Abinaya Ramakrishnan1, Cynthia Zheng2, Manuel L Fontes3, Frederic W Lombard4, Austin A Woolard4, Yaping Shi5, Matthew S Shotwell5, Frederic T Billings4, Mias Pretorius4, Jonathan P Wanderer4,6, Rushikesh Vyas7, Tarek S Absi7, Ashish S Shah7, Miklos D Kertai8,9. 1. Vanderbilt University, Nashville, TN, USA. 2. Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. 3. Yale School of Medicine, New Haven, CT, USA. 4. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA. 5. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA. 6. Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA. 7. Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 8. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA. miklos.kertai@vumc.org. 9. Perioperative Precision Medicine Program, Division of Adult Cardiothoracic Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building, Office 526, Nashville, TN, 37212, USA. miklos.kertai@vumc.org.
Abstract
PURPOSE: Increased mean platelet volume (MPV) may indicate platelet activation, platelet aggregation, and a resulting prothrombotic state. Such changes in the postoperative period have been associated with organ injury and adverse outcomes. We hypothesized that changes in MPV after cardiac surgery are associated with both a higher risk of acute kidney injury (AKI) and mortality. METHODS: In this retrospective study, we evaluated consecutive patients undergoing adult cardiac surgery patients between 12 December 2011 and 5 June 2018. The change in MPV was derived by calculating the difference between the baseline MPV before surgery and the average postoperative MPV just prior to the occurrence of AKI. We defined postoperative AKI according to Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for Acute Kidney Injury as either a ≥ 50% increase in serum creatinine in the first ten postoperative days, or an increase of ≥ 0.3 mg·dL-1 during any 48-hr window across the ten-day postoperative period. Multivariable logistic regression analysis was used to examine the association between MPV change and postoperative AKI and mortality. RESULTS: Of the 4,204 patients studied, 1,373 (32.7%) developed postoperative AKI, including 83 (2.0%) and 38 (0.9%) who developed stages II and III AKI, respectively. Compared with patients who had an increase in median postoperative MPV of 0.2 femtolitre (fL), those with an increase of 0.8 fL had an 80% increase in the odds of developing AKI (adjusted odds ratio [aOR], 1.80; 95% confidence interval [CI],1.36 to 2.38; P < 0.001) and were almost twice as likely to progress to a higher severity AKI (aOR, 1.66; 95% CI, 1.28 to 2.16; P < 0.001). Change in MPV was not associated with mortality (aOR,1.32; 95% CI, 0.92 to 1.89; P = 0.14). CONCLUSION: Increased MPV change in the postoperative period was associated with both increased risk and severity of AKI, but not mortality.
PURPOSE: Increased mean platelet volume (MPV) may indicate platelet activation, platelet aggregation, and a resulting prothrombotic state. Such changes in the postoperative period have been associated with organ injury and adverse outcomes. We hypothesized that changes in MPV after cardiac surgery are associated with both a higher risk of acute kidney injury (AKI) and mortality. METHODS: In this retrospective study, we evaluated consecutive patients undergoing adult cardiac surgery patients between 12 December 2011 and 5 June 2018. The change in MPV was derived by calculating the difference between the baseline MPV before surgery and the average postoperative MPV just prior to the occurrence of AKI. We defined postoperative AKI according to Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for Acute Kidney Injury as either a ≥ 50% increase in serum creatinine in the first ten postoperative days, or an increase of ≥ 0.3 mg·dL-1 during any 48-hr window across the ten-day postoperative period. Multivariable logistic regression analysis was used to examine the association between MPV change and postoperative AKI and mortality. RESULTS: Of the 4,204 patients studied, 1,373 (32.7%) developed postoperative AKI, including 83 (2.0%) and 38 (0.9%) who developed stages II and III AKI, respectively. Compared with patients who had an increase in median postoperative MPV of 0.2 femtolitre (fL), those with an increase of 0.8 fL had an 80% increase in the odds of developing AKI (adjusted odds ratio [aOR], 1.80; 95% confidence interval [CI],1.36 to 2.38; P < 0.001) and were almost twice as likely to progress to a higher severity AKI (aOR, 1.66; 95% CI, 1.28 to 2.16; P < 0.001). Change in MPV was not associated with mortality (aOR,1.32; 95% CI, 0.92 to 1.89; P = 0.14). CONCLUSION: Increased MPV change in the postoperative period was associated with both increased risk and severity of AKI, but not mortality.
Authors: R Clive Landis; Jeremiah R Brown; David Fitzgerald; Donald S Likosky; Linda Shore-Lesserson; Robert A Baker; John W Hammon Journal: J Extra Corpor Technol Date: 2014-09
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Authors: Stefan Kindler; Till Ittermann; Robin Bülow; Birte Holtfreter; Catharina Klausenitz; Philine Metelmann; Maria Mksoud; Christiane Pink; Christian Seebauer; Thomas Kocher; Thomas Koppe; Karl-Friedrich Krey; Hans-Robert Metelmann; Henry Völzke; Amro Daboul Journal: PLoS One Date: 2019-11-22 Impact factor: 3.240