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Ahmad RM, Strobel RJ, Young AM, Wisniewski A, Zhang A, Kaplan E, Yarboro LT, Yount KW, Beller J, Teman NR. Renal recovery in cardiac surgery patients requiring postoperative renal-replacement therapy. J Thorac Cardiovasc Surg 2023:S0022-5223(23)01201-1. [PMID: 38135000 DOI: 10.1016/j.jtcvs.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/22/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Renal failure after cardiac surgery is associated with increased morbidity and mortality. There is a lack of data examining the rate of renal recovery after patients have started dialysis following cardiac surgery. We aimed to determine the frequency of and time to renal recovery of patients requiring dialysis after cardiac surgery. METHODS All patients who developed new-onset renal failure requiring dialysis following cardiac surgery at our institution from 2011 to 2022 were included. Renal recovery, time to renal recovery, and mortality at 1 year were merged with patients' Society of Thoracic Surgeons Adult Cardiac Surgery Database files. Kaplan-Meier analysis was used to predict time to renal recovery; we censored patients who died or were lost to follow up. Cox regression was used for risk-adjustment. RESULTS A total of 312 patients were included in the final analysis. Mortality during index hospital admission was 33% (n = 105), and mortality at 1 year was 45% (n = 141). Of those surviving at 1 year, 69% (n = 118) remained renally recovered. Median renal recovery time was 56 (37-74) days. Accounting for mortality as a competing risk, 51% of patients were predicted to achieve renal recovery. Increasing age (hazard ratio, 0.98; 0.514-0.94, P < .026) and increasing total packed red blood cells (hazard ratio, 0.0958; 0.937-0.987, P < .001) received were found to be significant negative predictors of renal recovery in the Fine-Gray model for subhazard distribution. CONCLUSIONS More than two-thirds of patients with renal failure who survived the perioperative period had renal recovery within 1 year after surgery. Recovery was driven primarily by postoperative complications rather than comorbidities and intraoperative factors, suggesting renal failure in the postoperative cardiac surgery patient surviving to discharge is unlikely to be permanent.
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Affiliation(s)
- Raza M Ahmad
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Raymond J Strobel
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Andrew M Young
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Alex Wisniewski
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Ashley Zhang
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Emily Kaplan
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Leora T Yarboro
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Kenan W Yount
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Jared Beller
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Nicholas R Teman
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va.
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Rafiq Abbasi MS, Sultan K, Manzoor R, Nizami AA, Ullah N, Mushtaq A, Saleem H, Umaira Khan Q, Akbar A, Khan Jadoon S, Tasneem S, Saleem Khan M, Alvi S. Assessment of renal function and prevalence of acute kidney injury following coronary artery bypass graft surgery and associated risk factors: A retrospective cohort study at a tertiary care hospital in Islamabad, Pakistan. Medicine (Baltimore) 2023; 102:e35482. [PMID: 37861475 PMCID: PMC10589541 DOI: 10.1097/md.0000000000035482] [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: 07/05/2023] [Accepted: 09/13/2023] [Indexed: 10/21/2023] Open
Abstract
Acute kidney injury (AKI) is a sudden decline in renal function after cardiac surgery. It is characterized by a significant reduction in glomerular filtration rate, alterations in serum creatinine (S.Cr) levels, and urine output. This study aimed to retrospectively analyze a cohort of 704 patients selected using stringent inclusion and exclusion criteria. AKI was defined by an increase of 0.3 mg/dL in S.Cr levels compared to baseline. Data were collected from the hospital and analyzed using SPSS 16.0. Data analysis revealed that 22% (n = 155) of the patients developed AKI on the second post-operative day, accompanied by a substantial increase in S.Cr levels (from 1.064 ± 0.2504 to 1.255 ± 0.2673, P < .000). Age and cardiopulmonary bypass duration were identified as risk factors along with ejection fraction and days of hospital stay, contributing to the development of AKI. Early renal replacement therapy can be planned when the diagnosis of AKI is established early after surgery.
