| Literature DB >> 26553045 |
Eduardo Tamayo1, Inma Fierro2, Juan Bustamante-Munguira3, María Heredia-Rodríguez1, Pablo Jorge-Monjas1, Laura Maroto4, Esther Gómez-Sánchez1, Francisco Jesús Bermejo-Martín5, Francisco Javier Álvarez2, José Ignacio Gómez-Herreras1.
Abstract
Entities:
Year: 2015 PMID: 26553045 PMCID: PMC4638080 DOI: 10.1186/s13054-015-1117-0
Source DB: PubMed Journal: Crit Care ISSN: 1364-8535 Impact factor: 9.097
Patient population profile (Survivors and non-survivors)
| Variable | Survivors ( | Non survivors ( |
|
|---|---|---|---|
| Preoperative factors | |||
| Age, years | 66.3 ± 11.2 | 68.9 ± 11.3 |
|
| Sex, M/F male gender | 574 (69.2) | 48 (60) | 0.09 |
| Peso, kg | 72.7 ± 15 | 71.9 ± 11.4 | 0.69 |
| Talla, cm | 163.3 ± 9 | 162.3 ± 8.9 | 0.34 |
| Hypertension | 449 (54.2) | 50 (62.5) | 0.15 |
| Atrial fibrillation | 167 (20.1) | 23 (28.8) | 0.07 |
| Diabetes mellitus | 198 (23.9) | 20 (25) | 0.82 |
| Obesity | 132 (15.9) | 12 (15) | 0.82 |
| Smoking | 114 (13.8) | 6 (7.5) | 0.11 |
| Drinking alcohol | 50 (6) | 2 (2.5) | 0.19 |
| Hepatic disease | 23 (2.8) | 3 (3.8) | 0.61 |
| Respiratory disease | 93 (11.2) | 15(18.8) |
|
| Chronic renal failure | 50 (6) | 11 (13.8) |
|
| Immunosuppression | 23 (2.8) | 4 (5.0) | 0.26 |
| Previous cardiac surgery | 79 (9.5) | 11 (13.8) | 0.61 |
| Emergent surgery | 70 (8.4) | 23 (28.8) |
|
| Perioperative factors | |||
| Left ventricle ejection fraction | 56.8 ± 11.5 | 49.6 ± 13.6 |
|
| Valve | 455 (54.9) | 47 (58.8) | 0.5 |
| CABG | 399 (48.1) | 39 (48.8) | 0.91 |
| Valve + CABG | 109 (13.1) | 20 (25.0) |
|
| Total CPB time. min | 105.3 ± 44.29 | 156.1 ± 77.7 |
|
| Aortic cross-clamp time, min | 77.3 ± 37.04 | 106.9 ± 56.7 |
|
| Postoperative value | |||
| Duration of mechanical ventilation, days | 25.23 ± 62.59 | 19.75 ± 31.43 | 0.81 |
| Reintubation | 25 (3) | 16 (20) |
|
| Politrasfusion | 254 (30.6) | 25 (31.3) | 0.640 |
| Acute renal failure | 67 (8.1) | 36 (45.0) |
|
| Reintervención | 21 (2.5) | 13 (16.3) |
|
| Intra-aortic balloon pump | 32 (3.9) | 27 (33.8) |
|
| Pneumonia | 35 (4.2) | 15 (18.8) |
|
| Surgical site infections | 25 (3) | 1 (1.3) | 0.36 |
| Preoperative hospitalization, days | 18.2 ± 15.5 | 10.6 ± 11.3 |
|
| Mean ICU stay, days | 4.7 ± 12.1 | 14.3 ± 20.9 |
|
| Duration of hospitalization after surgery, days | 22.8 ± 20.9 | 24.9 ± 23.7 | 0.43 |
| Risk score | |||
| Additive EuroSCORE, points | 4.5 ± 2.8 | 7.4 ± 4.5 |
|
| Logistic EuroSCORE, points | 5.4 ± 6.2 | 16.7 ± 18.5 |
|
| ACEF score, points | 1.2 ± 0.4 | 1.7 ± 0.6 |
|
| SOFA score, points | 5.5 ± 1.7 | 7.7 ± 1.7 |
|
| SAP II score, points | 28.9 ± 8.7 | 43.0 ± 11.6 |
|
| APACHE II score, points | 13.3 ± 3.8 | 18.3 ± 5.6 |
|
Values are expressed as numbers (n), percentages (%), and means ± SD
