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Cai WT, Zeng XY, Huang YS, Chen WS, Chen XJ, Xie XH. The clinical outcome of minor changes in serum creatinine for patients after curative gastrectomy: a prospective study. Front Oncol 2024; 14:1416888. [PMID: 39234398 PMCID: PMC11371684 DOI: 10.3389/fonc.2024.1416888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/29/2024] [Indexed: 09/06/2024] Open
Abstract
Introduction Patients with renal insufficiency are more prone to postoperative complications (PCs). Studies have shown that minor changes in serum creatinine (SCr), immediately post-surgery, can aid in assessing patients' renal function. This study aimed to explore the relationship between the changes in SCr and PCs in patients with gastric cancer (GC). Materials and methods We prospectively collected data regarding the SCr of 530 GC patients, within 2 weeks before surgery and within 24 hours after surgery in our hospital (2014-2016). The patients were divided into three groups according to the level of SCr change after surgery: reduced (<10%), normal (10%), and elevated (>10%) creatinine groups. Univariate and multivariate logistic analysis were performed to evaluate its correlation with short-term PCs in the patients. The R language was used to construct a nomogram. Results 83, 217, and 230 patients were assigned to the elevated, reduced, and normal SCr groups, respectively. Multivariate analysis showed that the reduced and elevated SCr groups were independently associated with the occurrence of PCs and severe postoperative complications (SPCs), respectively. Additionally, postsurgical SCr change, age, hypoalbuminemia, total gastrectomy, combined resection, and laparoscopy, were independently related to PCs. Combining the above influential factors, the predictive model can distinguish patients with PCs more reliably (c-index is 0.715). Conclusion Post-surgery, reduced SCr is a protective factor for PCs, while elevated serum creatinine is an independent risk factor for SPCs. Our nomogram can identify GC patients with high risks of PCs.
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Affiliation(s)
- Wen-Tao Cai
- Department of Traumatic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiu-Ya Zeng
- Acupuncture Massage & Physical Therapy, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yun-Shi Huang
- Department of Traumatic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei-Sheng Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiang-Jian Chen
- Department of Traumatic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xian-Hai Xie
- Department of Traumatic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Zaky A, Younan DS, Meers B, Miller D, Melvin RL, Benz D, Davies J, Kidd B, Mathru M, Tolwani A. A pilot study to explore patterns and predictors of delayed kidney decline after cardiopulmonary bypass. Sci Rep 2024; 14:6739. [PMID: 38509206 PMCID: PMC10954642 DOI: 10.1038/s41598-024-57079-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/14/2024] [Indexed: 03/22/2024] Open
Abstract
There is no current consensus on the follow up of kidney function in patients undergoing cardiopulmonary bypass (CPB). The main objectives of this pilot study is to collect preliminary data on kidney function decline encountered on the first postoperative visit of patients who have had CPB and to identify predictors of kidney function decline post hospital discharge. Design: Retrospective chart review. Adult patients undergoing open heart procedures utilizing CPB. Patient demographics, type of procedure, pre-, intra-, and postoperative clinical, hemodynamic echocardiographic, and laboratory data were abstracted from electronic medical records. Acute kidney disease (AKD), and chronic kidney disease (CKD) were diagnosed based on standardized criteria. Interval change in medications, hospital admissions, and exposure to contrast, from hospital discharge till first postoperative visit were collected. AKD, and CKD as defined by standardized criteria on first postoperative visit. 83 patients were available for analysis. AKD occurred in 27 (54%) of 50 patients and CKD developed in 12 (42%) out of 28 patients. Older age was associated with the development of both AKD and CKD. Reduction in right ventricular cardiac output at baseline was associated with AKD (OR: 0.5, 95% CI: 0.3, 0.79, P = 0.01). Prolongation of transmitral early diastolic filling wave deceleration time was associated with CKD (OR: 1.02, 95% CI: 1.01, 1.05, P = 0.03). In-hospital acute kidney injury (AKI) was a predictor of neither AKD nor CKD. AKD and CKD occur after CPB and may not be predicted by in-hospital AKI. Older age, right ventricular dysfunction and diastolic dysfunction are important disease predictors. An adequately powered longitudinal study is underway to study more sensitive predictors of delayed forms of kidney decline after CPB.
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Affiliation(s)
- Ahmed Zaky
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA.
| | - Duraid S Younan
- Department of Surgery, Staten Island University, Staten Island, USA
| | - Bradley Meers
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA
| | - David Miller
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA
| | - Ryan L Melvin
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA
| | - David Benz
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA
| | - James Davies
- Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Brent Kidd
- Division of Critical Care, Department of Anesthesiology, University of Kansas Medical Center, Kansas City, USA
| | - Mali Mathru
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA
| | - Ashita Tolwani
- Department of Nephrology, University of Alabama at Birmingham, Birmingham, USA
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Khalpey Z, Wilson P, Suri Y, Culbert H, Deckwa J, Khalpey A, Rozell B. Leveling Up: A Review of Machine Learning Models in the Cardiac ICU. Am J Med 2023; 136:979-984. [PMID: 37343909 DOI: 10.1016/j.amjmed.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023]
Abstract
Machine learning has emerged as a significant tool to augment the medical decision-making process. Studies have steadily accrued detailing algorithms and models designed using machine learning to predict and anticipate pathologic states. The cardiac intensive care unit is an area where anticipation is crucial in the division between life and death. In this paper, we aim to review important studies describing the utility of machine learning algorithms to describe the future of artificial intelligence in the cardiac intensive care unit, especially in regards to the prediction of successful ventilatory weaning, acute respiratory distress syndrome, arrhythmia, and acute kidney injury.
