Abstract:IntroductionPreoperative renal insufficiency is an independent predictor of mortality
after coronary artery bypass graft (CABG) surgery. However, there are few
reports aimed to evaluate the impact of mild preoperative renal
insufficiency on long-term follow-up outcomes after isolated CABG surgery.
This study investigates the effect of mild preoperative renal insufficiency
on long-term follow-up outcomes of patients after CABG.MethodsFive hundred eighty-four patients' data that underwent CABG between 1 January
… Show more
“…The univariate factor analysis manifested that the 2 propensity score-matched groups had similar in-hospital outcomes, including surgical mortality, myocardial infarction, stroke, respiratory failure, pneumonia, redo for bleeding, RBC transfusion, DSWI, low cardiac output syndrome, IABP application, except the rates and severity of AKI. The same result was obtained by Weitie Wang et al, they reported older patients with mild preoperative RD had a higher mortality rate than normal patients in long-term survival, whereas no evidence of worse in-hospital mortality rate was found [10]. Jyrala et al who analyzed a cohort of 885 patients with or without mild preoperative RD received on-pump cardiac surgery, with respect to short- and long-term outcomes [11].…”
BackgroundMild preoperative renal dysfunction (RD) is not rare in patients receiving isolated cardiopulmonary coronary artery bypass grafting (CCABG). However, there are not too many studies about the impact of mild preoperative RD on in-hospital and follow-up outcomes after isolated CCABG. This single-centre, retrospective propensity score matching study designed to study the impact of mild preoperative RD on in-hospital and long-term outcomes after first isolated CCABG.MethodsAfter propensity score matching, 1144 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m2 receiving first isolated CCABG surgery from January 2012 to December 2015 entered the study, who were divided into 2 groups: A group (eGFR ≥90 ml/min/1.73 m2, n = 572) and B group (eGFR of 60–89 ml/min/1.73 m2, n = 572). The in-hospital and long-term outcomes were recorded and analyzed. The mean follow-up time was 54.4 ± 10.7 months. Acute kidney injury (AKI) was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria.ResultsThe 2 propensity score-matched groups had similar baseline and procedure except the baseline eGFR. There were 8 patients died in A group (mortality is 1.4%) and 14 died in B group (mortality is 2.5%) during the in hospital and 30-day postoperatively(χ2 = 1.159, p = 0.282). There were totally 38 patients lost to follow-up, 18 in group A and 20 in group B. 21 patients died in group A and 37 died in group B during the follow-up, and long-term survival in group A was higher than in group B (96.2% vs 93.1%, χ2 = 4.336, p = 0.037). Comparing with group A, group B was associated with an increased rates and severity of AKI postoperatively (total AKI: 62 vs 144. AKIN stageI: 54 vs 113; AKIN stageII: 6 vs 22; AKIN stageIII: 2 vs 9, p<0.0001). During follow-up, group B also had a higher rate of new onset of dialysis (0 vs 6, χ2 = 4.432, p = 0.039). Multivariable logistic regression showed that comparing with A group, the HR for long-term mortality and new onset of dialysis in B group was 1.67 and 1.52 respectively (95%CI 1.09–2.90, p = 0.035; 95%CI 1.14–2.49, p = 0.027).ConclusionsComparing with normal preoperative renal function, patients with mild preoperative RD had a similar in-hosptial mortality, but with an increased in-hosptial rates and severity of AKI, and with a decreased long-term survival and increased long-term new onset of dialysis.
“…The univariate factor analysis manifested that the 2 propensity score-matched groups had similar in-hospital outcomes, including surgical mortality, myocardial infarction, stroke, respiratory failure, pneumonia, redo for bleeding, RBC transfusion, DSWI, low cardiac output syndrome, IABP application, except the rates and severity of AKI. The same result was obtained by Weitie Wang et al, they reported older patients with mild preoperative RD had a higher mortality rate than normal patients in long-term survival, whereas no evidence of worse in-hospital mortality rate was found [10]. Jyrala et al who analyzed a cohort of 885 patients with or without mild preoperative RD received on-pump cardiac surgery, with respect to short- and long-term outcomes [11].…”
BackgroundMild preoperative renal dysfunction (RD) is not rare in patients receiving isolated cardiopulmonary coronary artery bypass grafting (CCABG). However, there are not too many studies about the impact of mild preoperative RD on in-hospital and follow-up outcomes after isolated CCABG. This single-centre, retrospective propensity score matching study designed to study the impact of mild preoperative RD on in-hospital and long-term outcomes after first isolated CCABG.MethodsAfter propensity score matching, 1144 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m2 receiving first isolated CCABG surgery from January 2012 to December 2015 entered the study, who were divided into 2 groups: A group (eGFR ≥90 ml/min/1.73 m2, n = 572) and B group (eGFR of 60–89 ml/min/1.73 m2, n = 572). The in-hospital and long-term outcomes were recorded and analyzed. The mean follow-up time was 54.4 ± 10.7 months. Acute kidney injury (AKI) was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria.ResultsThe 2 propensity score-matched groups had similar baseline and procedure except the baseline eGFR. There were 8 patients died in A group (mortality is 1.4%) and 14 died in B group (mortality is 2.5%) during the in hospital and 30-day postoperatively(χ2 = 1.159, p = 0.282). There were totally 38 patients lost to follow-up, 18 in group A and 20 in group B. 21 patients died in group A and 37 died in group B during the follow-up, and long-term survival in group A was higher than in group B (96.2% vs 93.1%, χ2 = 4.336, p = 0.037). Comparing with group A, group B was associated with an increased rates and severity of AKI postoperatively (total AKI: 62 vs 144. AKIN stageI: 54 vs 113; AKIN stageII: 6 vs 22; AKIN stageIII: 2 vs 9, p<0.0001). During follow-up, group B also had a higher rate of new onset of dialysis (0 vs 6, χ2 = 4.432, p = 0.039). Multivariable logistic regression showed that comparing with A group, the HR for long-term mortality and new onset of dialysis in B group was 1.67 and 1.52 respectively (95%CI 1.09–2.90, p = 0.035; 95%CI 1.14–2.49, p = 0.027).ConclusionsComparing with normal preoperative renal function, patients with mild preoperative RD had a similar in-hosptial mortality, but with an increased in-hosptial rates and severity of AKI, and with a decreased long-term survival and increased long-term new onset of dialysis.
