Risk factors for mortality in patients undergoing continuous renal replacement therapy after cardiac surgery

Liu, Chang; Zhang, Haitao; Yue, Lijun; Li, Zeshi; Pan, Ke; Chen, Zhong; Gu, Suping; Pan, Tuo; Pan, Jun; Wang, Dongjin

doi:10.1186/s12872-021-02324-8

Cited by 6 publications

(9 citation statements)

References 33 publications

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“…It is a big challenge for cardiac surgeons and nephrologists, the potential risk factors are urgently needed to uncover. Many studies have been done and attempted to figure out potential risk factors for the high mortality, including intraoperative transfusion, high lactic acid, low mean arterial pressure, timing of CRRT, positive blood volume post CRRT, duration of MV and post-operation bleeding, different authors held different opinion according to their own studies [13][14][15][16][17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for the in-hospital mortality of CRRT-therapy patients with cardiac surgery-associated AKI: a single-center clinical study in China

Jiang

Chen

Yu³

et al. 2022

Clin Exp Nephrol

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Objective We retrospectively analyzed risk factors on in-hospital mortality in CRRT-therapy patients with open cardiac surgery (CS)-induced acute kidney injury (AKI), to provide the clinical basis for predicting and lowering the in-hospital mortality after CS. Methods 84 CS-AKI patients with CRRT were divided into survival and death groups according to discharge status, and the perioperative data were analyzed with R version 4.0.2. Results There were significant differences between the two groups, including: urea nitrogen, Sequential Organ Failure Assessment (SOFA) score and vasoactive-inotropic score (VIS) on the first day after operation; VIS just before CRRT; SOFA score and negative balance of blood volume 24 h after CRRT; the incidence rate of bleeding, severe infection and MODS after operation; and the interval between AKI and CRRT. Univariate logistic regression analysis showed that SOFA score and VIS on the first day after operation; VIS just before CRRT; VIS and negative balance of blood volume 24 h after CRRT; the incidence rate of bleeding, infection and multiple organ dysfunction syndrome (MODS) after operation; bootstrap resampling analysis showed that SOFA score and VIS 24 h after CRRT, as well as the incidence of bleeding after operation were the independent risk factors. Conclusion Maintaining stable hemodynamics and active prevention of bleeding are expected to decrease the in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Risk factors for the in-hospital mortality of CRRT-therapy patients with cardiac surgery-associated AKI: a single-center clinical study in China

Jiang

Chen

Yu³

et al. 2022

Clin Exp Nephrol

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“…The ascending aorta was cannulated with a cannula appropriate to the patient's size. A separate cannula was used for intravenous cannulation in the superior and inferior vena cava [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

Dexmedetomidine as an anesthetic adjunct is associated with reduced complications and cardiac intensive care unit length of stay after heart valve surgery

Fan,

Tang,

Pan

et al. 2023

BMC Anesthesiol

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Background We sought to explore the relationship between dexmedetomidine as an anesthetic adjuvant in cardiac surgery and postoperative complications and length of stay (LOS) in the cardiac intensive care unit (CICU). Methods We conducted a retrospective study of patients aged 18 years and older who underwent heart valve surgery between October 2020 and June 2022. The primary endpoint of the study was major postoperative complications (cardiac arrest, atrial fibrillation, myocardial injury/infarction, heart failure) and the secondary endpoint was prolonged CICU LOS (defined as LOS > 90th percentile). Multivariate logistic regression analysis was performed for variables that were significant in the univariate analysis. Results A total of 856 patients entered our study. The 283 patients who experienced the primary and secondary endpoints were included in the adverse outcomes group, and the remaining 573 were included in the prognostic control group. Multivariate logistic regression analysis revealed that age > 60 years (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.23–2.31; p < 0.01), cardiopulmonary bypass (CPB) > 180 min (OR, 1.62; 95% CI, 1.03–2.55; p = 0.04) and postoperative mechanical ventilation time > 10 h (OR, 1.84; 95% CI, 1.35–2.52; p < 0.01) were independent risk factors for major postoperative complications; Age > 60 years (OR, 3.20; 95% CI, 1.65–6.20; p < 0.01), preoperative NYHA class 4 (OR, 4.03; 95% CI, 1.74–9.33; p < 0.01), diabetes mellitus (OR, 2.57; 95% CI, 1.22–5.41; p = 0.01), Intraoperative red blood cell (RBC) transfusion > 650 ml (OR, 2.04; 95% CI, 1.13–3.66; p = 0.02), Intraoperative bleeding > 1200 ml (OR, 2.69; 95% CI, 1.42–5.12; p < 0.01) were independent risk factors for prolonged CICU length of stay. Intraoperative use of dexmedetomidine as an anesthetic adjunct was a protective factor for major complications (odds ratio, 0.51; 95% confidence interval, 0.35–0.74; p < 0.01) and prolonged CICU stay. (odds ratio, 0.37; 95% confidence interval, 0.19–0.73; p < 0.01). Conclusions In patients undergoing heart valve surgery, age, duration of cardiopulmonary bypass, and duration of mechanical ventilation are associated with major postoperative complication. Age, preoperative NYHA classification 4, diabetes mellitus, intraoperative bleeding, and RBC transfusion are associated with increased CICU length of stay. Intraoperative use of dexmedetomidine may improve such clinical outcomes.

