Impact of major bleeding on the risk of acute kidney injury in patients undergoing off-pump coronary artery bypass grafting

Liu, Wei; Xi, Ziwei; Gu, Chengxiong; Dong, Ran; AlHelal, Jumana; Yan, Zhang

doi:10.21037/jtd.2018.05.98

Cited by 20 publications

(19 citation statements)

References 32 publications

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“…Massive blood loss makes the patients suffer a higher risk of developing cardiopulmonary events, renal failure, and cerebral infarction, especially for aged patients (over 60 years old) [ 4 – 6 ]. Although allogeneic blood transfusions could prevent the patients from suffering the above life-threatening complications, however, blood transfusions are usually limited with blood supply, potential risk of immunologic reaction, and infectious disease transmission [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Combined use of intravenous and topical tranexamic acid efficiently reduces blood loss in patients aged over 60 operated with a 2-level lumbar fusion

Wang

Bai

et al. 2020

J Orthop Surg Res

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Purpose: The current study was conducted to assess the efficacy and safety of the intravenous (IV) administration combined with topical administration of tranexamic acid (TXA)in patients (aged over 60) scheduled for a 2-level lumbar fusion surgery. Methods: Two hundred eighty patients scheduled for a 2-level lumbar fusion surgery were randomized into four groups, including an IV group, a local group, a combined group, and a control group. Patients in the combined group, in the IV group, in the topical group, and in the control group were administrated with 15 mg/kg of IV-TXA + 2 g TXA in local, 15 mg/kg IV-TXA, 2 g TXA in local, and 100 ml IV, respectively. The results of total blood loss (TBL), maximum hemoglobin drop, the transfusion rate, and the number of allogeneic blood units were compared. Deep venous thrombosis (DVT) and pulmonary embolism (PE) events were monitored and recorded.

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Section: Introductionmentioning

confidence: 99%

Combined use of intravenous and topical tranexamic acid efficiently reduces blood loss in patients aged over 60 operated with a 2-level lumbar fusion

Wang

Bai

et al. 2020

J Orthop Surg Res

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“…In addition to mortality, other adverse outcomes including AKI and low cardiac output were also associated high UDPB classes bleeding. In our recent study, we have confirmed that perioperative bleeding defined as the UDPB class 3 to 4 bleeding was associated with a higher risk of postoperative AKI in ACS patients who underwent OPCAB [24]. The UDPB classification was based on the amount of chest tube blood loss, use of blood products and the need of reexploration or delayed sternal closure.…”

Section: Discussionmentioning

confidence: 83%

The Prognostic Significance of Different Bleeding Classifications in off-pump coronary artery bypass grafting

Gao

Yan

et al. 2020

BMC Cardiovasc Disord

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Background: Perioperative bleeding during cardiac surgery are known to make patients susceptible to adverse outcomes and several bleeding classifications have been developed to stratify the severity of bleeding events. Further validation of different classifications was needed. The aim of present study was to validate and explore the prognostic value of different bleeding classifications in patients undergoing off-pump coronary artery bypass grafting (OPCAB). Methods: Data on baseline and operative characteristics of 3988 patients who underwent OPCAB in Beijing Anzhen Hospital from February 2008 to December 2014 were available. The primary endpoint was a composite of inhospital death and nonfatal postoperative myocardial infarction (MI). The secondary endpoint was postoperative acute kidney injury (AKI). We explored the association of major bleeding defined by the European registry of Coronary Artery Bypass Grafting (E-CABG), Universal Definition of Perioperative Bleeding (UDPB), Bleeding Academic Research Consortium (BARC) classification and Study of Platelet Inhibition and Patient Outcomes (PLATO) with primary endpoints by multivariable logistic regression analysis and investigated their significance of adverse event prediction using goodness-of-fit tests of − 2 log likelihood. Results: In-hospital mortality was 1.23% (n = 49) and postoperative MI was observed in 4.76% (n = 190) of patients, AKI in 24.69% (n = 985). The incidence of the primary outcome was 5.99% (n = 239). Multivariable logistic regression analysis showed that BARC type 4 (OR = 2.64, 95% CI: 1.66-4.19, P < 0.001), UDPB class 4 (OR = 3.52, 95% CI: 2.05-6.02, P < 0.001) and E-CABG class 2-3 (class 2: OR = 2.24, 95% CI: 1.36-3.70, P = 0.001; class 3: OR = 12.65, 95% CI: 2.74-18.43, P = 0.002) bleeding but not PLATO bleeding were associated with an increased risk of in-hospital death and postoperative MI. Major bleeding defined by all the four classifications mentioned above was an independent risk factor of AKI after surgery. Inclusion of major bleeding defined by these four classifications improved the predictive performance of the multivariable model with baseline characteristics. Conclusions: Bleeding assessed by BARC, E-CABG and UDPB classifications were significantly associated with poorer immediate outcomes. These classifications seemed to be valuable tool in the assessment of prognostic effect of perioperative bleeding.

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“…Previous meta-analyses including 2,399 patients show that the preoperative use of ASA is associated with a reduction in the risk of postoperative MI, without reducing mortality, but it also increases the risk of chest bleeding/drainage, the need for packed red blood cell transfusion, and bleeding-related reoperation after CABG [ 22 ] . Therefore, another variable that should be readily known upon admission is the use of ASA, which was associated with a 41% greater chance of readmission in our sample.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Hospital Readmission within 30 Days after Coronary Artery Bypass Grafting: Data Analysis of 2,272 Brazilian Patients

Chiorino¹,

Santos²,

Lopes³

et al. 2020

Braz J Cardiovasc Surg

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Introduction In order to reduce readmission rates after coronary artery bypass grafting (CABG), its predictors should be known in different contexts. The objective of this study was to identify predictive factors of hospital readmission within 30 days after CABG in a Brazilian center. Methods A secondary analysis of an electronic database of patients submitted to isolated CABG was performed. The relationship between readmission within 30 days and demographic, anthropometric, clinical, and surgery-related characteristics was investigated by univariate analyses. Predictors were identified by multiple logistic regression. Results Data from 2,272 patients were included, with an incidence of readmission of 8.6%. The predictors of readmission were brown skin color (Beta=1.613; 95% confidence interval [CI] 1.047-2.458; P =0.030), African-American ethnicity (Beta=0.136; 95% CI 0.019-0.988; P =0.049), chronic kidney disease (Beta=2.214; 95% CI 1.269-3.865; P =0.005), postoperative use of blood products (Beta=1.515; 95% CI 1.101-2.086; P =0.011), chronic obstructive pulmonary disease (Beta=2.095; 95% CI 1.284-3.419; P =0.003), and use of acetylsalicylic acid (Beta=1.418; 95% CI 1.000-2.011; P =0.05). Preoperative antibiotic prophylaxis (Beta=0.742; 95% CI 0.5471.007; P =0.055) was marginally significant. Conclusion The predictors identified may support a closer postoperative follow-up and individualized planning for a safe discharge.

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Impact of major bleeding on the risk of acute kidney injury in patients undergoing off-pump coronary artery bypass grafting

Cited by 20 publications

References 32 publications

Combined use of intravenous and topical tranexamic acid efficiently reduces blood loss in patients aged over 60 operated with a 2-level lumbar fusion

Combined use of intravenous and topical tranexamic acid efficiently reduces blood loss in patients aged over 60 operated with a 2-level lumbar fusion

The Prognostic Significance of Different Bleeding Classifications in off-pump coronary artery bypass grafting

Predictors of Hospital Readmission within 30 Days after Coronary Artery Bypass Grafting: Data Analysis of 2,272 Brazilian Patients

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