Introduction Acyanotic congenital heart disease (ACHD) patients with pulmonary hypertension (PH) are prone to postoperative complications, and characterization of the risk profile continues to fail in identifying inflammatory predilection. Our objective is to investigate the role of platelet-leukocyte indices (neutrophil-lymphocyte ratio [NLR], platelet-lymphocyte ratio [PLR], and systemic immune-inflammation index [SII] [neutrophil × platelet/lymphocyte]) in predicting poor outcomes following cardiac surgery in ACHD cohort with preoperative PH. Methods This single-center, retrospective risk-predictive study included ACHD patients undergoing surgical correction at our tertiary cardiac center between January 2015 and December 2019. Standard institutional perioperative management protocol was followed, and poor postoperative outcome was defined as ≥ 1 of: low cardiac output syndrome, new-onset renal failure, prolonged mechanical ventilation (MV > 24 hours), stroke, sepsis, and/or death. Results One hundred eighty patients out of 1,040 (17.3%) presented poor outcome. On univariate analysis, preoperative factors including right ventricular systolic pressure (RVSP) (PH-severity marker), congestive heart failure, albumin, NLR, PLR, SII, and aortic cross-clamping (ACC) and cardiopulmonary bypass (CPB) times predicted poor outcome. However, on multivariate analysis, RVSP, NLR, SII, and ACC and CPB times emerged as independent predictors. An NLR, SII prognostic cutoff of 3.33 and 860.6×103/mm3 was derived (sensitivity: 77.8%, 78.9%; specificity: 91.7%, 82.2%; area under the curve: 0.871, 0.833). NLR and SII values significantly correlated with postoperative MV duration, mean vasoactive-inotropic scores, and length of intensive care unit and hospital stay ( P <0.001). Conclusion Novel parsimonious, reproducible plateletleukocyte indices present the potential of stratifying the risk in congenital cardiac surgical patients with pre-existing PH.
Background The metabolic–nutritional profile of coronary artery disease (CAD) patients can be an important outcome determinant. A high visceral adiposity index (VAI) and a low prognostic nutritional index (PNI) have been described to predict major adverse cardiac and cerebral events (MACCE) in nonoperative settings and poor cardiac-surgical outcomes, respectively. The present study evaluated the MACCE-predictive value of the two indices, in isolation and as a combined adiposity–nutritional index (CANI = VAI/PNI) in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods The retrospective study was conducted in 1207 OPCABG patients at a tertiary cardiac care center. Thirty-day postoperative data was evaluated for the development of MACCE, defined by any of the following: cardiac arrest, ST-segment elevation myocardial ischemia (STEMI), repeat coronary revascularization, or stroke. The perioperative characteristics of the MACCE and no-MACCE groups were analyzed for the predictors of postoperative MACCE. Results One-hundred thirty-two patients (10.93%) developed MACCE postoperatively. On univariate analysis, age, EuroSCORE II, ejection fraction, diabetes mellitus, asymptomatic carotid artery disease, left main (LM) disease, PNI, and VAI predicted MACCE. Subsequent to multivariate analysis, age, EuroSCORE II, and CANI were the independent predictors. The MACCE predictive cutoffs of VAI, PNI, and CANI were 3.2, 38.46, and 0.075 (area under the curve [AUC]; sensitivity; specificity: 0.64; 77%; 81.3%, 0.77; 92.6%, 65%, 0.78; 64.5%; 80.2%, respectively). CANI correlated positively with duration of mechanical ventilation, length of intensive care unit (ICU) stay, and mean postoperative vasoactive inotropic scores (VIS). CANI ≥ 0.075 was also associated with a higher incidence of postoperative atrial fibrillation, low cardiac output syndrome, and acute kidney injury. Conclusions CANI emerged as an independent predictor of MACCE following OPCABG.
Background and Aims:At equal minimum alveolar concentration (MAC), volatile agents may produce different bispectral index (BIS) values especially at low BIS levels when the effect is volatile agent specific. The present study was performed to compare the BIS values produced by sevoflurane and isoflurane at equal MAC and thereby assessing which is a better hypnotic agent.Methods:Sixty American Society of Anaesthesiologists I and II patients undergoing elective mastoidectomy were divided into groups receiving either isoflurane or sevoflurane, and at equi-MAC. BIS value was measured during both wash in and wash out phase, keeping other parameters same. Statistical analysis was performed using the Friedman two-way analysis and Mann-Whitney U-test. A P < 0.05 was considered significant.Results:BIS value was significantly lower with sevoflurane at all MAC values as compared to isoflurane, except in the beginning and at MAC awake. However, both the drugs proved to be cardiostable.Conclusion:At equi-MAC sevoflurane produces lower BIS values during wash in as well as wash out phase as compared to isoflurane, reflecting probably an agent specific effect and a deficiency in BIS algorithm for certain agents and their interplay.
The health care burden and risks to health care workers imposed by novel coronavirus disease 2019 (COVID-19) mandated the need for a simple, noninvasive, objective, and parsimonious risk stratification system predicting the level of care, need for definitive airway, and titration of the ongoing patient care. Shock index (SI = heart rate/systolic blood pressure) has been evaluated in emergency triage, sepsis, and trauma settings including different age group of patients. The ever accumulating girth of evidences demonstrated a superior predictive value of SI over other hemodynamic parameters. Inclusion of respiratory and/or neurological parameters and adjustment of the cutoffs appropriate to patient age increase the predictability in the trauma and sepsis scenario. Being reproducible, dynamic, and simple, SI can be a valuable patient risk stratification tool in this ongoing era of COVID-19 pandemic.
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