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Affiliation(s)
| | - Khawar Sultan
- Rawal Institute of Health Sciences, Islamabad, Pakistan
| | - Rukhsana Manzoor
- IMT-2, East Kent University Hospital, Canterbury, United Kingdom
| | - Awais Ahmad Nizami
- Director Cath Lab, Department of Cardiology, Shahida Islam Institute of Cardiology, Bahawalpur, Pakistan
| | - Naeem Ullah
- Post Graduate Resident Nephrology, Pakistan Institute of Medical Sciences, PIMS, Islamabad, Pakistan
| | - Adnan Mushtaq
- Registrar Nephrology, Pakistan institute of Medical Sciences (PIMS) Islamabad, Islamabad, Pakistan
| | | | | | - Amna Akbar
- District Headquarter Hospital Jhelum Valley, Muzaffarabad AJK, Pakistan
| | | | - Sabahat Tasneem
- Public Health Professional, Health Services Academy, Islamabad, Pakistan
| | | | - Sarosh Alvi
- Teaching Faculty, University of Khartoum, Khartoum, Sudan
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Almramhi KG, Alkhateeb MA, Alsulami OA, Alhudaifi SA, Alamoudi H, Nabalawi RA. Prevalence and Risk Factors for Acute Kidney Injury Among Adults Undergoing Cardiac Interventions in King Abdulaziz University Hospital: A Retrospective Review. Cureus 2022; 14:e23387. [PMID: 35481303 PMCID: PMC9033530 DOI: 10.7759/cureus.23387] [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] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background Acute kidney injury (AKI) is a syndrome that has been receiving considerable attention as a common risk in cardiac surgeries, which has consequences for short- and long-term survival implications, even for those who do not progress to renal failure. There have been limited studies in the Middle East, and specifically in the Kingdom of Saudi Arabia (KSA). Therefore, our study aimed to identify the prevalence of and risk factors for AKIs following adult cardiac interventions during 2010-2020 at the King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. Methods Setting and Design: A retrospective medical record review was conducted among all the adult patients who underwent cardiac interventions and developed AKIs between 2010 and 2020. Google forms were used to extract the data from the hospital records. About statistical analysis binary logistic regression analyses, relative risks (RRs), and confidence intervals (CI) were used to determine the associations among the variables. Results After applying the inclusion and exclusion criteria, 564 patients were included. Their baseline demographic, clinical, biological, and operative characteristics were analyzed. AKIs developed in 110 (19.5%) patients and patients with diabetes were more likely to develop AKIs (P < 0.012, RR = 2.280, CI = 1.198-4.339). Hypertension showed a strong effect in the development of AKIs (P < 0.004, RR = 2.865, CI = 1.391-5.900). Moreover, patients who suffered from chronic heart failure were more prone to the development of AKIs (P < 0.008, RR = 4.189, CI =1.452-12.087). Furthermore, anemia with significant P-values (<0.002), and CIs of 1.509-6.822, indicated that these patients were more likely to develop AKIs (3.209 times). Conclusion We demonstrated that AKIs are frequent complications in adults after cardiac interventions and were associated with poor outcomes. Risk factors for the development of AKIs were identified to be diabetes mellitus, hypertension, chronic heart failure, and anemia. Further investigation of this cohort is necessary to better understand the problem of kidney injuries.
