Serum Creatinine Measurement Immediately After Cardiac Surgery and Prediction of Acute Kidney Injury
Julie HoMartina ReslerovaBrent GaliPeter NickersonDavid N. RushManish M. SoodJoe BuetiPaul KomendaEdward PascoeRakesh C. AroraClaudio Rigatto
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Purpose: EuroSCORE had been the most widely used risk model for predicting outcomes after cardiac surgery for over a decade, but recent studies have found the score to over-estimate operative mortality. The revised EuroSCORE II and AusSCORE, based on an Australasian population, were recently developed. We compared the prognostic utility of EuroSCORE I, EuroSCORE II and AusSCORE for coronary artery bypass grafting (CABG).
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Abstract Background Higher EuroSCORE II values are usually associated with increased postoperative morbidity and longer durations of Cardiac intensive care unit (CICU) stay following cardiac surgery. Aim/Purpose The aim is to investigate the predictive performance of EuroSCORE II for the Indian population and its relationship with ICU length of stay. Methods Prospective, observational study in 250 adult cardiac patients undergoing CABG under general Anaesthesia. Preoperatively values of EuroSCORE II was calculated by an online calculator available on www.euroscore.org . These patients were followed up after surgery for 30 days to note mortality and length of CICU stay. Results Of 250 cases studied, 39 (15.6%) had EuroSCORE II less than 1, 163 (65.2%) had EuroSCORE II between 1 and 3, 36 (14.4%) had EuroSCORE II between 3.1 and 5.0 and 12 (4.8%) had EuroSCORE II more than 5 in the study group. Mean EuroSCORE II and length of stay in CICU after surgery was 2.2 ± 1.4 and 4.2 ± 2.5 days respectively. The area under the curve (AUC) for EuroSCORE II as a sole predictor of mortality in the study group based on receiver operating characteristic curve (ROC) analysis was 0.919 (95% CI 0.86–0.97). Based on ROC analysis, AUC is significantly higher for predicting mortality ( p < 0.001). Conclusion EuroSCORE II in Indian cardiac patients undergoing cardiac surgery is lesser than in European patients (mean 2.2 vs 3.7). Incidence of mortality is higher in patients with higher EuroSCORE II. As per our study patients with higher EuroSCORE II tend to stay longer in ICU.
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AIM : To evaluate risk factors and prevalence of acute kidney injury (AKI) in patients with chronic kidney disease (CKD) in the early period after isolated coronary artery bypass graft (CABG). PATIENTS AND METHODS: The study included 830 patients with isolated CABG. All surgeries were performed in 2016. To evaluate kidney function in preoperative period glomerular filtration rate (GFR) was estimated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. AKI was diagnosed according to KDIGO criteria. Patients were stratified into two groups according to estimated glomerular filtration rate (eGFR). RESULTS: The prevalence of AKI in patients group without CKD after CABG was 11,5% (n=59), in CKD-AKI group – 12,3% (n=39). In patients with CKD and after intraoperative inotropic/vasopressor therapy use of only 2 medicinal drugs of this group the probability of AKI development increases 11,16 times (OR 11,46; 95% CI 3,47- 37,83; р<0,01). During complete bypass (CB) when haematocrit decreases on 1% AKI probability increases on 12,36% (OR 0,89; 95% CI 0,81-0,98; р=0,02). The necessity of haemodialisys, duration of stay in intensive care unit and hospitalization duration were equal to all groups. AKI-CKD development significantly increases intrahospital mortality (p<0,05). CONCLUSIONS : History of CKD increases probability of severe AKI and also mortality in early postoperative period. Revealed risk factors for AKI development are potentially modifiable.
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To assess the value of European system for cardiac operative risk evaluation (EuroSCORE) in predicting quality of life in patients post coronary artery bypass graft surgery (CABG).A total of 387 patients underwent CABG in our institute from December of 2002 to December of 2007 were assessed by EuroSCORE before operation. Health-related quality of life (QoL) was estimated postoperatively with Seattle angina questionnaire (SAQ), Nottingham healthy profile (NHP) and Duke activity status index (DASI) in order to evaluate the value of EuroSCORE for predicting quality of life in patients post CABG.There were statistically significant but weak correlations between postoperative QoL score and preoperative EuroSCORE score (r: 0.010 - 0.276). Emotional and psychological experience subgroup analysis showed better predictive value of EuroSCORE score on postoperative QoL score in improved physical functioning subgroups (r > 0.2). Linear regression analysis showed that EuroSCORE score was significant but weakly (r(2) < 0.1) correlated with postoperative QoL score (P < 0.05).Preoperative EuroSCORE score is weakly correlated with postoperative QoL score in patients post CABG.
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Canadian Cardiovascular Society
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Coronary Artery Bypass Graft (CABG) is one solution to overcome cardiovascular problems. EuroSCORE II is a scoring system to predict mortality risk in patients undergoing cardiac surgery including CABG. Unfortunately, there's still much debate about the benefits of EuroSCORE II in Asia, including Indonesia. This study aims to validates EuroSCORE II in predicting the outcomes in patients underwent CABG without any other procedure.A total of 2628 patients were included. The mean age was 59 years, mostly male (84.97%; n = 2233). Most patients underwent elective surgery (93.07%; n = 2446) and only 1.67% (n = 44) of the patients has high EuroSCORE category. Death was found in 4.22% (n-111) patients. EuroSCORE II had fair discriminant power (AUC 0.72), but a lower mortality predicted value for each group.The parameters in EuroSCORE II are related with mortality in isolated CABG patients, but they cannot be used as mortality predictors in Indonesia.
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