Serum creatinine as a predictor of mortality in patients readmitted to the intensive care unit after cardiac surgery: a retrospective cohort study in China

Zhong, Jun; Gao, Xin; Luo, Jing-Chao; Zheng, Jie; Tu, Guo-Wei; Xue, Yan

doi:10.21037/jtd-20-3205

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…Clinically, reports in various regions on the number of patients readmitted to the ICU after cardiac surgery vary, and have reached as high as 19% (18)(19)(20). In a meta-analysis by Hughes et al (21) of 4,417 patients with surgically corrected coronary heart disease, the proportion of patients readmitted to the ICU was 10.2%.…”

Section: Discussionmentioning

confidence: 99%

Incidence of readmission to the ICU after cardiac surgery: a systematic review and meta-analysis

Lv¹,

Meng²,

Yu³

et al. 2022

J Thorac Dis

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Background: Due to the complexity of cardiac surgery, almost all patients need to be admitted to the intensive care unit (ICU) for postoperative care after surgery. After being discharged from the ICU, some patients need to be readmitted due to disease deterioration during hospitalization. We conducted a metaanalysis of the literature to investigate the incidence of readmission to the ICU in patients undergoing cardiac surgery. Methods:The PubMed, Medline, and Elsevier databases were searched using the keywords "cardiac surgery," "readmission," "intensive care unit," and "ICU" to retrieve English-language articles published from January 2000 to January 2021. The articles were screened, and their quality was evaluated. A meta-analysis was performed on the outcomes of patients after readmission to the ICU using Stata16.0 software.Results: Ultimately, 9 articles were included in the meta-analysis, comprising 32,825 cardiac surgery cases, of whom 1,302 were readmitted to the ICU. The incidence of readmission to the ICU was 3.97%.Among the direct reasons for readmission to the ICU, respiratory failure accounted for 13.6-48.6%, while hemodynamic instability accounted for 21.6-51.9%. The results of the meta-analysis showed that the mortality rate of patients readmitted to the ICU was significantly higher than that of patients not readmitted to the ICU [risk difference (RD) =8.05, 95% confidence interval (CI): 5.10-12.69, Z=8.965; P<0.0001],as was the length of hospital stay [standard mean difference (SMD) =3.17, 95% CI: 1.40-4.94, Z=3.504; P<0.001], and the incidence of complications (odds ratio =1.97, 95% CI: 1.35-2.87, Z=3.507; P<0.001).Discussion: Nine articles were included in this meta-analysis on the incidence rate of readmission to the ICU of patients undergoing cardiac surgery. The results showed that the proportion of readmission to the ICU was 3.97%. Patients readmitted to the ICU had a higher rate of complications, longer hospital stay, and higher mortality rate than those not readmitted.

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Section: Discussionmentioning

confidence: 99%

Incidence of readmission to the ICU after cardiac surgery: a systematic review and meta-analysis

Lv¹,

Meng²,

Yu³

et al. 2022

J Thorac Dis

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“…27,[32][33][34] A CrS, que é um parâmetro muito importante na avaliação das funções renais, foi associada a mau prognóstico em pacientes de cirurgia cardíaca. 35 Doenças cardíacas e renais, tanto agudas quanto crônicas, interagem ao longo de muitas vias comuns, incluindo mecanismos inflamatórios e imunológicos. 36 Portanto, a insuficiência renal aprofunda ainda mais a insuficiência cardíaca e contribui para um aumento na mortalidade dos pacientes.…”

Section: Güntürk Et Al Mortalidade Hospitalar Relacionada à Cec E Siiunclassified

The Systemic Immune-Inflammation Index Predicts In-Hospital Mortality in Patients Who Underwent On-Pump Cardiac Surgery

Güntürk,

Ozmen,

Ozocak

et al. 2024

Arq. Bras. Cardiol.