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Lin PY, Yen YT, Lam CT, Li KC, Lu MJ, Hsu HS. Use of modified-NUTRIC score to assess nutritional risk in surgical intensive care unit. J Chin Med Assoc 2021; 84:860-864. [PMID: 34108425 DOI: 10.1097/jcma.0000000000000565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Modified Nutrition Risk in the Critically Ill (m-NUTRIC) score is used to evaluate the nutritional risk of patients in intensive care units (ICUs). This study aimed to investigate whether m-NUTRIC can be used as a predictive factor related to the outcome of patients in surgical ICU (SICU) and to identify which patients will benefit from aggressive nutritional intervention according to the results of m-NUTRIC score. METHODS A total of 205 patients who were admitted to surgical ICU (SICU) with ventilator use for more than 24 hours were enrolled. The m-NUTRIC score data were calculated the day when the patients were admitted to SICU. Patients were divided into two groups according to their m-NUTRIC score: the low-risk group (<5 points, 116 patients) and the high risk group (≥5 points, 89 patients). RESULTS In this study, a total of 205 patients were enrolled for analysis, including patients in the low-risk group (n = 116) and those in the high risk group (n = 89). The mean duration of ventilator use was 3.6 ± 6.5 days, and average SICU stays for all patients was 5.1 ± 7.4 days. The SICU mortality was significantly higher in the high-risk group (10.3% vs 1.7%). Comparison between survivals and nonsurvivals was carried out, and the data showed that the AKI, Vasopressors, SOFA, APACHE-II, m-NUTRIC score, and shock patient were all significantly associated with higher mortality. The multivariate analysis revealed that acute kidney injury (OR = 13.16; 95% confidence intervals = 3.69-46.92; p < 0.0001) and m-NUTRIC score were independent factors of ICU mortality in these patients. A receiver operating characteristic curve was used to calculate the area under the curve, which was 0.801. The data indicated that high m-NUTRIC score were significantly associated with SICU mortality with the cutoff score > 4 (sensitivity = 90.5%, specificity = 62.3%, p < 0.001). CONCLUSION We found in this study that the high m-NUTRIC score is an independent factor of ICU mortality, and m-NUTRIC score can be used as an initial screening tool for nutritional assessment in patients admitted to surgical ICU. Further investigations to evaluate whether the aggressive nutritional intervention would be beneficial in the SICU patients with higher m-NUTRIC score is mandatory.
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Affiliation(s)
- Pi-Yi Lin
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Critical Care Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Yu-Tong Yen
- Division of Cardiovascular Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Chee-Tat Lam
- Division of Neurosurgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Kuan-Chen Li
- Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Ming-Jen Lu
- Department of Critical Care Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
- Division of Neurosurgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Han-Shui Hsu
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Brain and Muscle Oxygen Saturation Combined with Kidney Injury Biomarkers Predict Cardiac Surgery Related Acute Kidney Injury. Diagnostics (Basel) 2021; 11:diagnostics11091591. [PMID: 34573933 PMCID: PMC8466978 DOI: 10.3390/diagnostics11091591] [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: 07/11/2021] [Revised: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 02/04/2023] Open
Abstract
Background: Early identification of patients at risk for cardiac surgery-associated acute kidney injury (CS-AKI) based on novel biomarkers and tissue oxygen saturation might enable intervention to reduce kidney injury. Aims: The study aimed to ascertain whether brain and muscle oxygenation measured by near-infrared spectroscopy (NIRS), in addition to cystatin C and NGAL concentrations, could help with CS-AKI prediction. Methods: This is a single-centre prospective observational study on adult patients undergoing cardiac surgery using cardiopulmonary bypass (CPB). Brain and muscle NIRS were recorded during surgery. Cystatin C was measured on the first postoperative day, while NGAL directly before and 3 h after surgery. Results: CS-AKI was diagnosed in 18 (16%) of 114 patients. NIRS values recorded 20 min after CPB (with cut-off value ≤ 54.5% for muscle and ≤ 62.5% for the brain) were revealed to be the most accurate predictors of CS-AKI. Preoperative NGAL ≥ 91.5 ng/mL, postoperative NGAL ≥ 140.5 ng/mL, and postoperative cystatin C ≥ 1.23 mg/L were identified as independent and significant CS-AKI predictors. Conclusions: Brain and muscle oxygen saturation 20 min after CPB could be considered early parameters possibly related to CS-AKI risk, especially in patients with increased cystatin C and NGAL levels.
