Effect of perioperative sodium bicarbonate administration on renal function following cardiac surgery for infective endocarditis: a randomized, placebo-controlled trial

Cho, Jin Sun; Soh, Sarah; Shim, Jæ Kwang; Kang, Sanghwa; Choi, Hyang Suk; Kwak, Young Lan

doi:10.1186/s13054-016-1591-z

Cited by 10 publications

(7 citation statements)

References 44 publications

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“…This remarkable trend was reproducible in previous studies [ 2 , 18 ]. In terms of mortality among IE patients, the mortality rate in RCT was much lower than our cohort, showing 2.9–18% of in-hospital mortality rate [ 17 , 19 , 20 ]. Differences in patients’ general conditions and strict entry criteria for the RCTs might have contributed to better outcomes than the real-world data.…”

Section: Discussioncontrasting

confidence: 53%

“…We are concerned that clinicians may apply a biased EBM to patients who cannot be enrolled in a clinical trial. More than 50% of IE patients are generally indicated for surgical intervention and despite evident surgical indication that were present, surgery was not performed in 26–42% of patients [ 17 , 21 ]. Those who were not indicated for surgical treatment showed a high mortality rate of about 63% [ 21 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Exclusion criteria commonly used in the past ordinary clinical trials are as follows [ 15 , 16 , 17 ]: Age < 18 years, >80 years. Coexisting comorbidities or medical conditions that could make the evaluation of infective endocarditis difficult such as severe liver dysfunction, severe renal dysfunction, or HIV/AIDS.…”

Section: Methodsmentioning

confidence: 99%

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A Gap of Patients with Infective Endocarditis between Clinical Trials and the Real World

Asai

Shibata

Hirai

et al. 2023

JCM

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Introduction: A randomized control trial (RCT) is considered to be the highest level in the Evidence-Based Medicine (EBM) pyramid. While EBM is essential to make a practical tool such as a prognostic guideline, it has been unclear how many patients in the real world can be eligible for a randomized control trial (RCT). Patients and method: This study was performed to clarify if there is a difference in patients’ profiles and clinical outcomes between the patients eligible and not eligible for any RCT. We reviewed all IE patients at our institute between 2007 and 2019. The patients were divided into two groups: those eligible for RCTs (RCT appropriate group) and those who were not (RCT inappropriate group). Exclusion criteria for clinical trials were set based on previous clinical trials. Results: A total of 66 patients were enrolled in the study. The median age was 70 years (range 18 to 87 years), and 46 (70%) were male. Seventeen (26%) of the patients were eligible for RCTs. Comparing the two groups, patients in the RCT appropriate group were younger and had fewer comorbidities. The disease severity was milder in the RCT appropriate groups than in the RCT inappropriate groups. Patients in the RCT appropriate group showed significantly longer overall survival times than those in the RCT inappropriate group (Log-Rank test, p < 0.001). Conclusions: We found a significant gap in patients’ characteristics and clinical outcomes between the groups. Physicians should be aware that RCT can never reflect the real-world population.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

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A Gap of Patients with Infective Endocarditis between Clinical Trials and the Real World

Asai

Shibata

Hirai

et al. 2023

JCM

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“…Conversely, more attention should be paid to the occurrence of potential intrinsic renal AKI in surgical patients. Unfortunately, until recently, there have been no effective drugs to prevent nephrotoxicity or infection induced post-operative AKI, such as high-dose atorvastatin 27 or sodium bicarbonate 28 . Therefore, tightly controlled AKI occurrence, particularly in patients exposed to nephrotoxic factors or with comorbidities, is essential to improve the prognosis of patients undergoing a major operation.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of in-hospital mortality from AKI after non-cardiovascular operation: A nationwide Survey in China

Pan

Wang

et al. 2017

Sci Rep

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This study aimed to describe the mortality and risk factors of in-hospital mortality from acute kidney injury (AKI) after non-cardiovascular operation in China based on a nationwide survey about AKI. The study sample was drawn from ISN AKF 0by25 China Consortiums, which is a nationwide, cross-sectional survey from 22 provinces in mainland China. AKI after non-cardiovascular operation was identified according to the 2012 KDIGO AKI creatinine criteria or expanded criteria. In total, 3468 cases were identified as hospital-acquired AKI (HA-AKI). Of these, 1059 cases were defined as AKI after major non-cardiovascular surgery. Post-operative AKI and non-operative AKI were similar in aetiology and in the need for RRT intervention. The all-cause in-hospital mortality was 17.0% (180 of 1059) among patients with AKI after a major surgery. Older age (OR = 1.14, p = 0.046), more severe comorbidities (OR = 9.29, p < 0.001), a history of CVD (OR = 1.85, p = 0.007), more severe peak AKI stage, and being located in the northwest region of China (OR = 2.47, p = 0.012) were all significantly associated with increased in-hospital mortality risk in AKI patients who underwent an operation. AKI after a non-cardiovascular operation has become a huge medical burden in China. The features of operative AKI varied substantially in different regions of China. Increased attention must be paid to the occurrence of potential intrinsic renal AKI when patients are exposed to nephrotoxic factors or comorbidities.

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“…177 Another specific renal protective approach, the perioperative administration of sodium bicarbonate, has not been proven to be effective in patients with infective endocarditis. 179…”

Section: Review Articlementioning

confidence: 99%

Anesthesia Considerations in Infective Endocarditis

et al. 2022

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The management of infective endocarditis is complex and inherently requires multidisciplinary cooperation. About half of all patients diagnosed with infective endocarditis will meet the criteria to undergo cardiac surgery, which regularly takes place in urgent or emergency settings. The pathophysiology and clinical presentation of infective endocarditis make it a unique disorder within cardiac surgery that warrants a thorough understanding of specific characteristics in the perioperative period. This includes, among others, echocardiography, coagulation, bleeding management, or treatment of organ dysfunction. In this narrative review article, the authors summarize the current knowledge on infective endocarditis relevant for the clinical anesthesiologist in perioperative management of respective patients. Furthermore, the authors advocate for the anesthesiologist to become a structural member of the endocarditis team.

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Effect of perioperative sodium bicarbonate administration on renal function following cardiac surgery for infective endocarditis: a randomized, placebo-controlled trial

Cited by 10 publications

References 44 publications

A Gap of Patients with Infective Endocarditis between Clinical Trials and the Real World

A Gap of Patients with Infective Endocarditis between Clinical Trials and the Real World

Incidence and Risk Factors of in-hospital mortality from AKI after non-cardiovascular operation: A nationwide Survey in China

Anesthesia Considerations in Infective Endocarditis

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