APACHE II Acute Physiology and Chronic Health Evaluation II, CABG coronary artery bypass graft, CPB cardiopulmonary bypass
Parameters at the admission to the intensive care unit in survivors and non-survivors
| Variable | Survivors ( | Non-survivors ( |
|
|---|---|---|---|
| pH | 7.37 ± 0.06 | 7.31 ± 0.9 |
|
| HCO3 − mEq/l | 24.4 ± 3.15 | 21.04 ± 3.9 |
|
| PCO2, mmHg | 41.0 ± 6.3 | 41.3 ± 6.2 | 0.69 |
| PaO2/FiO2, range | 245.6 ± 72.8 | 226.2 ± 77.1 |
|
| Core temperature, °C | 36.6 ± 0.8 | 36.7 ± 1.5 | 0.22 |
| Leukocyte count, cells/mm3 | 10535.1 ± 6396.8 | 13454.8 ± 5727.4 |
|
| C-reactive protein, mg/L | 14.3 ± 35.1 | 29.5 ± 53.1 |
|
| Procalcitonin, ng/mL | 0.8 ± 4.9 | 3.1 ± 5. |
|
| Lactates, mmol/L | 29.4 ± 14.9 | 63.6 ± 43.7 |
|
| ScvO2, % | 73.4 ± 8.6 | 65.6 ± 12.3 |
|
| Heart rate, beats/min | 92.3 ± 18.5 | 109.7 ± 17.2 |
|
| Mean arterial pressure, mmHg | 72.5 ± 13.7 | 53.6 ± 10.5 |
|
| Glucose, mg/dl | 181 ± 57.2 | 193.7 ± 70.5 | 0.13 |
| Creatinine, mg/dl | 1 ± 0.5 | 1.5 ± 1.3 |
|
| Hematocrit, % | 29.1 ± 4.4 | 28 ± 4.5 |
|
| Na, mmol/L | 140.1 ± 7.6 | 142 ± 4.8 |
|
| K, mmol/L | 3.9 ± 0.6 | 4 ± 0.7 | 0.47 |
| TnT, μg/l | 0.8 ± 1.4 | 3.8 ± 6.1 |
|
| CK-MB, ng/mL | 336.4 ± 283.2 | 161.6 ± 186.4 |
|
| INR, range | 1.5 ± 0.2 | 2 ± 0.8 |
|
| aPTTr, range | 1.2 ± 0.3 | 1.8 ± 1.2 |
|
| Platelet count, cells/mm3 | 119490.8 ± 47226.4 | 119898.7 ± 65476.3 | 0.95 |
Values are expressed as means ± SD
aPTTr activated partial thromboplastin time ratio, CK-MB creatine kinase-MB, INR international normalized ratio, K potassium, Na sodium, PaO2/FiO2 ratio ratio of partial pressure of arterial oxygen to fraction of inspired oxygen, PCO partial pressure of carbon dioxide, ScvO2 central venous oxygen saturation, TnT troponin T
Logistic regression model: risk factors for 90-day In-Hospital Mortality
| B | SE |
| OR | 95 % CI | |
|---|---|---|---|---|---|
| Constant | −11.561 | 1.155 | 0.0001 | 0.0001 | |
| 1000/MAP (mmHg) | 0.308 | 0.046 | 0.0001 | 1.360 | 1.242–1.489 |
| 1000/Bicarbonate (mEq/L) | 0.034 | 0.013 | 0.011 | 1.035 | 1.008–1.062 |
| Lactate (mg/dL) | 0.022 | 0.007 | 0.001 | 1.023 | 1.009–1.036 |
| INR | 1.025 | 0.397 | 0.0101 | 2.788 | 1.282–6.064 |
Hosmer-Lemeshow 2 = 8.62; P = .37. Multicollinearity diagnostics: 1000/MAP, 0.78 tolerance; 1000/Bicarbonate, 0.87 tolerance; Lactate, 0.64 tolerance and INR, 0.65 tolerance
B regression coefficient, CI confidence interval, INR international normalized ratio, MAP Mean arterial pressure, OR Odds Ratio
A new system to predict operative mortality in patients undergoing cardiac surgery: POCAS score
| Lactate (mmol/L) | Score | INR | Score |
| <16.00 | 3 | <1.31 | 12 |
| 16.00 to 24.90 | 4 | 1.31 to 1.52 | 14 |
| 25.00 to 34.90 | 6 | 1.53 to 1.94 | 16 |
| 35.00 to 52.90 | 9 | 1.95 to 2.65 | 20 |
