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Hill A, Bergmann D, Schulte J, Zayat R, Marx G, Simon TP, Mossanen J, Brücken A, Stoppe C. Proenkephalin A and bioactive adrenomedullin are useful for risk prognostication in cardiac surgery. Front Cardiovasc Med 2023; 9:1017867. [PMID: 36756642 PMCID: PMC9900105 DOI: 10.3389/fcvm.2022.1017867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/28/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Various clinical scores have been developed to predict organ dysfunction and mortality in patients undergoing cardiac surgery, but outcome prediction may be inaccurate for some patient groups. Proenkephalin A (penKid) and bioactive adrenomedullin (bio-ADM) have emerged as promising biomarkers correlating with shock and organ dysfunction. This imposes the question of whether they can be used as prognostic biomarkers for risk stratification in the perioperative setting of cardiac surgery. Methods Patients undergoing cardiac surgery were prospectively enrolled in this observational study. PenKid and bio-ADM plasma levels, as well as markers evaluating inflammation and organ dysfunction, were measured at five perioperative time points from before the induction of anesthesia to up to 48 h postoperatively. Clinical data regarding organ dysfunction and patient outcomes were recorded during the intensive care unit (ICU)-stay with a special focus on acute kidney injury (AKI). Results In 136 patients undergoing cardiac surgery, the bio-ADM levels increased and the penKid levels decreased significantly over time. PenKid was associated with chronic kidney disease (CKD), the incidence of AKI, and renal replacement therapy (RRT). Bio-ADM was associated with lactate and the need for vasopressors. PenKid was useful to predict an ICU-length of stay (LOS)>1 day and added prognostic value to the European System for Cardiac Operative Risk Evaluation Score (EuroSCORE) II when measured after the end of cardiopulmonary bypass and 24 h after cardiac surgery. For bio-ADM, the same was true when measured 24 h after surgery. PenKid also added prognostic value to the EuroSCORE II for the combined outcome "ICU length of stay >1 day and in-hospital mortality." Conclusion The combination of preoperative EuroSCORE II and intraoperative measurement of penKid may be more useful to predict a prolonged ICU LOS and increased mortality than EuroSCORE II alone. Bio-ADM correlates with markers of shock. More research is encouraged for early risk stratification and validation of penKid and bio-ADM as a tool involved in clinical decisions, which may enable the early initiation of organ protective strategies.
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Affiliation(s)
- Aileen Hill
- Department of Intensive Care and Intermediate Care, Medical Faculty RWTH Aachen, Aachen, Germany
- Department of Anesthesiology, Medical Faculty RWTH Aachen, Aachen, Germany
| | | | | | - Rashad Zayat
- Department of Cardiothoracic Surgery, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Gernot Marx
- Department of Intensive Care and Intermediate Care, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Tim-Philipp Simon
- Department of Intensive Care and Intermediate Care, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Jana Mossanen
- Department of Intensive Care and Intermediate Care, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Anne Brücken
- Department of Intensive Care and Intermediate Care, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Christian Stoppe
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
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Zamperoni A, Carrara G, Greco M, Rossi C, Garbero E, Nattino G, Minniti G, Del Sarto P, Bertolini G, Finazzi S. Benchmark of Intraoperative Activity in Cardiac Surgery: A Comparison between Pre- and Post-Operative Prognostic Models. J Clin Med 2022; 11:jcm11113231. [PMID: 35683616 PMCID: PMC9181738 DOI: 10.3390/jcm11113231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives: Despite its large diffusion and improvements in safety, the risks of complications after cardiac surgery remain high. Published predictive perioperative scores (EUROSCORE, STS, ACEF) assess risk on preoperative data only, not accounting for the intraopertive period. We propose a double-fold model, including data collected before surgery and data collected at the end of surgery, to evaluate patient risk evolution over time and assess the direct contribution of surgery. Methods: A total of 15,882 cardiac surgery patients from a Margherita-Prosafe cohort study were included in the analysis. Probability of death was estimated using two logistic regression models (preoperative data only vs. post-operative data, also including information at discharge from the operatory theatre), testing calibration and discrimination of each model. Results: Pre-operative and post-operative models were built and demonstrate good discrimination and calibration with AUC = 0.81 and 0.87, respectively. Relative difference in pre- and post-operative mortality in separate centers ranged from −0.36 (95% CI: −0.44–−0.28) to 0.58 (95% CI: 0.46–0.71). The usefulness of this two-fold preoperative model to benchmark medical care in single hospital is exemplified in four cases. Conclusions: Predicted post-operative mortality differs from predicted pre-operative mortality, and the distance between the two models represent the impact of surgery on patient outcomes. A double-fold model can assess the impact of the intra-operative team and the evolution of patient risk over time, and benchmark different hospitals on patients subgroups to promote an improvement in medical care in each center.
