Medical College of Nanjing Medical University, Nanjing, 210029, China
| | - Yuliang Wang
- Department of Hygiene Analysis and Detection School of Public Health Nanjing Medical University, Nanjing, 210029, China
| | - Chennan Shi
- The First Clinical Medical College of Nanjing Medical University, Nanjing, 210029, China
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China. .,Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
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Abstract
BACKGROUND As a marker of myocardial injury, troponin level correlates with adverse outcomes after myocardial infarction (MI). We hypothesized that patients with a higher preoperative troponin level would have increased morbidity and mortality after coronary artery bypass grafting (CABG). METHODS Preoperative troponin measurements were available for 1,272 patients who underwent urgent or emergent isolated CABG at our institution from 2002 to 2016. Logistic regression assessed the risk-adjusted effect of peak troponin level on morbidity and mortality. Long-term survival analysis was performed with Kaplan-Meier and Cox proportional hazards models. RESULTS Preoperative troponin was positive in 835 patients (65.6%). The median peak troponin for this group was 3.2 ng/mL (interquartile range, 0.6 to 11.9 ng/mL), with a median time from peak troponin to the operation of 3 days (interquartile range, 1 to 4 days). Positive troponin was associated with more significant comorbid conditions and more extensive coronary artery disease. Operative mortality (3.7% versus 1.1%, p = 0.009), major morbidity (11.7% versus 3.9%, p < 0.001), and long-term mortality (median survival 12.5 years versus 13.6 years, p = 0.01) were increased in the positive troponin group. After risk adjustment, positive troponin was not independently associated with increased operative mortality (odds ratio, 2.61; p = 0.053). Adjusted and unadjusted analysis showed the peak preoperative troponin level did not independently predict death at any time point (all odds ratios, 1.0; p > 0.05). CONCLUSIONS A positive preoperative troponin correlates with worse outcomes after CABG, but risk adjustment eliminates much of the short-term predictive value of this biomarker. Peak troponin level does not influence outcomes after CABG and is a poor predictor of events when The Society of Thoracic Surgeons predictive models are used.
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Gahl B, Göber V, Odutayo A, Tevaearai Stahel HT, da Costa BR, Jakob SM, Fiedler GM, Chan O, Carrel TP, Jüni P. Prognostic Value of Early Postoperative Troponin T in Patients Undergoing Coronary Artery Bypass Grafting. J Am Heart Assoc 2018; 7:JAHA.117.007743. [PMID: 29487111 PMCID: PMC5866325 DOI: 10.1161/jaha.117.007743] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac troponin T (cTnT) is elevated after coronary artery bypass grafting surgery. The aim of this study was to determine the association between cTnT elevations between 6 and 12 hours after coronary artery bypass grafting and in-hospital outcome. METHODS AND RESULTS We prospectively studied 1722 patients undergoing isolated coronary artery bypass grafting. We assessed the association between conventional cTnT (749 patients) and high-sensitivity cTnT (hs-cTnT; 973 patients) 6 to 12 hours postoperatively with in-hospital major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, or stroke. The prespecified secondary outcome was a safety composite of MACCE, resuscitation, intensive care unit readmission or admission ≥48 hours, inotrope or vasopressor use ≥24 hours, or new-onset renal insufficiency. Among patients with a conventional cTnT measurement, 92 experienced a MACCE (12%) and 146 experienced a safety composite event (19%). Likewise, for hs-cTnT, 114 experienced a MACCE (12%) and 153 experienced a safety composite event (16%). Compared with cTnT ≤200 ng/L, each 200-ng/L increment in cTnT was associated with a monotonous increase in the odds of MACCE and the safety composite outcome. Conventional and hs-cTnT demonstrated moderate discrimination for MACCE (areas under the fitted receiver operating characteristics curve, 0.72 and 0.77 for conventional and hs-cTnT, respectively) and the safety composite outcome (areas under the fitted receiver operating characteristics curve, 0.66 and 0.74 for conventional and hs-cTnT, respectively) and resulted in improved prognostic performance when added to the EuroSCORE. At a cutoff of 800 ng/L, conventional and hs-cTnT provided clinically relevant power to rule in MACCE and the safety composite outcome. CONCLUSIONS cTnT levels assessed between 6 and 12 hours after coronary artery bypass grafting identify patients at increased risk of MACCE or other complications.
