Occult renal dysfunction: a mortality and morbidity risk factor in coronary artery bypass grafting surgery

Antonio Miceli; Vito D Bruno; Radek Capoun; Francesco Romeo; Gianni D Angelini; Massimo Caputo

doi:10.1016/j.jtcvs.2010.08.016

Occult renal dysfunction: a mortality and morbidity risk factor in coronary artery bypass grafting surgery

Antonio Miceli, Vito D Bruno, Radek Capoun, Francesco Romeo, Gianni D Angelini, Massimo Caputo

Bristol Medical School (THS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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Abstract

OBJECTIVE: Elevated preoperative serum creatinine is considered an independent risk factor for postoperative mortality and morbidity in patients undergoing coronary artery bypass grafting. However, the impact of occult renal dysfunction, defined as an impairment of glomerular filtration rate with normal serum creatinine, is still unknown. The aim of this study was to analyze the effects of occult renal dysfunction on early outcomes after coronary artery bypass grafting.

METHODS: This was a retrospective, observational, cohort study of prospectively collected data on 9159 consecutive patients with normal serum creatinine levels undergoing coronary artery bypass grafting between April 1996 and February 2009. Patients were divided into two groups based on preoperative creatinine clearance estimated with the Cockcroft-Gault equation: 5484 patients with a creatinine clearance ≥ 60 mL/min and 3675 patients with a creatinine clearance < 60 mL/min (occult renal dysfunction group).

RESULTS: Overall in-hospital mortality was 1%. Occult renal dysfunction was associated with a doubling in the risk of operative mortality (1.4% vs 0.7%; P = .001), postoperative renal dysfunction (5.1% vs 2.5%; P < .0001), and need for dialysis (0.8% vs 0.4%; P = .014). Moreover, occult renal dysfunction increased the risk of stroke (1% vs 0.3%; P < .0001), arrhythmia (28.5% vs 21.2%; P < .0001), and hospital stay > 7 days (36.45 vs 24.5%; P < .0001). In a multivariable analysis adjusting for preoperative risk factors, occult renal dysfunction was confirmed to be an independent predictor of mortality (odds ratio, 1.72), postoperative renal dysfunction (odds ratio, 1.9), dialysis (odds ratio, 1.82), stroke (odds ratio, 2.6) arrhythmia (odds ratio, 1.42), and hospital stay > 7 days (odds ratio, 1.65).

CONCLUSIONS: Occult renal dysfunction is an independent risk factor for early mortality and morbidity in patients undergoing coronary artery bypass grafting.

Original language	English
Pages (from-to)	771-776
Number of pages	6
Journal	Journal of Thoracic and Cardiovascular Surgery
Volume	141
Issue number	3
Early online date	29 Sep 2010
DOIs	https://doi.org/10.1016/j.jtcvs.2010.08.016
Publication status	Published - Mar 2011

Keywords

Aged
Arrhythmias, Cardiac
Biomarkers
Chi-Square Distribution
Coronary Artery Bypass
Coronary Artery Disease
Creatinine
England
Female
Glomerular Filtration Rate
Hospital Mortality
Humans
Kidney
Kidney Diseases
Length of Stay
Logistic Models
Male
Middle Aged
Odds Ratio
Propensity Score
Renal Dialysis
Retrospective Studies
Risk Assessment
Risk Factors
Stroke
Time Factors
Treatment Outcome
Journal Article
Research Support, Non-U.S. Gov't

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10.1016/j.jtcvs.2010.08.016

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@article{387ae07dca654601a3056a548ff8b4ce,

title = "Occult renal dysfunction: a mortality and morbidity risk factor in coronary artery bypass grafting surgery",

abstract = "OBJECTIVE: Elevated preoperative serum creatinine is considered an independent risk factor for postoperative mortality and morbidity in patients undergoing coronary artery bypass grafting. However, the impact of occult renal dysfunction, defined as an impairment of glomerular filtration rate with normal serum creatinine, is still unknown. The aim of this study was to analyze the effects of occult renal dysfunction on early outcomes after coronary artery bypass grafting.METHODS: This was a retrospective, observational, cohort study of prospectively collected data on 9159 consecutive patients with normal serum creatinine levels undergoing coronary artery bypass grafting between April 1996 and February 2009. Patients were divided into two groups based on preoperative creatinine clearance estimated with the Cockcroft-Gault equation: 5484 patients with a creatinine clearance ≥ 60 mL/min and 3675 patients with a creatinine clearance < 60 mL/min (occult renal dysfunction group).RESULTS: Overall in-hospital mortality was 1%. Occult renal dysfunction was associated with a doubling in the risk of operative mortality (1.4% vs 0.7%; P = .001), postoperative renal dysfunction (5.1% vs 2.5%; P < .0001), and need for dialysis (0.8% vs 0.4%; P = .014). Moreover, occult renal dysfunction increased the risk of stroke (1% vs 0.3%; P < .0001), arrhythmia (28.5% vs 21.2%; P < .0001), and hospital stay > 7 days (36.45 vs 24.5%; P < .0001). In a multivariable analysis adjusting for preoperative risk factors, occult renal dysfunction was confirmed to be an independent predictor of mortality (odds ratio, 1.72), postoperative renal dysfunction (odds ratio, 1.9), dialysis (odds ratio, 1.82), stroke (odds ratio, 2.6) arrhythmia (odds ratio, 1.42), and hospital stay > 7 days (odds ratio, 1.65).CONCLUSIONS: Occult renal dysfunction is an independent risk factor for early mortality and morbidity in patients undergoing coronary artery bypass grafting.",