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Chang CY, Chien YJ, Kao MC, Lin HY, Chen YL, Wu MY. Pre-operative proteinuria, postoperative acute kidney injury and mortality: A systematic review and meta-analysis. Eur J Anaesthesiol 2021; 38:702-714. [PMID: 34101638 DOI: 10.1097/eja.0000000000001542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the association of pre-operative proteinuria with postoperative acute kidney injury (AKI) development as well as the requirement for a renal replacement therapy (RRT) and mortality at short-term and long-term follow-up. BACKGROUND Postoperative AKI is associated with surgical morbidity and mortality. Pre-operative proteinuria is potentially a risk factor for postoperative AKI and mortality. However, the results in literature are conflicting. METHODS We searched PubMed, Embase, Scopus, Web of Science and Cochrane Library from the inception through to 3 June 2020. Observational cohort studies investigating the association of pre-operative proteinuria with postoperative AKI development, requirement for RRT, and all-cause mortality at short-term and long-term follow-up were considered eligible. Using inverse variance method with a random-effects model, the pooled effect estimates and 95% confidence interval (CI) were calculated. RESULTS Twenty-eight studies were included. Pre-operative proteinuria was associated with postoperative AKI development [odds ratio (OR) 1.74, 95% CI, 1.45 to 2.09], in-hospital RRT (OR 1.70, 95% CI, 1.25 to 2.32), requirement for RRT at long-term follow-up [hazard ratio (HR) 3.72, 95% CI, 2.03 to 6.82], and long-term all-cause mortality (hazard ratio 1.50, 95% CI, 1.30 to 1.73). In the subgroup analysis, pre-operative proteinuria was associated with increased odds of postoperative AKI in both cardiovascular (OR 1.77, 95% CI, 1.47 to 2.14) and noncardiovascular surgery (OR 1.63, 95% CI, 1.01 to 2.63). Moreover, there is a stepwise increase in OR of postoperative AKI development when the quantity of proteinuria increases from trace to 3+. CONCLUSION Pre-operative proteinuria is significantly associated with postoperative AKI and long-term mortality. Pre-operative anaesthetic assessment should take into account the presence of proteinuria to identify high-risk patients. PROSPERO REGISTRATION CRD42020190065.
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Affiliation(s)
- Chun-Yu Chang
- From the Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City (C-YC, M-CK, H-YL), Department of Anesthesiology, School of Medicine, Tzu Chi University, Hualien (C-YC, M-CK, H-YL), Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City (Y-JC), Department of Physical Medicine and Rehabilitation, School of Medicine, Tzu Chi University, Hualien (Y-JC), Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City (Y-LC, M-YW) and Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan (Y-LC, M-YW)
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7
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Huang DD, Li YY, Fan Z, Wu YG. Preoperative proteinuria may be a risk factor for postoperative acute kidney injury:a meta-analysis. Ren Fail 2021; 43:958-967. [PMID: 34148499 PMCID: PMC8218691 DOI: 10.1080/0886022x.2021.1940201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective To investigate the relationship between preoperative proteinuria and postoperative acute kidney injury (AKI). Methods We performed a search on databases included PubMed, Embase, the Cochrane Library, and Web of Science, from December 2009 to September 2020. Data extracted from eligible studies were synthesized to calculate the odds ratio (OR) and 95% confidence interval (CI). A fixed or random effects model was applied to calculate the pooled OR based on heterogeneity through the included studies. Results This meta-analysis of 11 observational studies included 203,987 participants, of whom 21,621 patients suffered from postoperative AKI and 182,366 patients did not suffer from postoperative AKI. The combined results demonstrated that preoperative proteinuria is an independent risk factor for postoperative AKI (adjusted OR = 1.65, 95%CI:1.44–1.89, p < 0.001). Subgroup analysis showed that both preoperative mild proteinuria (adjusted OR = 1.30, 95%CI:1.24–1.36, p < 0.001) and preoperative heavy proteinuria (adjusted OR = 1.93, 95%CI:1.65–2.27, p < 0.001) were independent risk factors for postoperative AKI. The heterogeneity was combined because its values were lower. Further subgroup analysis found that preoperative proteinuria measured using dipstick was an independent risk factor for postoperative AKI (adjusted OR = 1.48, 95%CI:1.37–1.60, p < 0.001). Finally, preoperative proteinuria was an independent risk factor for postoperative AKI in the non-cardiac surgery group (adjusted OR = 2.06, 95%CI:1.31–3.24, p = 0.002) and cardiac surgery group (adjusted OR = 1.69, 95%CI:1.39–2.06, p < 0.001) Conclusion Preoperative proteinuria is an independent risk factor for postoperative AKI and in instances when proteinuria is detected using dipsticks.