| 53.00 to 79.00 | 14 | >2.65 | 30 |
| >79.00 | 21 | ||
| MAP (mm Hg) | Score | Bicarbonate (mEq/L) | Score |
| >75 | 35 | >27.4 | 14 |
| 69 to 75 | 41 | 25.7 to 27.4 | 15 |
| 61 to 68 | 46 | 24.1 to 25.6 | 16 |
| 60 | 50 | 22.8 to 24.0 | 17 |
| 45 to 59 | 58 | 20.4 to 22.7 | 18 |
| <45 | 75 | 14.6 to 20.3 | 22 |
| <14.6 | 35 |
Development series: predictive function of POCAS score scale for 90-day In- Hospital Mortality (Logistic regression)
| B | SE |
| OR | 95 % CI | ||
|---|---|---|---|---|---|---|
| POCAS | 0.113 | 0.011 | 0.0001 | 1.119 | 1.096 | 1.143 |
| Constant | −12.671 | 1.051 | 0.0001 | 0.000 | ||
B regression coefficient, CI confidence interval, OR Odds Ratio
Operative risk categories with corresponding cumulative risk score for 90-day In-Hospital Mortality after cardiac surgery for the risk groups calculated from the roc curve, cumulative risk score*
| Risk score | Observed no. | Predicted no. | % probability (95 % CI) | 90-Day In-Hospital Mortality (%) | Operative risk categories | % probability (95 % CI) |
|---|---|---|---|---|---|---|
| <75 | 1 | 1 | 0.92 (0.89–0.95) | 0.4 | Low | 2.33 (2.19–2.46) |
| 75–81 | 3 | 3 | 2.10 (2.03–2.16) | 1.5 | ||
| 82–90 | 11 | 11 | 4.82 (4.62–5.02) | 6.1 | ||
| 91–100 | 12 | 12 | 12.99 (12.34–13.65) | 11.1 | Medium | 16.32 (15.25–17.38) |
| 101–105 | 11 | 10 | 25.53 (24.40–26.66) | 28.2 | ||
| 106–128 | 29 | 28 | 56.22 (51.86–60.58) | 55.8 | High | 56.22 (51.86–60.58) |
| >128 | 13 | 13 | 94.98 (92.75–97.21) | 100.0 | Very high | 94.98 (92.75–97.21) |
CI confidence interval, n number
Validity of Additive EuroSCORE, Logistic EuroSCORE, ACEF, SOFA, SAP II, APACHE II, and POCAS to predict the 90-day In-Hospital Mortality rate after cardiac surgery with CEC
| Criterion for assigning a mortality | AUC [95 % IC] | Ind.Youden Máx | Cutoff value | Sensitivity | Specifity | NPV | PPV |
|
|---|---|---|---|---|---|---|---|---|
| POCAS | 0.899 [0.864–0.934]* | 0.63 | 85.5 | 0.91 | 0.72 | 98.7 | 24.9 | -- |
| APACHE II | 0.768 [0.709–0.828]* | 0.42 | 17.5 | 0.54 | 0.88 | 95.2 | 30.7 | 20.42* |
| SOFA | 0.825 [0.782–0.867]* | 0.52 | 5.5 | 0.92 | 0.59 | 98.7 | 18.8 | 10.16** |
| SAPS II | 0.847 [0.800–0.893]* | 0.56 | 32.5 | 0.85 | 0.71 | 98.2 | 20.1 | 24.10* |
| ACEF | 0.699 [0.639–0.758]* | 0.31 | 1.49 | 0.50 | 0.81 | 93.5 | 22.3 | 652.30* |
| Logistic EuroSCORE | 0.754 [0.693–0.814]* | 0.40 | 4.11 | 0.81 | 0.58 | 96.7 | 17.3 | 398.28* |
| Additive EuroSCORE | 0.714 [0.647–0.780]* | 0.38 | 5.50 | 0.71 | 0.67 | 95.4 | 19.2 | 30.39* |
(*) p < 0.0001; (**) p < 0.05
AUC area under the curve, NPV negative predictive value, PPV positive predictive value, SOFA Secuencial Organ Failure Assesment, SAP II Simplified Acute Physiology Score II, APACHE II Acute Physiology and Chronic Health Evaluation II