Oliveira MABD, Santos CAD, Brandi AC, Dotta AH, Botelho PHH, Godoy MFD, Braile DM. Effect of Preoperative Creatinine Levels on Mortality after Coronary Artery Bypass Grafting Surgery: an Observational Study.
Braz J Cardiovasc Surg 2019;
34:149-155. [PMID:
30916124 PMCID:
PMC6436786 DOI:
10.21470/1678-9741-2018-0261]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/26/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction
Renal function is an independent risk factor for mortality among on-pump
coronary bypass grafting (ONCABG) patients. This association is well known
in the international literature, but there is a lack of knowledge of how
admission creatinine (AC) levels modulate each cardiovascular risk
factor.
Objective
The aim of this paper was to assess the effect of different AC levels on
mortality among ONCABG patients.
Methods
1,599 patients who underwent ONCABG between December 1999 and February 2006
at Hospital de Base in São José do Rio Preto/SP-Brazil were
included. They were divided into quartiles according to their AC levels (QI:
0.2 ≤AC < 1.0 mg/dL; QII: 1.0 ≤ AC < 1.2 mg/dL; QIII:
1.2 ≤ AC < 1.4 mg/dL; and QIV: 1.4 ≤ AC ≤ 2.6
mg/dL). Seven risk factors were then evaluated in each stratum.
Results
Mortality was higher in the QIV group than QI or QII groups. Factors such as
age (≥ 65 years) and cardiopulmonary bypass (CPB) time (≥ 115
minutes) in QIV, as well preoperative hospital stay (≥ 5 days) in
QIII, were associated with higher mortality rates. Creatinine variation
greater than or equal to 0.4 mg/dL increased mortality rates in all groups.
The use of intra-aortic balloon pump and dialysis increased mortality rates
in all groups except for QII. Type I neurological dysfunction increased the
mortality rate in the QII and III groups.
Conclusion
Creatinine levels play an important role in ONCABG mortality. The combination
of selected risk factors and higher AC values leads to a worse prognosis. On
the other hand, lower AC values were associated with a protective effect,
even among elderly patients and those with a high CPB time.
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