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Affiliation(s)
- Dan-Dan Huang
- Department of Nephropathy, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, P. R. China
| | - Yuan-Yuan Li
- Department of Nephropathy, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, P. R. China
| | - Zhe Fan
- Department of Nephropathy, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, P. R. China
| | - Yong-Gui Wu
- Department of Nephropathy, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, P. R. China
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Surgical Versus Transcatheter Aortic Valve Replacement in Patients With Malignancy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 23:59-65. [DOI: 10.1016/j.carrev.2020.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 11/22/2022]
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Guerrero-Orriach JL, Malo-Manso A, Ramirez-Aliaga M, Florez Vela AI, Galán-Ortega M, Moreno-Cortes I, Gonzalez-Almendros I, Ramirez-Fernandez A, Ariza-Villanueva D, Escalona-Belmonte JJ, Quesada-Muñoz G, Sepúlveda-Haro E, Romero-Molina S, Bellido-Estevez I, Gomez-Luque A, Rubio-Navarro M, Alcaide-Torres J, Santiago-Fernandez C, Garrido-Sanchez L, Cruz-Mañas J. Renal and Neurologic Benefit of Levosimendan vs Dobutamine in Patients With Low Cardiac Output Syndrome After Cardiac Surgery: Clinical Trial FIM-BGC-2014-01. Front Pharmacol 2020; 11:1331. [PMID: 32982742 PMCID: PMC7479222 DOI: 10.3389/fphar.2020.01331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 08/10/2020] [Indexed: 12/19/2022] Open
Abstract
Background Low-cardiac output syndrome (LCOS) after cardiac surgery secondary to systemic hypoperfusion is associated with a higher incidence of renal and neurological damage. A range of effective therapies are available for LCOS. The beneficial systemic effects of levosimendan persist even after cardiac output is restored, which suggests an independent cardioprotective effect. Methods A double-blind clinical trial was conducted in patients with a confirmed diagnosis of LCOS randomized into two treatment groups (levosimendan vs. dobutamine). Monitoring of hemodynamic (cardiac index, systolic volume index, heart rate, mean arterial pressure, central venous pressure, central venous saturation); biochemical (e.g. creatinine, S100B protein, NT-proBNP, troponin I); and renal parameters was performed using acute kidney injury scale (AKI scale) and renal and brain ultrasound measurements [vascular resistance index (VRI)] at diagnosis and during the first 48 h. Results Significant differences were observed between groups in terms of cardiac index, systolic volume index, NT-proBNP, and kidney injury stage at diagnosis. In the levosimendan group, there were significant variations in AKI stage after 24 and 48 h. No significant differences were observed in the other parameters studied. Conclusion Levosimendan showed a beneficial effect on renal function in LCOS patients after cardiac surgery that was independent from cardiac output and vascular tone. This effect is probably achieved by pharmacological postconditioning. Clinical Trial Registration EUDRA CT, identifier 2014-001461-27. https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-001461-27.
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Affiliation(s)
- Jose L Guerrero-Orriach
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain.,Department of Pharmacology and Pediatrics, School of Medicine, University of Malaga, Malaga, Spain
| | - Alfredo Malo-Manso
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Marta Ramirez-Aliaga
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| | | | - Manuel Galán-Ortega
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Isabel Moreno-Cortes
- Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| | | | - Alicia Ramirez-Fernandez
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| | | | - Juan Jose Escalona-Belmonte
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Guillermo Quesada-Muñoz
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| | | | | | - Inmaculada Bellido-Estevez
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Pharmacology and Pediatrics, School of Medicine, University of Malaga, Malaga, Spain
| | - Aurelio Gomez-Luque
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain.,Department of Pharmacology and Pediatrics, School of Medicine, University of Malaga, Malaga, Spain
| | - Manuel Rubio-Navarro
- Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Juan Alcaide-Torres
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Unidad de Gestión Clínica de Endocrinología y Nutrición, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Concepcion Santiago-Fernandez
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Unidad de Gestión Clínica de Endocrinología y Nutrición, Virgen de la Victoria University Hospital, Málaga, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición-CIBEROBN, Instituto de Salud Carlos III, Málaga, Spain
| | - Lourdes Garrido-Sanchez
- Institute of Biomedical Research in Malaga [IBIMA], Malaga, Spain.,Unidad de Gestión Clínica de Endocrinología y Nutrición, Virgen de la Victoria University Hospital, Málaga, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición-CIBEROBN, Instituto de Salud Carlos III, Málaga, Spain
| | - Jose Cruz-Mañas
- Department of Anaesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
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