The role of endogenous kallikrein inhibition in perioperative transfusion and adverse outcome in cardiac surgical patients
| Autor: | M. J. Gallimore, Catherine M.N. O'Malley, Robert J. Frumento, Andrew L. Hirsh, Elliott Bennett-Guerrero, Ian J. Mackie |
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| Rok vydání: | 2006 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Blood Loss Surgical Hemostatics Perioperative Care law.invention Cohort Studies Aprotinin Postoperative Complications law Blood product Outcome Assessment Health Care medicine Cardiopulmonary bypass Humans Blood Transfusion Prospective Studies Cardiac Surgical Procedures Intraoperative Complications Aged Mechanical ventilation Cardiopulmonary Bypass business.industry Perioperative Length of Stay Middle Aged Intensive care unit Respiration Artificial Cardiac surgery Anesthesiology and Pain Medicine Treatment Outcome Quartile Hematocrit Anesthesia Female Kallikreins Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Journal of cardiothoracic and vascular anesthesia. 21(1) |
| ISSN: | 1053-0770 |
| Popis: | Objective: The goal of this study was to explore the relationship among endogenous plasma kallikrein inhibition (KI), perioperative bleeding, and adverse outcomes in cardiac surgery. Design: A prospective, observational study. Setting: University teaching hospitals. Participants: Cardiac surgical patients. Interventions: Endogenous plasma KI levels (%) and kallikrein-like activity (KKA) were measured preoperatively, 30 minutes into cardiopulmonary bypass, and at the end of surgery. Patients were divided into quartiles of preoperative KI. Data including risk factors, blood loss, transfusion requirements, and postoperative outcomes were collected. Measurements and Main Results: Preoperative endogenous KI ranged from 40% to 175%, where 100% represents the activity of pooled healthy volunteer plasma. The quartiles of KI levels were as follows: quartile 1, KI = 40% to 83.8% (n = 40); quartile 2, KI = 84% to 101.5% (n = 40); quartile 3, KI = 102% to 120% (n = 42); and quartile 4, KI = 121% to 175% (n = 38). The hematocrits on admission to the intensive care unit were as follows: quartile 1, 28% ± 4%; quartile 2, 26% ± 4%; quartile 3, 26% ± 4%; and quartile 4, 24% ± 4% (p = 0.009). Blood product use was similar among quartiles in the operating room. Quartiles 3 and 4 received more blood (p = 0.003) and platelet (p = 0.04) transfusions than quartiles 1 and 2 in the first 24 hours after surgery. More patients in quartile 4 were ventilated for more than 24 hours after surgery (p Conclusion: Contrary to expectation, higher endogenous KI levels were associated with more blood product transfusion, longer postoperative mechanical ventilation, and hospital length of stay. These findings raise questions as to the role of KI in postoperative outcomes. |
| Databáze: | OpenAIRE |
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