Michelle C Ellis1, Theron A Paugh1, Timothy A Dickinson2, John Fuller3, Jeffrey Chores3, Gaetano Paone4, Michael Heung5, Karsten Fliegner6, Andrew L Pruitt7, Himanshu J Patel1, Min Zhang8, Richard L Prager1, Donald S Likosky9. 1. Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan. 2. Specialty Care, Nashville, Tennessee. 3. St. John Providence Health System Detroit Hospitals, Detroit, Michigan. 4. Division of Cardiac Surgery, Henry Ford Hospital, Detroit, Michigan. 5. Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan. 6. Genesys Heart Institute, Grand Blanc, Michigan. 7. Michigan Heart and Vascular Institute, St. Joseph Mercy Hospital, Ann Arbor, Michigan. 8. Department of Biostatistics, University of Michigan, Ann Arbor, Michigan. 9. Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address: likosky@med.umich.edu.
Abstract
BACKGROUND: Reports have associated nadir hematocrit (Hct) on cardiopulmonary bypass with the occurrence of renal dysfunction. Recent literature has suggested that women, although more often exposed to lower nadir Hct, have a lower risk of postoperative renal dysfunction. We assessed whether this relationship held across a large multicenter registry. METHODS: We undertook a prospective, observational study of 15,221 nondialysis-dependent patients (10,376 male, 68.2%; 4,845 female, 31.8%) undergoing cardiac surgery between 2010 and 2014 across 26 institutions in Michigan. We calculated crude and adjusted OR between nadir Hct during cardiopulmonary bypass and stage 2 or 3 acute kidney injury (AKI), and tested the interaction of sex and nadir Hct. The predicted probability of AKI was plotted separately for men and women. RESULTS: Nadir Hct less than 21% occurred among 16.6% of patients, although less commonly among men (9.5%) than women (31.9%; p < 0.001). Acute kidney injury occurred among 2.7% of patients, with small absolute differences between men and women (2.6% versus 3.0%, p = 0.20). There was a significant interaction between sex and nadir Hct (p = 0.009). The effect of nadir Hct on AKI was stronger among male patients (adjusted odds ratio per 1 unit decrease in nadir Hct 1.10, 95% confidence interval: 1.05 to 1.13) than female patients (adjusted odds ratio 1.01, 95% CI: 0.96, 1.06). CONCLUSIONS: Lower nadir Hct was associated with an increased risk of AKI, and the effect appears to be stronger among men than women. Understanding of the mechanism underlying this association remains uncertain, although these results suggest the need to limit exposure to lower nadir Hct, especially for male patients.
BACKGROUND: Reports have associated nadir hematocrit (Hct) on cardiopulmonary bypass with the occurrence of renal dysfunction. Recent literature has suggested that women, although more often exposed to lower nadir Hct, have a lower risk of postoperative renal dysfunction. We assessed whether this relationship held across a large multicenter registry. METHODS: We undertook a prospective, observational study of 15,221 nondialysis-dependent patients (10,376 male, 68.2%; 4,845 female, 31.8%) undergoing cardiac surgery between 2010 and 2014 across 26 institutions in Michigan. We calculated crude and adjusted OR between nadir Hct during cardiopulmonary bypass and stage 2 or 3 acute kidney injury (AKI), and tested the interaction of sex and nadir Hct. The predicted probability of AKI was plotted separately for men and women. RESULTS: Nadir Hct less than 21% occurred among 16.6% of patients, although less commonly among men (9.5%) than women (31.9%; p < 0.001). Acute kidney injury occurred among 2.7% of patients, with small absolute differences between men and women (2.6% versus 3.0%, p = 0.20). There was a significant interaction between sex and nadir Hct (p = 0.009). The effect of nadir Hct on AKI was stronger among male patients (adjusted odds ratio per 1 unit decrease in nadir Hct 1.10, 95% confidence interval: 1.05 to 1.13) than female patients (adjusted odds ratio 1.01, 95% CI: 0.96, 1.06). CONCLUSIONS: Lower nadir Hct was associated with an increased risk of AKI, and the effect appears to be stronger among men than women. Understanding of the mechanism underlying this association remains uncertain, although these results suggest the need to limit exposure to lower nadir Hct, especially for male patients.