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Affiliation(s)
- Anna Zamperoni
- Cà Foncello Hospital, AULSS2 Treviso, 31100 Treviso, Italy; (A.Z.); (G.M.)
| | - Greta Carrara
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (G.C.); (C.R.); (E.G.); (G.N.); (G.B.); (S.F.)
| | - Massimiliano Greco
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
- Correspondence: ; Tel.: +39-02-82244136
| | - Carlotta Rossi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (G.C.); (C.R.); (E.G.); (G.N.); (G.B.); (S.F.)
| | - Elena Garbero
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (G.C.); (C.R.); (E.G.); (G.N.); (G.B.); (S.F.)
| | - Giovanni Nattino
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (G.C.); (C.R.); (E.G.); (G.N.); (G.B.); (S.F.)
| | - Giuseppe Minniti
- Cà Foncello Hospital, AULSS2 Treviso, 31100 Treviso, Italy; (A.Z.); (G.M.)
| | - Paolo Del Sarto
- Department of Critical Care, G. Pasquinucci Heart Hospital, Fondazione Toscana G. Monasterio, 54100 Massa, Italy;
| | - Guido Bertolini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (G.C.); (C.R.); (E.G.); (G.N.); (G.B.); (S.F.)
| | - Stefano Finazzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (G.C.); (C.R.); (E.G.); (G.N.); (G.B.); (S.F.)
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Cromhout PF, Thygesen LC, Moons P, Nashef S, Damgaard S, Berg SK. Social and emotional factors as predictors of poor outcomes following cardiac surgery. Interact Cardiovasc Thorac Surg 2021; 34:193-200. [PMID: 34606597 PMCID: PMC8766216 DOI: 10.1093/icvts/ivab261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/21/2021] [Accepted: 08/13/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Existing risk prediction models in cardiac surgery stratify individuals based on their predicted risk, including only medical and physiological factors. However, the complex nature of risk assessment and the lack of parameters representing non-medical aspects of patients’ lives point towards the need for a broader paradigm in cardiac surgery. Objectives were to evaluate the predictive value of emotional and social factors on 4 outcomes; death within 90 days, prolonged stay in intensive care (≥72 h), prolonged hospital admission (≥10 days) and readmission within 90 days following cardiac surgery, as a supplement to traditional risk assessment by European System for Cardiac Operative Risk Evaluation (EuroSCORE). METHODS The study included adults undergoing cardiac surgery in Denmark 2014–2017 including information on register-based socio-economic factors, and, in a nested subsample, self-reported symptoms of anxiety and depression. Logistic regression analyses were conducted, adjusted for EuroSCORE, of variables reflecting social and emotional factors. RESULTS Amongst 7874 included patients, lower educational level (odds ratio 1.33; 95% confidence interval 1.17–1.51) and living alone (1.25; 1.14–1.38) were associated with prolonged hospital admission after adjustment for EuroSCORE. Lower educational level was also associated with prolonged intensive care unit stay (1.27; 1.00–1.63). Having a high income was associated with decreased odds of prolonged hospital admission (0.78; 0.70–0.87). No associations or predictive value for symptoms of anxiety or depression were found on any outcomes. CONCLUSIONS Social disparity is predictive of poor outcomes following cardiac surgery. Symptoms of anxiety and depression are frequent especially amongst patients with a high-risk profile according to EuroSCORE. Subj collection 105, 123
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Affiliation(s)
| | - Lau Caspar Thygesen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Samer Nashef
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Sune Damgaard
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
