Alexander A Brescia1, Xiaoting Wu1, Gaetano Paone2, Michael Heung1, Theron A Paugh1, Kenneth G Shann3, David C Fitzgerald4, Timothy A Dickinson5, David Sturmer1, Jeffrey Chores6, Andrew L Pruitt7, Haley Allgeyer1, Sim Uppal1, Min Zhang1, Himanshu J Patel1, Richard L Prager8, Donald S Likosky9. 1. University of Michigan, Ann Arbor, Mich. 2. Division of Cardiac Surgery, Henry Ford Hospital, Detroit, Mich. 3. Massachusetts General Hospital, Boston, Mass. 4. Medical University of South Carolina, Charleston, SC. 5. Mayo Clinic, Rochester, Minn. 6. St John Providence Health System, Detroit, Mich. 7. Michigan Heart and Vascular Institute, St Joseph Mercy Hospital, Ann Arbor, Mich. 8. University of Michigan, Ann Arbor, Mich; PERForm Registry and The Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich. 9. University of Michigan, Ann Arbor, Mich; PERForm Registry and The Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich. Electronic address: likosky@med.umich.edu.
Abstract
OBJECTIVE: Findings from a large multicenter experience showed that sex influenced the relationship between low nadir hematocrit and increased risk of acute kidney injury after cardiac surgery. We explored whether sex-related differences persisted among patients undergoing isolated coronary artery bypass grafting. METHODS: We undertook a prospective, observational study of 17,363 patients without dialysis (13,137 male: 75.7%; 4226 female: 24.3%) undergoing isolated coronary artery bypass grafting between 2011 and 2016 across 41 institutions in the Perfusion Measures and Outcomes registry. Odds ratios between nadir hematocrit and stage 2 or 3 acute kidney injury were calculated, and the interaction of sex with nadir hematocrit was tested. The multivariable, generalized, linear mixed-effect model adjusted for preoperative and intraoperative factors and institution. RESULTS: Median nadir hematocrit was 22% among women and 27% among men (P < .001). Women were administered a greater median net prime volume indexed to body surface area (407 vs 363 mL/m2) and more red blood cell transfusions (55.5% vs 24.3%; both P < .001). Acute kidney injury was higher among women (6.0% vs 4.3%, P < .001). There was no effect of sex on the relationship between nadir hematocrit and acute kidney injury (P = .67). Low nadir hematocrit was inversely associated with acute kidney injury (adjusted odds ratios per 1-unit increase in nadir hematocrit 0.96; 95% confidence interval, 0.93-0.98); this effect was similar across sexes and independent of red blood cell transfusions. CONCLUSIONS: We found no sex-related differences in the effect of nadir hematocrit on acute kidney injury after isolated coronary artery bypass grafting. However, the strong inverse relationship between anemia and acute kidney injury across sexes suggests the importance of reducing exposure to low nadir hematocrit.
OBJECTIVE: Findings from a large multicenter experience showed that sex influenced the relationship between low nadir hematocrit and increased risk of acute kidney injury after cardiac surgery. We explored whether sex-related differences persisted among patients undergoing isolated coronary artery bypass grafting. METHODS: We undertook a prospective, observational study of 17,363 patients without dialysis (13,137 male: 75.7%; 4226 female: 24.3%) undergoing isolated coronary artery bypass grafting between 2011 and 2016 across 41 institutions in the Perfusion Measures and Outcomes registry. Odds ratios between nadir hematocrit and stage 2 or 3 acute kidney injury were calculated, and the interaction of sex with nadir hematocrit was tested. The multivariable, generalized, linear mixed-effect model adjusted for preoperative and intraoperative factors and institution. RESULTS: Median nadir hematocrit was 22% among women and 27% among men (P < .001). Women were administered a greater median net prime volume indexed to body surface area (407 vs 363 mL/m2) and more red blood cell transfusions (55.5% vs 24.3%; both P < .001). Acute kidney injury was higher among women (6.0% vs 4.3%, P < .001). There was no effect of sex on the relationship between nadir hematocrit and acute kidney injury (P = .67). Low nadir hematocrit was inversely associated with acute kidney injury (adjusted odds ratios per 1-unit increase in nadir hematocrit 0.96; 95% confidence interval, 0.93-0.98); this effect was similar across sexes and independent of red blood cell transfusions. CONCLUSIONS: We found no sex-related differences in the effect of nadir hematocrit on acute kidney injury after isolated coronary artery bypass grafting. However, the strong inverse relationship between anemia and acute kidney injury across sexes suggests the importance of reducing exposure to low nadir hematocrit.
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: Sean Gallagher; Dan A Jones; Matthew J Lovell; Sevda Hassan; Andrew Wragg; Akhil Kapur; Rakesh Uppal; Muhammad M Yaqoob Journal: J Thorac Cardiovasc Surg Date: 2013-04-12 Impact factor: 5.209
Authors: Jeremiah R Brown; William M Hisey; Emily J Marshall; Donald S Likosky; Elizabeth L Nichols; Allen D Everett; Sara K Pasquali; Marshall L Jacobs; Jeff P Jacobs; Chirag R Parikh Journal: Ann Thorac Surg Date: 2016-06-17 Impact factor: 4.330
Authors: Ravindra L Mehta; John A Kellum; Sudhir V Shah; Bruce A Molitoris; Claudio Ronco; David G Warnock; Adeera Levin Journal: Crit Care Date: 2007 Impact factor: 9.097
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
Authors: Yeiwon Lee; Ho Young Hwang; Hee Ju Hong; Sue Hyun Kim; Suk Ho Sohn; Jae Woong Choi; Kyung Hwan Kim Journal: J Thorac Dis Date: 2022-09 Impact factor: 3.005