Analysis of risk factors for in-hospital mortality in 177 patients who underwent isolated coronary bypass grafting and received intra aortic balloon pump

Risk factors of in-hospital mortality for isolated on-pump coronary artery bypass graft surgery in the northeast of Iran from 2007 to 2016

BACKGROUND AND OBJECTIVE

Coronary artery bypass graft (CABG) surgery is the most common cardiac surgery worldwide. The reported mortality rates for this operation vary greatly. We aimed to determine the risk factors of in-hospital mortality for isolated on-pump CABG surgery.

METHODS

This was a large-scale retrospective cohort study of two heart centers in Golestan province. Patients over the age of 18 from both genders who underwent isolated on-pump CABG procedures from 2007 to 2016 were included. The study outcome was in-hospital mortality, which was determined according to the clinical records of study patients.

RESULTS

A total of 3704 patients were included in the study, and 63% were men. In-hospital mortality occurred in 2.8% (n=103) of the patients. The median (IQR) age of survived and not-survived patients were 59 (53-65) and 62 (55-75) years, respectively. 44% of the mortalities occurred in patients older than 65, while 28% of the survivors were older than 65. Multivariable logistic regression indicated that emergency CABG (OR 4.52, 95% CI, 1.45, 14.02; P = 0.009) and cardiopulmonary bypass time (CPB) (OR 1.004, 95% CI 1.001, 1.008; P = 0.034) were the risk factors of in-hospital mortality. The area under the receiver operating characteristic (ROC) curve (AUC) of the model consisting of operative and preoperative variables was 0.70 (acceptable performance).

CONCLUSION

Our study revealed an acceptable mortality proportion for CABG surgeries conducted in the region. Emergency CABG and CPB time were the main risk factors for in-hospital mortality after CABG.

Risk factors for development of acute renal failure in 5077 coronary artery bypass grafting patients in the current era

BACKGROUND

Acute renal failure (ARF) is one of the major complications after coronary artery bypass grafting (CABG) surgery. The risk factors are changing along with the technical evolution. The aim of this study was to identify the risk factors for ARF requiring dialysis after CABG surgery in the current era.

METHODS

Between April 2012 and November 2019, 5077 consecutive patients who underwent CABG were analyzed retrospectively. The patients were divided into ARF group and non-ARF group according to whether ARF occurred and dialysis was required after operation. Univariate analysis was performed to find possible factors associated with ARF. Any variables that had trends to be associated with ARF were included in stepwise multiple logistic regression analysis.

RESULTS

Of the 5077 patients who underwent CABG, 53 (1.04%) developed ARF requiring dialysis whereas 5024 (98.96%) were in non-ARF group. Cardiopulmonary bypass (CPB) time (odds ratio [OR], 1.009; 95% confidence interval [CI], 1.003-1.016; p = .006), insertion of intra-aortic balloon pump (IABP; OR, 19.294; 95% CI, 5.49-67.808; p = .000), and low ejection fraction (EF; OR, 0.943; 95% CI, 0.894-0.994; p = .030) were independent risk factors for development of ARF requiring dialysis in patients undergoing CABG surgery.

CONCLUSION

Our study identified prolonged CPB time, insertion of IABP, and low EF as independent risk factors for developing ARF requiring dialysis after CABG. The results suggest that shortening of CPB time and protection of cardiac function are important factors to prevent ARF and that special care should be taken to protect the renal function when the patient need insertion of IABP.

Prediction Models for One-Year Survival of Adult Patients with Acute Kidney Injury: A Longitudinal Study Based on the Data from the Medical Information Mart for Intensive Care III Database

Acute kidney injury (AKI) is a common complication of acute illnesses with unfavorable outcomes. This cohort study aimed at constructing prediction models for one-year survival in adult AKI patients based on prognostic nutritional index (PNI), platelet-to-lymphocyte ratio (PLR), neutrophil percentage-to-albumin ratio (NPAR), or neutrophil-to-lymphocyte ratio (NLR), respectively. In total, 6050 patients from Medical Information Mart for Intensive Care III (MIMIC-III) were involved. The least absolute shrinkage and selection operator (LASSO) regression was utilized to screen possible covariates. The samples were randomly divided into the training set and the testing set at a ratio of 7.5 : 2.5, and the prediction models were constructed in the training set by random forest. The prediction values of the models were measured via sensitivity, specificity, negative prediction value (NPV), positive prediction value (PPV), area under the curve (AUC), and accuracy. We found that NLR (OR = 1.261, 95% CI: 1.145–1.388), PLR (OR = 1.295, 95% CI: 1.152–1.445), and NPAR (OR = 1.476, 95% CI: 1.261–1.726) were associated with an increased risk, while PNI (OR = 0.035, 95% CI: 0.020–0.059) was associated with a decreased risk of one-year mortality in AKI patients. The AUC was 0.964 (95% CI: 0.959–0.969) in the training set based on PNI, age, gender, length of stay (LOS) in hospital, platelets (PLT), ethnicity, LOS in ICU, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, glucose, AKI stage, atrial fibrillation (AF), vasopressor, renal replacement therapy (RRT), and mechanical ventilation. The testing set was applied as the internal validation of the model with an AUC of 0.778 (95% CI: 0.754–0.801). In conclusion, PNI accompanied by age, gender, ethnicity, SBP, DBP, heart rate, PLT, glucose, AF, RRT, mechanical ventilation, vasopressor, AKI stage, LOS in ICU, and LOS in hospital exhibited a good predictive value for one-year mortality of AKI patients.