Serum N-terminal Pro-B-type Natriuretic Peptide Predicts Mortality in Cardiac Surgery Patients Receiving Renal Replacement Therapy

Su, Ying; Hou, Jun; Zhang, Yijie; Ma, Genshan; Hao, Guang-Wei; Luo, Jing-Chao; Luo, Zhe; Tu, Guo-Wei

doi:10.3389/fmed.2020.00153

Cited by 5 publications

(3 citation statements)

References 44 publications

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“…Numerous studies show improved outcomes with an earlier initiation of continuous RRT (3,4). Many studies have focused on the choice of early treatment timing and the progress of RRT (5)(6)(7). However, the choice of treatment timing is based on the "clinical judgment" of the physician.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Short-Term Mortality With Renal Replacement Therapy in Patients With Cardiac Surgery-Associated Acute Kidney Injury

Han

Wen

Wang

et al. 2021

Front. Cardiovasc. Med.

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Objective: We aimed to: (1) explore the risk factors that affect the prognosis of cardiac surgery-associated acute kidney injury (CS-AKI) in patients undergoing renal replacement therapy (RRT) and (2) investigate the predictive value of the Acute Physiology and Chronic Health Evaluation (APACHE) III score, Sequential Organ Failure Assessment (SOFA) score, and Vasoactive-Inotropic Score (VIS) for mortality risk in patients undergoing RRT.Methods: Data from patients who underwent cardiac surgery from January 2015 through February 2021 were retrospectively reviewed to calculate the APACHE III score, SOFA score, and VIS on the first postoperative day and at the start of RRT. Various risk factors influencing the prognosis of the patients during treatment were evaluated; the area under the receiver operating characteristics curve (AUCROC) was used to measure the predictive ability of the three scores. Independent risk factors influencing mortality were analyzed using multivariable binary logistic regression.Results: A total of 90 patients were included in the study, using 90-day survival as the end point. Of those patients, 36 patients survived, and 54 patients died; the mortality rate reached 60%. At the start of RRT, the AUCROC of the APACHE III score was 0.866 (95% CI: 0.795–0.937), the VIS was 0.796 (95% CI: 0.700–0.892), and the SOFA score was 0.732 (95% CI: 0.623–0.842). The AUCROC-value of the APACHE III score on the first postoperative day was 0.790 (95% CI: 0.694–0.885). After analyzing multiple factors, we obtained the final logistic regression model with five independent risk factors at the start of RRT: a high APACHE III score (OR: 1.228, 95% CI: 1.079–1.397), high VIS (OR: 1.147, 95% CI: 1.021–1.290), low mean arterial pressure (MAP) (OR: 1.170, 95% CI: 1.050–1.303), high lactate value (OR: 1.552, 95% CI: 1.032–2.333), and long time from AKI to initiation of RRT (OR: 1.014, 95% CI: 1.002–1.027).Conclusion: In this study, we showed that at the start of RRT, the APACHE III score and the VIS can accurately predict the risk of death in patients undergoing continuous RRT for CS-AKI. The APACHE III score on the first postoperative day allows early prediction of patient mortality risk. Predictors influencing patient mortality at the initiation of RRT were high APACHE III score, high VIS, low MAP, high lactate value, and long time from AKI to the start of RRT.

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Section: Introductionmentioning

confidence: 99%

Prediction of Short-Term Mortality With Renal Replacement Therapy in Patients With Cardiac Surgery-Associated Acute Kidney Injury

Han

Wen

Wang

et al. 2021

Front. Cardiovasc. Med.

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“…Although most cases of AKI following cardiac surgery are characterized by a mild and transient course, it is noteworthy that approximately 10-25% of patients initially presenting with mild AKI will experience a more severe stage or even dialysis during their postoperative hospitalization [2][3][4]. Once progression to severe AKI or requiring renal replacement therapy (RRT), there is a substantial increase in the long-term risks of developing chronic kidney disease (CKD), perioperative mortality by a magnitude of 3-8 times, prolonged hospital length of stay, and escalated healthcare costs [5][6][7]. Early identification of AKI progression could provide guidance for individualized clinical care, allocation of resources, and enrollment in AKI clinical trials.…”

Section: Introductionmentioning

confidence: 99%

AKI-Pro score for predicting progression to severe acute kidney injury or death in patients with early acute kidney injury after cardiac surgery