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Affiliation(s)
- Zain Khalpey
- Division of Cardiothoracic Surgery, Heart and Vascular Institute, HonorHealth, Scottsdale, Ariz.
| | | | - Yash Suri
- University of Arizona College of Medicine, Tucson
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Magoon R, Kaushal B, Jose J. Comment on: "Prediction of the severity of acute kidney injury after on-pump cardiac surgery". J Clin Anesth 2022; 78:110678. [PMID: 35151146 DOI: 10.1016/j.jclinane.2022.110678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Rohan Magoon
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi 110001, India.
| | - Brajesh Kaushal
- Department of Anaesthesia, Gandhi Medical College and Hamidia Hospital, Bhopal 462001, Madhya Pradesh, India
| | - Jes Jose
- Department of Cardiac Anesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bannerghatta Main Rd, Phase 3, Jayanagara 9th Block, Jayanagar, Bengaluru, Karnataka 5600692, India
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Morimoto Y, Matsuo T, Yano Y, Fukushima T, Eishi K, Kozu R. Impact of sarcopenia on the progress of cardiac rehabilitation and discharge destination after cardiovascular surgery. J Phys Ther Sci 2021; 33:213-221. [PMID: 33814707 PMCID: PMC8012189 DOI: 10.1589/jpts.33.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/01/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate the factors that affect the progress of cardiac rehabilitation, length of stay in the hospital, and discharge destination after cardiovascular surgery. [Participants and Methods] This was a prospective observational study. Sixty-seven patients scheduled to undergo open-heart surgery were included in the study. We evaluated physical and psychiatric functions pre- and post-surgery. Sarcopenia was defined as a short physical performance battery score of <9.5. [Results] Sarcopenia was a significant factor of delay of the day of the first rehabilitation, independence in 100-m walking, and exercise training at the rehabilitation gym. Comparisons between pre- and post-surgery were performed in the sarcopenia group. No significant decreases in physical and psychiatric functions were found. The discharge transfer rate was significantly different between the sarcopenia and non-sarcopenia groups. Sarcopenia and the decline in balance score significantly correlated with discharge transfer. [Conclusion] Cardiac rehabilitation can achieve recovery of physical and psychiatric functions even in patients with sarcopenia; however, the discharge transfer rate among the patients with sarcopenia was high. Improving balance ability may result in early home discharge.
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Affiliation(s)
- Yosuke Morimoto
- Department of Physical Therapy, Faculty of Rehabilitation,
Kobe Gakuin University: 518 Ikawadanicho, Arise, Nishi-ku, Kobe, Hyogo 651-2180,
Japan
| | - Tomohiro Matsuo
- Department of Rehabilitation, Nishi Memorial Port-island
Rehabilitation Hospital, Japan
| | - Yudai Yano
- Department of Rehabilitation Medicine, Nagasaki University
Hospital, Japan
| | - Takuya Fukushima
- Department of Musculoskeletal Oncology and Rehabilitation,
National Cancer Center Hospital, Japan
| | - Kiyoyuki Eishi
- Department of Cardiovascular Surgery, Nagasaki University
Hospital, Japan
| | - Ryo Kozu
- Department of Rehabilitation Medicine, Nagasaki University
Hospital, Japan
- Department of Cardiopulmonary Rehabilitation Science,
Nagasaki University Graduate School of Biomedical Sciences, Japan
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Dong P, Xue FS, Liu SH. Identification of risk factors for acute kidney injury after pulmonary endarterectomy with cardiopulmonary bypass. J Cardiothorac Surg 2020; 15:99. [PMID: 32414397 PMCID: PMC7229587 DOI: 10.1186/s13019-020-01152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/10/2020] [Indexed: 11/10/2022] Open
Abstract
The letter to the editor made several comments on possible issues in the recent article by Zhang et al. determining the risk factors of acute kidney injury after pulmonary endarterectomy with cardiopulmonary bypass, which has been published in Journal of Cardiothoracic Surgery at December 30, 2019.
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Affiliation(s)
- Peng Dong
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
| | - Shao-Hua Liu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
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Liu SH, Xue FS, Zheng L, Hou HJ. Development of a risk prediction model for acute kidney injury after coronary artery bypass grafting: methodological issues. Int Urol Nephrol 2020; 52:803-804. [PMID: 32124235 DOI: 10.1007/s11255-020-02428-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Shao-Hua Liu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
| | - Li Zheng
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Hai-Jun Hou
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
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