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Cromhout PF, Thygesen LC, Moons P, Nashef S, Damgaard S, Christensen AV, Rasmussen TB, Borregaard B, Thrysoee L, Thorup CB, Mols RE, Juel K, Berg SK. Supplementing prediction by EuroSCORE with social and patient-reported measures among patients undergoing cardiac surgery. J Card Surg 2020; 36:509-521. [PMID: 33283356 DOI: 10.1111/jocs.15227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/28/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The risk of poor outcomes is traditionally attributed to biological and physiological processes in cardiac surgery. However, evidence exists that other factors, such as emotional, behavioral, social, and functional, are predictive of poor outcomes. Objectives were to evaluate the predictive value of several emotional, social, functional, and behavioral factors on four outcomes: death within 90 days, prolonged stay in intensive care, prolonged hospital admission, and readmission within 90 days following cardiac surgery. METHODS This prospective study included adults undergoing cardiac surgery 2013-2014, including information on register-based socioeconomic factors and self-reported health in a nested subsample. Logistic regression analyses to determine the association and incremental value of each candidate predictor variable were conducted. Multiple regression analyses were used to determine the incremental value of each candidate predictor variable, as well as discrimination and calibration based on the area under the curve (AUC) and Brier score. RESULTS Of 3217 patients, 3% died, 9% had prolonged intensive care stay, 51% had prolonged hospital admission, and 39% were readmitted to hospital. Patients living alone (odds ratio, 1.19; 95% confidence interval, 1.02-1.38), with lower educational levels (1.27; 1.04-1.54) and low health-related quality of life (1.43; 1.02-2.01) had prolonged hospital admission. Analyses revealed living alone as predictive of prolonged intensive care unit (ICU) stay (Brier, 0.08; AUC, 0.68), death (0.03; 0.71), and prolonged hospital admission (0.24; 0.62). CONCLUSION Living alone was found to supplement EuroSCORE in predicting death, prolonged hospital admission, and prolonged ICU stay following cardiac surgery. Low educational level and impaired health-related quality of life were, furthermore, predictive of prolonged hospital admission.
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Affiliation(s)
- Pernille F Cromhout
- Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lau C Thygesen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Samer Nashef
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom
| | - Sune Damgaard
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne V Christensen
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Trine B Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Charlotte B Thorup
- Department of Cardiology, Cardiac Surgery & Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Rikke E Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Knud Juel
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Selina K Berg
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
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Abstract
PURPOSE OF REVIEW To review the current state of preoperative psychological preparation to improve outcomes after cardiac surgery. RECENT FINDINGS Preoperative psychosocial factors are associated with short- and long-term outcomes after cardiac surgery. There are several approaches to optimize patients' preoperative psychological status with promising effects on postoperative outcomes (e.g., less complications, improved quality of life). Preoperative psychological preparation often aims to improve patients' knowledge or social support and to modify and optimize expectations and illness beliefs. Preoperative psychological preparation is gaining importance for cardiac surgery. However, patients' psychological status still does not get as much attention as it deserves. Preoperative psychological preparation seems to have positive effects on postoperative outcomes. Since overall evidence is still weak, further studies are warranted to understand which intervention works best for whom and why.
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Affiliation(s)
- Stefan Salzmann
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
| | | | - Marcel Wilhelm
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Frank Euteneuer
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
- Department of Psychology, Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
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