Su,

Wang,

et al. 2024

J Transl Med

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Background No reliable clinical tools exist to predict acute kidney injury (AKI) progression. We aim to explore a scoring system for predicting the composite outcome of progression to severe AKI or death within seven days among early AKI patients after cardiac surgery. Methods In this study, we used two independent cohorts, and patients who experienced mild/moderate AKI within 48 h after cardiac surgery were enrolled. Eventually, 3188 patients from the MIMIC-IV database were used as the derivation cohort, while 499 patients from the Zhongshan cohort were used as external validation. The primary outcome was defined by the composite outcome of progression to severe AKI or death within seven days after enrollment. The variables identified by LASSO regression analysis were entered into logistic regression models and were used to construct the risk score. Results The composite outcome accounted for 3.7% (n = 119) and 7.6% (n = 38) of the derivation and validation cohorts, respectively. Six predictors were assembled into a risk score (AKI-Pro score), including female, baseline eGFR, aortic surgery, modified furosemide responsiveness index (mFRI), SOFA, and AKI stage. And we stratified the risk score into four groups: low, moderate, high, and very high risk. The risk score displayed satisfied predictive discrimination and calibration in the derivation and validation cohort. The AKI-Pro score discriminated the composite outcome better than CRATE score, Cleveland score, AKICS score, Simplified renal index, and SRI risk score (all P < 0.05). Conclusions The AKI-Pro score is a new clinical tool that could assist clinicians to identify early AKI patients at high risk for AKI progression or death. Graphical Abstract

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“…Benzodiazepines have been widely prescribed for treating insomnia, however, they have severe side effects such as rebound insomnia, delirium, dementia, and falls [ 9 , 10 ]. To avoid these severe side effects, benzodiazepines aren’t recommended to be prescribed for elderly patients [ 3 ], and melatonin receptor agonists and orexin receptor antagonists have been developed [ 11 , 12 ]. However, in one study, even zolpidem and suvorexant resulted in impaired balance ability versus a placebo [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Balance dysfunction the most significant cause of in-hospital falls in patients taking hypnotic drugs: A retrospective study

Hashida

Matsuse²,

Yokoyama³

et al. 2022

PLoS ONE

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Purpose Preventing falls in patients is one of the most important concerns in acute hospitals. Balance disorder and hypnotic drugs lead to falls. The Standing Test for Imbalance and Disequilibrium (SIDE) is developed for the evaluation of static standing balance ability. There have been no reports of a comprehensive assessment of falls risk including hypnotic drugs and SIDE. The purpose of this study was to investigate the fall rate of each patient who took the hypnotic drug and the factor associated with falls. Methods Fall rates for each hypnotic drug were calculated as follows (number of patients who fell/number of patients prescribed hypnotic drug x 100). We investigated the hypnotic drugs as follows; benzodiazepine drugs, Z-drugs, melatonin receptor agonists, and orexin receptor antagonists. Hypnotic drug fall rate was analyzed using Pearson’s chi-square test. Decision tree analysis is the method we used to discover the most influential factors associated with falls. Results This study included 2840 patients taking hypnotic drugs. Accidents involving falls were reported for 211 of inpatients taking hypnotic drugs. Z-drug recipients had the lowest fall rate among the hypnotic drugs. We analyzed to identify independent factors for falls, a decision tree algorithm was created using two divergence variables. The SIDE levels indicating balance disorder were the initial divergence variable. The rate of falls in patients at SIDE level ≦ 2a was 14.7%. On the other hand, the rate of falls in patients at SIDE level ≧ 2b was 2.9%. Gender was the variable for the second classification. In this analysis, drugs weren’t identified as divergence variables for falls. Conclusion The SIDE balance assessment was the initial divergence variable by decision tree analysis. In order to prevent falls, it seems important not only to select appropriate hypnotic drugs but also to assess patients for balance and implement preventive measures.

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Serum N-terminal Pro-B-type Natriuretic Peptide Predicts Mortality in Cardiac Surgery Patients Receiving Renal Replacement Therapy

Cited by 5 publications

References 44 publications

Prediction of Short-Term Mortality With Renal Replacement Therapy in Patients With Cardiac Surgery-Associated Acute Kidney Injury

Prediction of Short-Term Mortality With Renal Replacement Therapy in Patients With Cardiac Surgery-Associated Acute Kidney Injury

AKI-Pro score for predicting progression to severe acute kidney injury or death in patients with early acute kidney injury after cardiac surgery

Balance dysfunction the most significant cause of in-hospital falls in patients taking hypnotic drugs: A retrospective study

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