Background: Acute kidney injury (AKI) is a common complication of coronary artery bypass grafting (CABG) that results in worse prognosis. Studies have shown that recombinant human brain natriuretic peptide (rh-BNP) reduces renal injury. However, its treatment effects for AKI in patients underwent cardiac surgery are unclear. This study sought to explore the efficacy of rh-BNP in patients with AKI after bypass surgery.Methods: This study included patients with AKI diagnosed within 4 days after CABG during the period January 2016 to December 2020. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The clinical characteristics and outcomes were collected. Patients were divided into BNP and non-BNP groups according to whether rh-BNP was injected intravenously after the operation.Multivariable logistic regression was adjusted the confounding effects between clinical characteristics and rh-BNP. Propensity score matching (PSM) was used to perform a sensitivity analysis.Results: A total of 395 patients, including 56 and 339 patients in the BNP and non-BNP groups, respectively, were included in this study. The decreasing trend of postoperative serum creatinine levels (P<0.001) and postoperative urine volume (P=0.001) within 4 days of surgery were independent associated with rh-BNP. From PSM, 175 patients, including 44 and 131 patients in the BNP and non-BNP groups, respectively, were included in this study. The decreasing trend of postoperative serum creatinine levels in the BNP group was significantly stronger than that in the non-BNP group (0.04±0.28 vs. −0.16±0.36, P=0.001).The postoperative urine volume within 4 days of surgery of the BNP group was higher than that of the non-BNP group (11.3±2.8 vs. 9.11±2.66, P<0.001). The cumulative dosage of diuretics after the procedure did not differ between the BNP and non-BNP groups {60 [40, 80] vs. 60 [40, 120], P=0.852}.Conclusions: Rh-BNP can reduce creatinine levels and increases postoperative urine volume to improve renal function in patients.
BackgroundThe identification of uropathogens (UPBs) and urinary tract colonizing bacteria (UCB) conduces to guide the antimicrobial therapy to reduce resistant bacterial strains and study urinary microbiota. This study established a nomogram based on the nanopore-targeted sequencing (NTS) and other infectious risk factors to distinguish UPB from UCB.MethodsBasic information, medical history, and multiple urine test results were continuously collected and analyzed by least absolute shrinkage and selection operator (LASSO) regression, and multivariate logistic regression was used to determine the independent predictors and construct nomogram. Receiver operating characteristics, area under the curve, decision curve analysis, and calibration curves were used to evaluate the performance of the nomogram.ResultsIn this study, the UPB detected by NTS accounted for 74.1% (401/541) of all urinary tract microorganisms. The distribution of ln(reads) between UPB and UCB groups showed significant difference (OR = 1.39; 95% CI, 1.246–1.551, p < 0.001); the reads number in NTS reports could be used for the preliminary determination of UPB (AUC=0.668) with corresponding cutoff values being 7.042. Regression analysis was performed to determine independent predictors and construct a nomogram, with variables ranked by importance as ln(reads) and the number of microbial species in the urinary tract of NTS, urine culture, age, urological neoplasms, nitrite, and glycosuria. The calibration curve showed an agreement between the predicted and observed probabilities of the nomogram. The decision curve analysis represented that the nomogram would benefit clinical interventions. The performance of nomogram with ln(reads) (AUC = 0.767; 95% CI, 0.726–0.807) was significantly better (Z = 2.304, p-value = 0.021) than that without ln(reads) (AUC = 0.727; 95% CI, 0.681–0.772). The rate of UPB identification of nomogram was significantly higher than that of ln(reads) only (χ2 = 7.36, p-value = 0.009).ConclusionsNTS is conducive to distinguish uropathogens from colonizing bacteria, and the nomogram based on NTS and multiple independent predictors has better prediction performance of uropathogens.
Objective Using the nomogram to intuitively predict atrial fibrillation after coronary artery bypass grafting. Identify high-risk patients with atrial fibrillation and provide preoperative protective therapy. Methods A total of 397 patients that underwent coronary artery bypass grafting were consecutively enrolled. Independent predictors of patients were analyzed by multivariate logistic regression. Two nomograms were constructed to predict postoperative atrial fibrillation. Results The incidence of postoperative atrial fibrillation in this study was 29% (115/397). Multivariate Logistic showed that Age, Operative Time > 4 h, Left Atrial Diameter > 40 mm, Mean Arterial Pressure, Body Mass Index > 23 kg/m2, Insulins, and Statins were independently associated with atrial fibrillation after isolated coronary artery bypass grafting. The nomogram of postoperative atrial fibrillation in patients was constructed using total predictor variables (AUC = 0.727, 95% CI 0.673–0.781). The model was internally validated (AUC = 0.701) by K-fold Cross-validation resampling (K = 5, Times = 400). To make an early intervention, the intraoperative information of the patients was excluded. Only 6 variables before surgery were used to establish the brief nomogram to predict postoperative atrial fibrillation (AUC = 0.707, 95% CI 0.651–0.764). The brief model was internally validated (AUC = 0.683) by resampling with K-fold Cross-validation resampling. Conclusions These two nomograms could be used to predict patients at high risk for atrial fibrillation after isolated coronary artery bypass grafting.
Background: Postoperative atrial fibrillation (POAF) after cardiac surgery is a common complication. We aimed to investigate the impact of serum uric acid level (UA) on the POAF of patients undergoing coronary artery bypass grafting (CABG). Methods: A retrospective cohort study of patients undergoing CABG at the Hospital between January 2019 and December 2019 was performed. Hyperuricemia (HUA) was defined as serum UA levels >420 µmol/l in men and>360 µmol/l in women. The included patients were divided into the HUA group (103) and the normal UA group (306) based on serum uric acid levels before surgery. POAF was defined as atrial fibrillation that occurred within 7 days of cardiac surgery. We use COX regression analysis and Kaplan-Meier curves (log-rank test) for statistical analysis. Results: The incidence of HUA was 25.2% (103/409). The rate of POAF was 28.61%. Univariate COX regression analysis showed the risk of POAF occurrence. It was revealed that UA was an independent predictor of POAF (HR=1.493, 95% CI1.007-2.212, P = 0.046). Kaplan-Meier curves showed that high serum UA was associated with the occurrence of POAF (P = 0.034). Moreover, age (HR=1.05, 95%CI 1.024-1.076, P < 0.001), AD (HR=1.567, 95%CI .015-2.42, P = 0.043), and CCB (HR=0.647, 95%CI 0.424-0.988, P = 0.044) also were independent predictors of POAF. Conclusions: Preoperative UA level was significantly associated with POAF. Higher serum UA was an independent risk factor for POAF.
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