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Affiliation(s)
- Brigitta Gahl
- Department for Cardiovascular Surgery, Inselspital, Bern University Hospital University of Bern, Switzerland
| | - Volkhard Göber
- Department for Cardiovascular Surgery, Inselspital, Bern University Hospital University of Bern, Switzerland
| | - Ayodele Odutayo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine, University of Toronto, Ontario, Canada
| | - Hendrik T Tevaearai Stahel
- Department for Cardiovascular Surgery, Inselspital, Bern University Hospital University of Bern, Switzerland
| | - Bruno R da Costa
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.,Department of Cardiology, Swiss Cardiovascular Center Bern, Inselspital Bern University Hospital, Bern, Switzerland
| | - Stephan M Jakob
- Department of Intensive Care Medicine, Inselspital University Hospital Bern, Switzerland
| | - G Martin Fiedler
- Center for Laboratory Medicine, Inselspital University Hospital Bern, Bern, Switzerland
| | - Olivia Chan
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine, University of Toronto, Ontario, Canada
| | - Thierry P Carrel
- Department for Cardiovascular Surgery, Inselspital, Bern University Hospital University of Bern, Switzerland
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine, University of Toronto, Ontario, Canada
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Laine A, Niemi T, Schramko A. Transfusion Threshold of Hemoglobin 80 g/L Is Comparable to 100 g/L in Terms of Bleeding in Cardiac Surgery: A Prospective Randomized Study. J Cardiothorac Vasc Anesth 2018; 32:131-139. [DOI: 10.1053/j.jvca.2017.08.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Indexed: 01/28/2023]
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Brynildsen J, Petäjä L, Pettilä V, Nygård S, Vaara ST, Linko R, Okkonen M, Hagve TA, Soininen L, Suojaranta-Ylinen R, Lyngbakken MN, Omland T, Røsjø H. The predictive value of NT-proBNP and hs-TnT for risk of death in cardiac surgical patients. Clin Biochem 2018; 53:65-71. [PMID: 29371002 DOI: 10.1016/j.clinbiochem.2018.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/11/2017] [Accepted: 01/19/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is used for risk stratification before cardiac surgery, but whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT) may add prognostic information to EuroSCORE II is not known. METHODS Preoperative (n=640) and postoperative (n=629) blood samples were available from cardiac surgical patients with 961-day follow-up (FINNAKI Heart study; cohort #1). The accuracy of a parsimonious risk model with NT-proBNP measurements was also tested in 90 patients with respiratory failure after cardiac surgery (FINNALI study; cohort #2). RESULTS Sixty-one patients (9.5%) died during follow-up in cohort #1. Preoperative NT-proBNP and hs-TnT concentrations correlated (rho=0.58; p<0.001) and were higher in non-survivors compared to survivors: median 2027 (Q1-3 478-5387) vs. 373 (134-1354) ng/L [NT-proBNP] and 39 (16-191) vs. 13 (8-32) ng/L [hs-TnT]; p<0.001 for both. Preoperative NT-proBNP concentrations were associated with time to death after adjustment for EuroSCORE II (HR [lnNT-proBNP] 1.33 [95% CI 1.08-1.64]), p=0.008 and reclassified patients on top of EuroSCORE II (net reclassification index 0.39 [95% CI 0.14-0.64], p=0.003). Pre- and postoperative NT-proBNP concentrations were closely correlated (rho=0.80, p<0.001) and postoperative NT-proBNP concentrations were also associated with long-term mortality after adjustment for EuroSCORE II. A parsimonious risk model that included age, creatinine clearance, chronic pulmonary disease, and NT-proBNP measurements provided comparable prognostic accuracy as EuroSCORE II in cohort #1 and #2 for risk of long-term mortality. hs-TnT measurements did not add to NT-proBNP measurements CONCLUSION: NT-proBNP measurements could improve and simplify risk prediction in cardiac surgical patients.
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Affiliation(s)
- Jon Brynildsen
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liisa Petäjä
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Ville Pettilä
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland; Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ståle Nygård
- Bioinformatics Core Facility, Institute for Medical Informatics, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Suvi T Vaara
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Rita Linko
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Marjatta Okkonen
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Tor-Arne Hagve
- Division of Diagnostics and Technology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Leena Soininen
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Raili Suojaranta-Ylinen
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Magnus Nakrem Lyngbakken
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Petäjä L, Vaara S, Liuhanen S, Suojaranta-Ylinen R, Mildh L, Nisula S, Korhonen AM, Kaukonen KM, Salmenperä M, Pettilä V. Acute Kidney Injury After Cardiac Surgery by Complete KDIGO Criteria Predicts Increased Mortality. J Cardiothorac Vasc Anesth 2017; 31:827-836. [DOI: 10.1053/j.jvca.2016.08.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Indexed: 02/05/2023]
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