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Jiang, H., Hultkvist, H., Holm, J., Vánky, F., Yang, Y. & Svedjeholm, R. (2018). Impact of underlying heart disease per se on the utility of preoperative NT-proBNP in adult cardiac surgery. PLoS ONE, 13(2), Article ID e0192503.
Öppna denna publikation i ny flik eller fönster >>Impact of underlying heart disease per se on the utility of preoperative NT-proBNP in adult cardiac surgery
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2018 (Engelska)Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, nr 2, artikel-id e0192503Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective The primary aim was to investigate the role of underlying heart disease on preoperative NT-proBNP levels in patients admitted for adult cardiac surgery, after adjusting for the known confounders age, gender, obesity and renal function. The second aim was to investigate the predictive value of preoperative NT-proBNP with regard to severe postoperative heart failure (SPHF) and postoperative mortality. Methods A retrospective cohort study based on preoperative NT-proBNP measurements in an unselected cohort including all patients undergoing first time surgery for coronary artery disease (CAD; n = 2226), aortic stenosis (AS; n = 406) or mitral regurgitation (MR; n = 346) from April 2010 to August 2016 in the southeast region of Sweden (n = 2978). Concomitant procedures were not included, with the exception of Maze or tricuspid valve procedures. Results Preoperative NT-proBNP was 1.67 times (pamp;lt;0.0001) and 1.41 times (pamp;lt;0.0001) higher in patients with AS or MR respectively, than in patients with CAD after adjusting for confounders. NT-proBNP demonstrated significant discrimination with regard to SPHF in CAD (AUC = 0.79, 95% CI 0.73 +/- 0.85, pamp;lt;0.0001), MR (AUC = 0.80, 95% CI 0.72 +/- 0.87, pamp;lt;0.0001) and AS (AUC = 0.66, 95% CI 0.51 +/- 0.81, p = 0.047). In CAD patients NT-proBNP demonstrated significant discrimination with regard to postoperative 30-day or in-hospital mortality (AUC = 0.78; 95% CI 0.71 +/- 0.85, pamp;lt;0.0001). The number of deaths was too few in the AS and MR group to permit analysis. Elevated NT-proBNP emerged as an independent risk factor for SPHF, and postoperative mortality in CAD. Conclusions Patients with AS or MR have higher preoperative NT-proBNP than CAD patients even after adjusting for confounders. The predictive value of NT-proBNP with regard to SPHF was confirmed in CAD and MR patients but was less convincing in AS patients.

Ort, förlag, år, upplaga, sidor
PUBLIC LIBRARY SCIENCE, 2018
Nationell ämneskategori
Kardiologi
Identifikatorer
urn:nbn:se:liu:diva-145771 (URN)10.1371/journal.pone.0192503 (DOI)000424517900085 ()29420603 (PubMedID)
Anmärkning

Funding Agencies|Region Ostergotland [LIO-443891]

Tillgänglig från: 2018-03-22 Skapad: 2018-03-22 Senast uppdaterad: 2019-05-13
Jiang, H., Zhang, L., Hu, H., Hua, P., Zeng, K., Wang, M., . . . Yang, Y. (2015). Mixed venous oxygen saturation as an index of goal-directed therapy in postoperative care after cardiac surgery.. In: 23rd annual meeting of the Asian Society for Cardiovascular and Thoracic Surgery, 11-14 May 2015: . Paper presented at 23rd annual meeting of the Asian Society for Cardiovascular and Thoracic Surgery, Hong Kong, 11-14 May 2015.
Öppna denna publikation i ny flik eller fönster >>Mixed venous oxygen saturation as an index of goal-directed therapy in postoperative care after cardiac surgery.
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2015 (Engelska)Ingår i: 23rd annual meeting of the Asian Society for Cardiovascular and Thoracic Surgery, 11-14 May 2015, 2015Konferensbidrag, Publicerat paper (Övrigt vetenskapligt)
Nationell ämneskategori
Kardiologi
Identifikatorer
urn:nbn:se:liu:diva-124324 (URN)
Konferens
23rd annual meeting of the Asian Society for Cardiovascular and Thoracic Surgery, Hong Kong, 11-14 May 2015
Tillgänglig från: 2016-01-26 Skapad: 2016-01-26 Senast uppdaterad: 2016-02-08
Jiang, H., Zhang, L., Svedjeholm, R. & Yang, Y. (2015). Mixed venous oxygen saturation as an index of goal-directed therapy in postoperative care after cardiac surgery.. In: : . Paper presented at 7th joint Scandinavian Conference in Cardiothoracic Surgery,Bergen, Norway, 3-5 September 2015 (pp. 79-79).
Öppna denna publikation i ny flik eller fönster >>Mixed venous oxygen saturation as an index of goal-directed therapy in postoperative care after cardiac surgery.
2015 (Engelska)Konferensbidrag, Poster (med eller utan abstract) (Övrigt vetenskapligt)
Abstract [en]

Background: Adequate mixed venous oxygen saturation (SvO2) indicates sufficient oxygen supply and better prognosis after cardiac surgery.

Aim: In this study, clinical significance of SvO2 as an index of goal-directed therapy in postope-rative care after cardiac surgery was retrospectively assessed.

Methods: SvO2 was collected postoperatively from 741 consecutive adult patients under-going different types of cardiac surgery. SvO2 on admission to ICU was defined as base point (SvO2base). SvO2 was followed every 6 hours or whenever necessary to evaluate efficacy of postoperative therapy in the first 24 hours. Receiver operating characteristic (ROC) analysis was used to analyze changes of SvO2 (△SvO2) in relation to hospital mortality.

Results: SvO2base demonstrated significant discriminatory power with regard to hospital mortality ( AUC 0.70; 95% CI 0.57-0.81; P=0.000). The best cutoff for SvO2base was 56.8%. Average △SvO2A for patients with SvO2base ≤56.8% (Group A ) was 10.6%. The best cutoff for △SvO2A with regard to hospital mortality was 6.6%, with a sensitivity of 0.68 and speci-ficity of 0.72. The negative predictive value was 91.2%. Average △SvO2B for patients with SvO2base>56.8% (Group B) was -2.4%. The best cutoff for △SvO2B with regard to hospital mortality was -4.5%, with a sensitivity of 0.61 and specificity of 0.79.The negative predictive value was 99.5%.

Conclusion: An increase of SvO2 by more than 6.6% in patients with SvO2base≤56.8% may improve prognosis significantly. Goal of ICU therapy for patients with SvO2base> 56.8% should be to avoid a drop of SvO2 by more than 4.5%, in order to prevent from worsened prognosis.

Nationell ämneskategori
Kardiologi
Identifikatorer
urn:nbn:se:liu:diva-124326 (URN)
Konferens
7th joint Scandinavian Conference in Cardiothoracic Surgery,Bergen, Norway, 3-5 September 2015
Tillgänglig från: 2016-01-26 Skapad: 2016-01-26 Senast uppdaterad: 2016-02-08Bibliografiskt granskad
Organisationer
Identifikatorer
ORCID-id: ORCID iD iconorcid.org/0000-0003-4173-8565

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