“…Previous studies mostly focused on the patients of renal insufficiency to verify the important regulatory role of preop-eGFR [ 12 , 13 , 15 ]. High preop-eGFR levels have also been connected with greater mortality among nonsurgical patients indicating a potential U-shaped association of preop-eGFR with poor prognosis [ 26 – 28 ].…”
Background
There is limited evidence to clarify the specific relationship between preoperative estimated glomerular filtration rate (preop-eGFR) and postoperative 30-day mortality in Asian patients undergoing non-cardiac and non-neuron surgery. We aimed to investigate details of this relationship.
Methods
We reanalyzed a retrospective analysis of the clinical records of 90,785 surgical patients at the Singapore General Hospital from January 1, 2012 to October 31, 2016. The main outcome was postoperative 30-day mortality.
Results
The average age of these recruited patients was 53.96 ± 16.88 years, of which approximately 51.64% were female. The mean of preop-eGFR distribution was 84.45 ± 38.56 mL/min/1.73 m2. Multivariate logistic regression analysis indicated that preop-eGFR was independently associated with 30-day mortality (adjusted odds ratio: 0.992; 95% confidence interval [CI] 0.990–0.995; P < 0.001). A U-shaped relationship was detected between preop-eGFR and 30-day mortality with an inflection point of 98.688 (P for log likelihood ratio test < 0.001). The effect sizes and confidence intervals on the right and left sides of the inflection point were 1.013 (1.007 to 1.019) [P < 0.0001] and 0.984 (0.981 to 0.987) [P < 0.0001], respectively. Preoperative comorbidities such as congestive heart failure (CHF), type 1 diabetes, ischemic heart disease (IHD), and anemia were associated with the odds ratio of preop-eGFR to 30-day mortality (interaction P < 0.05).
Discussion
The relationship between preop-eGFR and 30-day mortality is U-shaped. The recommended preop-eGFR at which the rate of the 30-day mortality was lowest was 98.688 mL/min/1.73 m2.
“…Previous studies mostly focused on the patients of renal insufficiency to verify the important regulatory role of preop-eGFR [12][13]15]. High preop-eGFR levels have also been connected with greater mortality among nonsurgical patients indicating a potential U-shaped association of preop-eGFR with poor prognosis [28][29][30].…”
Section: Discussionmentioning
confidence: 99%
“…Studies have shown that preop-eGFR is a moderately effective predictor of thirty-day mortality in hospitalized surgical patients [4]. However, the current research population is mainly concentrated on patients who have undergone critical surgery such as cardiac surgery [6] [7][8] [9][10] [11][12][13][14], lack of other surgeries. The ethnicity of these studies is also rarely related to Asians.…”
Introduction: There is limited evidence to clarify the specific relationship between preoperative estimated glomerular filtration rate (preop-eGFR) and postoperative thirty-day mortality in patients undergoing non-cardiac surgery. We aimed to investigate details of this relationship.Methods: We reanalyzed a retrospective analysis of the clinical records of 90,785 surgical patients at the Singapore General Hospital from January 1, 2012 to October 31, 2016. The main outcome was postoperative thirty-day mortality.Results: The average age of these recruited patients was 53.96 ± 16.88 years, of which approximately 51.64% were female. The mean of preop-eGFR distribution was 84.45 ± 38.56 mL/min/1.73 m2. Multivariate logistic regression analysis indicated that preop-eGFR was independently associated with thirty-day mortality (adjusted odds ratio: 0.992; 95% confidence interval [CI]: 0.990–0.995; P < 0.001). A U-shaped relationship was detected between preop-eGFR and thirty-day mortality with an inflection point of 98.688(P for log likelihood ratio test < 0.001). The effect sizes and confidence intervals on the right and left sides of the inflection point were 1.013 (1.007 to 1.019) [P < 0.0001] and 0.984 (0.981 to 0.987) [P < 0.0001], respectively. Preoperative comorbidities such as congestive heart failure (CHF), type 1 diabetes, ischemic heart disease (IHD),and anemia were associated with the odds ratio of preop-eGFR to thirty-day mortality (interaction P < 0.05).Discussion: The relationship between preop-eGFR and thirty-day mortality is U-shaped. The recommended preop-eGFR at which the rate of the thirty-day mortality was lowest was 98.688 mL/min/1.73 m2.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.