Authors: L David Hillis; Peter K Smith; Jeffrey L Anderson; John A Bittl; Charles R Bridges; John G Byrne; Joaquin E Cigarroa; Verdi J Disesa; Loren F Hiratzka; Adolph M Hutter; Michael E Jessen; Ellen C Keeley; Stephen J Lahey; Richard A Lange; Martin J London; Michael J Mack; Manesh R Patel; John D Puskas; Joseph F Sabik; Ola Selnes; David M Shahian; Jeffrey C Trost; Michael D Winniford Journal: Circulation Date: 2011-11-07 Impact factor: 29.690
Authors: Scott H Johnson; Patricia F Theurer; Gail F Bell; Luigi Maresca; Thomas Leyden; Richard L Prager Journal: Ann Thorac Surg Date: 2010-10 Impact factor: 4.330
Authors: Richard L Prager; Frederick R Armenti; Joseph S Bassett; Gail F Bell; Daniel Drake; Eric C Hanson; John C Heiser; Scott H Johnson; F B Plasman; Francis L Shannon; David Share; Patty Theurer; Jaelene Williams Journal: Semin Thorac Cardiovasc Surg Date: 2009
Authors: Victor A Ferraris; Jeremiah R Brown; George J Despotis; John W Hammon; T Brett Reece; Sibu P Saha; Howard K Song; Ellen R Clough; Linda J Shore-Lesserson; Lawrence T Goodnough; C David Mazer; Aryeh Shander; Mark Stafford-Smith; Jonathan Waters; Robert A Baker; Timothy A Dickinson; Daniel J FitzGerald; Donald S Likosky; Kenneth G Shann Journal: Ann Thorac Surg Date: 2011-03 Impact factor: 4.330
Authors: Robert H Habib; Anoar Zacharias; Thomas A Schwann; Christopher J Riordan; Milo Engoren; Samuel J Durham; Aamir Shah Journal: Crit Care Med Date: 2005-08 Impact factor: 7.598
Authors: K Karkouti; W S Beattie; D N Wijeysundera; V Rao; C Chan; K M Dattilo; G Djaiani; J Ivanov; J Karski; T E David Journal: J Thorac Cardiovasc Surg Date: 2005-02 Impact factor: 5.209
Authors: O M Shapira; G S Aldea; P R Treanor; R M Chartrand; K M DeAndrade; H L Lazar; R J Shemin Journal: Ann Thorac Surg Date: 1998-03 Impact factor: 4.330
Authors: Glenn S Murphy; Joseph W Szokol; Martin Nitsun; David A Alspach; Michael J Avram; Jeffery S Vender; Nick DeMuro; William J Hoff Journal: J Cardiothorac Vasc Anesth Date: 2006-01-06 Impact factor: 2.628
Authors: Donald S Likosky; Robert A Baker; Richard F Newland; Theron A Paugh; Timothy A Dickinson; David Fitzgerald; Joshua B Goldberg; Nicholas B Mellas; Alan F Merry; Paul S Myles; Gaetano Paone; Kenneth G Shann; Jane Ottens; Timothy W Willcox Journal: J Extra Corpor Technol Date: 2018-12
Authors: Alexander A Brescia; Xiaoting Wu; Gaetano Paone; Michael Heung; Theron A Paugh; Kenneth G Shann; David C Fitzgerald; Timothy A Dickinson; David Sturmer; Jeffrey Chores; Andrew L Pruitt; Haley Allgeyer; Sim Uppal; Min Zhang; Himanshu J Patel; Richard L Prager; Donald S Likosky Journal: J Thorac Cardiovasc Surg Date: 2019-03-29 Impact factor: 5.209
Authors: Juan G Ripoll; Mark M Smith; Andrew C Hanson; Phillip J Schulte; Erica R Portner; Daryl J Kor; Matthew A Warner Journal: Anesth Analg Date: 2021-04-01 Impact factor: 6.627