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“…Similar association between SOFA score and ICU mortality was also reported in other observational studies. 29,30 In a retrospective study by Liu et al, 31 mechanical ventilation time (OR 5.03, 95%CI (2.40-10.54); p < 0.01) were independent risk factor for in-hospital mortality in patients undergoing CRRT after cardiac surgery. This is consistent with the results of the present study, in which patients who required mechanical ventilation had a 2.5fold higher mortality risk than those who did not.…”

Section: Independent Predictors For Icu Mortalitymentioning

confidence: 97%

Characteristics and predictors of ICU-mortality in critically ill patients with hyperlactatemia requiring CRRT: A retrospective cohort study

Bai

Zhang

et al. 2022

Int J Artif Organs

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Background: Hyperlactatemia is a common complication in critically ill patients with high morbidity and mortality. Hyperlactatemia patients who require continuous renal replacement therapy (CRRT) constitute a subgroup with increased mortality risk. The clinical significance of serum lactate in these patients was not well understood and clearance of lactate using CRRT shown no survival benefits. The aim of this study is to investigate the incidence and non-lactate risk factors for ICU mortality in hyperlactatemia patients who underwent CRRT. Method: Hyperlactatemia patients with a serum lactate level >2 μmol/L who underwent CRRT between January, 2014 and May, 2021 were retrospectively investigated. Demographic characteristics and clinical data were collected from the electronic medical record system. The primary endpoint was predictors for ICU mortality which were identified by using multivariate logistic regression analysis. Results: A total of 178 eligible patients were finally included with a mean age of 56.6 ± 17.9 years and a median APACHE II score of 18 (IQR (14–22)). The multivariate regression results showed that male gender (OR 0.55 (95%CI 0.27–1.12), p = 0.1), mechanical ventilation (OR 2.60 (95%CI 1.27–5.34), p = 0.008), history of hypertension (OR 2.40 (95%CI 1.12–5.14), p = 0.02), SOFA score (OR 1.16 (95%CI 1.05–1.28), p = 0.002), AST (OR 1.0005 (95%CI 0.99–1.001), p = 0.08), and PT (OR 1.08 (95%CI 0.99–1.17), p = 0.06) were independently associated with ICU mortality. After adjusting for age, illness severity (APACHE II score), and serum lactate level, the statistical significances of SOFA score (OR 1.16 (95%CI 1.04–1.29), p = 0.005), hypertension (OR 2.25 (95%CI 1.02–4.95), p = 0.04), and mechanical ventilation (OR 2.54 (95%CI 1.22–5.25), p = 0.01) were not affected. The overall ICU mortality was 58.4% (104/178). Conclusion: The hyperlactatemia patients who underwent CRRT were at increased ICU mortality. Gender, AST, PT, SOFA score, history of hypertension, and mechanical ventilation were independent predictors for ICU mortality. Future studies with prospectively design, large sample size, and subgroup analyses are warranted to validate these findings.

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Risk factors for mortality in patients undergoing continuous renal replacement therapy after cardiac surgery

Cited by 6 publications

References 33 publications

Risk factors for the in-hospital mortality of CRRT-therapy patients with cardiac surgery-associated AKI: a single-center clinical study in China

Risk factors for the in-hospital mortality of CRRT-therapy patients with cardiac surgery-associated AKI: a single-center clinical study in China

Dexmedetomidine as an anesthetic adjunct is associated with reduced complications and cardiac intensive care unit length of stay after heart valve surgery

Characteristics and predictors of ICU-mortality in critically ill patients with hyperlactatemia requiring CRRT: A retrospective cohort study

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