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Background: Systemic immune-inflammation index (SII), a new inflammatory index calculated using platelet, neutrophil, and lymphocyte counts, has been demonstrated to be an independent risk factor for the identification of high-risk coronary artery disease in patients undergoing percutaneous coronary intervention and cardiovascular surgery with cardiopulmonary bypass (CPB). The relationship between SII and CPB-related mortality rates remains unclear. Objective: This research was designed to investigate the use of SII to predict in-hospital mortality in patients undergoing cardiac surgery with CPB. Methods: Four hundred eighty patients who underwent a cardiac procedure involving CPB over 3 years, were obtained from the hospital's database. The demographic data, comorbidities, hematological and biochemical profiles, and operative data of the groups were compared. Multiple logistic regression analyses were done to determine independent predictors of mortality. Prognostic factors were assessed by multivariate analysis, and the predictive values of SII, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) for mortality were compared. A p-value <0.05 was considered significant. Results: Of 480 patients, 78 developed in-hospital mortality after cardiac surgery. SII was an independent predictor of in-hospital mortality (Odds ratio: 1.003, 95% confidence interval: 1.001-1.005, p<0.001). The cut-off value of the SII was >811.93 with 65% sensitivity and 65% specificity (area under the curve: 0.690). The predictive values of SII, PLR, and NLR were close to each other. Conclusion: High preoperative SII scores can be used for early determination of appropriate treatments, which may improve surgical outcomes of cardiac surgery in the future.

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“…Наиболее частыми осложнениями в данном аспекте являются периоперационный инфаркт миокарда (ИМ), неврологические и инфекционные осложнения, системный воспалительный ответ, а также развитие почечной недостаточности и различных аритмий [17][18][19][20]. В ряде исследований отмечается, что госпитальная летальность и более высокая доля грозных осложнений (ИМ, инсульт, острое повреждение почек с развитием почечной недостаточности) после вмешательства характерны в большей степени для женского пола [21][22][23]. У женщин чаще рецидивирует стенокардия, отмечается более высокая частота интраоперационного ИМ, острой сердечной недостаточности или декомпенсации хронической соответственно [24,25].…”

Section: Source Of Financingunclassified

Surgical revascularization in women: focus on factors worsening the prognosis

2023

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In recent years, there has been an increase in the number of women undergoing coronary artery bypass grafting (CABG). Although the evidence of gender effects on outcomes is controversial, a number of publications have reported less favorable outcomes of CABG in women. The aim of this paper was to review the literature regarding factors that worsen short- and long-term prognosis in women undergoing surgical myocardial revascularization.Gender differences in early outcomes of CABG are largely explained by gender distribution of baseline clinical characteristics. Women, compared to men, undergo CABG at an older age and have a worse profile of cardiovascular disease (CVD) risk factors (RF), comorbidity burden, structural and functional cardiac pathology, and coronary lesions. In women, complete myocardial revascularization is less frequent than in men, venous shunts are used more frequently, and the left internal mammary artery is less frequently used as a conduit. In addition to the baseline characteristics, higher incidence of perioperative myocardial infarction (MI), higher prevalence of anxiety and depression, lower quality of life and social adaptation after CABG, and lower involvement of women in rehabilitation programs, compared to men, may contribute to a less favorable long-term prognosis after CABG in women.There is a need for more information for physicians about the specifics of CVDs and anatomical and surgical aspects of CABG in women. It is also necessary to raise patients’ awareness of RF correction and to involve them in educational technologies. Recommendations for diagnosis and treatment of CVDs should be developed taking into account gender. Further research is also required to develop and implement sex-specific models for predicting surgical risks. Long-term follow-up is appropriate in women with recent MI and a history of diabetes mellitus. To further improve clinical outcomes of CABG in women, development of approaches that facilitate more complete revascularization and reduce the incidence of perioperative complications, such as MI and pneumonia, is needed. More answers to questions regarding gender differences in long-term outcomes of CABG may be obtained by analyzing further studies involving a larger number of female patients.

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Serum creatinine as a predictor of mortality in patients readmitted to the intensive care unit after cardiac surgery: a retrospective cohort study in China

Cited by 6 publications

References 26 publications

Incidence of readmission to the ICU after cardiac surgery: a systematic review and meta-analysis

Incidence of readmission to the ICU after cardiac surgery: a systematic review and meta-analysis

The Systemic Immune-Inflammation Index Predicts In-Hospital Mortality in Patients Who Underwent On-Pump Cardiac Surgery

Surgical revascularization in women: focus on factors worsening the prognosis

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