Calculated plasma volume status and outcomes in patients undergoing coronary bypass graft surgery
| Autor: | Annette Maznyczka, Amit Kaura, Fadi Jouhra, Olaf Wendler, Max Baghai, George Amin-Youssef, Bassey Ussen, Shyam Kolvekar, Mohamad F. Barakat, Huda Abu-Own, Niki Nicou, Ranjit Deshpande, Hannah Jaumdally, Darlington O. Okonko |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty New York Heart Association Class 030204 cardiovascular system & hematology Plasma volume Cohort Studies 03 medical and health sciences 0302 clinical medicine Diabetes mellitus Intensive care medicine Humans 030212 general & internal medicine Coronary Artery Bypass Plasma Volume Aged Retrospective Studies Aged 80 and over business.industry Retrospective cohort study EuroSCORE Middle Aged Prognosis medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Heart failure Preoperative Period Female Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | Heart. 105:1020-1026 |
| ISSN: | 1468-201X 1355-6037 |
| DOI: | 10.1136/heartjnl-2018-314246 |
| Popis: | ObjectivesCongestion is associated with worse outcomes in critically ill surgical patients but can be difficult to quantify noninvasively. We hypothesised that plasma volume status (PVS), estimated preoperatively using a validated formula that enumerates percentage change from ideal plasma volume (PV), would provide incremental prognostic utility after coronary artery bypass graft (CABG) surgery.MethodsIn this retrospective cohort study, patients who underwent CABG surgery (1999–2010) were identified from a prospectively collected database. Actual ([1-haematocrit] x [a+(b x weight [kg])]) and ideal (c x weight [kg]) PV were obtained from equations where a, b and c are sex-dependent constants. Calculated PVS was then derived (100% x [(actual−ideal)/ideal]).ResultsIn 1887 patients (mean age 67±10 years; 79% male; median European System for Cardiac Operative Risk Evaluation [EuroSCORE] 4), mean PVS was −8.2±9%. While 8% of subjects had clinical evidence of congestion, a relatively increased PV (PVS >0%) was estimated in 17% and correlated with lower serum sodium, higher EuroSCORE and a diagnosis of diabetes mellitus. A PVS≥5.6% was optimally prognostic and associated with greater mortality (HR: 2.31, p=0.009), independently of, and incremental to, EuroSCORE, New York Heart Association class and serum sodium. A PVS≥5.6% also independently predicted longer intensive care (β: 0.65, p=0.007) and hospital (β: 2.01, p=0.006) stays, and greater postoperative renal (OR: 1.61, p=0.008) and arrhythmic (OR: 1.29, p=0.03) complications.ConclusionsHigher PVS values, calculated simply from weight and haematocrit, are associated with worse inpatient outcomes after CABG. PVS could help refine risk stratification and further investigations are warranted to evaluate the potential clinical utility of PVS-guided management in patients undergoing CABG. |
| Databáze: | OpenAIRE |
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