keywords = "Aged, Arrhythmias, Cardiac, Biomarkers, Chi-Square Distribution, Coronary Artery Bypass, Coronary Artery Disease, Creatinine, England, Female, Glomerular Filtration Rate, Hospital Mortality, Humans, Kidney, Kidney Diseases, Length of Stay, Logistic Models, Male, Middle Aged, Odds Ratio, Propensity Score, Renal Dialysis, Retrospective Studies, Risk Assessment, Risk Factors, Stroke, Time Factors, Treatment Outcome, Journal Article, Research Support, Non-U.S. Gov't",

author = "Antonio Miceli and Bruno, {Vito D} and Radek Capoun and Francesco Romeo and Angelini, {Gianni D} and Massimo Caputo",

year = "2011",

month = mar,

doi = "10.1016/j.jtcvs.2010.08.016",

language = "English",

volume = "141",

pages = "771--776",

journal = "Journal of Thoracic and Cardiovascular Surgery",

issn = "0022-5223",

publisher = "Elsevier Inc.",

number = "3",

}

TY - JOUR

T1 - Occult renal dysfunction

T2 - a mortality and morbidity risk factor in coronary artery bypass grafting surgery

AU - Miceli, Antonio

AU - Bruno, Vito D

AU - Capoun, Radek

AU - Romeo, Francesco

AU - Angelini, Gianni D

AU - Caputo, Massimo

PY - 2011/3

Y1 - 2011/3

N2 - OBJECTIVE: Elevated preoperative serum creatinine is considered an independent risk factor for postoperative mortality and morbidity in patients undergoing coronary artery bypass grafting. However, the impact of occult renal dysfunction, defined as an impairment of glomerular filtration rate with normal serum creatinine, is still unknown. The aim of this study was to analyze the effects of occult renal dysfunction on early outcomes after coronary artery bypass grafting.METHODS: This was a retrospective, observational, cohort study of prospectively collected data on 9159 consecutive patients with normal serum creatinine levels undergoing coronary artery bypass grafting between April 1996 and February 2009. Patients were divided into two groups based on preoperative creatinine clearance estimated with the Cockcroft-Gault equation: 5484 patients with a creatinine clearance ≥ 60 mL/min and 3675 patients with a creatinine clearance < 60 mL/min (occult renal dysfunction group).RESULTS: Overall in-hospital mortality was 1%. Occult renal dysfunction was associated with a doubling in the risk of operative mortality (1.4% vs 0.7%; P = .001), postoperative renal dysfunction (5.1% vs 2.5%; P < .0001), and need for dialysis (0.8% vs 0.4%; P = .014). Moreover, occult renal dysfunction increased the risk of stroke (1% vs 0.3%; P < .0001), arrhythmia (28.5% vs 21.2%; P < .0001), and hospital stay > 7 days (36.45 vs 24.5%; P < .0001). In a multivariable analysis adjusting for preoperative risk factors, occult renal dysfunction was confirmed to be an independent predictor of mortality (odds ratio, 1.72), postoperative renal dysfunction (odds ratio, 1.9), dialysis (odds ratio, 1.82), stroke (odds ratio, 2.6) arrhythmia (odds ratio, 1.42), and hospital stay > 7 days (odds ratio, 1.65).CONCLUSIONS: Occult renal dysfunction is an independent risk factor for early mortality and morbidity in patients undergoing coronary artery bypass grafting.

AB - OBJECTIVE: Elevated preoperative serum creatinine is considered an independent risk factor for postoperative mortality and morbidity in patients undergoing coronary artery bypass grafting. However, the impact of occult renal dysfunction, defined as an impairment of glomerular filtration rate with normal serum creatinine, is still unknown. The aim of this study was to analyze the effects of occult renal dysfunction on early outcomes after coronary artery bypass grafting.METHODS: This was a retrospective, observational, cohort study of prospectively collected data on 9159 consecutive patients with normal serum creatinine levels undergoing coronary artery bypass grafting between April 1996 and February 2009. Patients were divided into two groups based on preoperative creatinine clearance estimated with the Cockcroft-Gault equation: 5484 patients with a creatinine clearance ≥ 60 mL/min and 3675 patients with a creatinine clearance < 60 mL/min (occult renal dysfunction group).RESULTS: Overall in-hospital mortality was 1%. Occult renal dysfunction was associated with a doubling in the risk of operative mortality (1.4% vs 0.7%; P = .001), postoperative renal dysfunction (5.1% vs 2.5%; P < .0001), and need for dialysis (0.8% vs 0.4%; P = .014). Moreover, occult renal dysfunction increased the risk of stroke (1% vs 0.3%; P < .0001), arrhythmia (28.5% vs 21.2%; P < .0001), and hospital stay > 7 days (36.45 vs 24.5%; P < .0001). In a multivariable analysis adjusting for preoperative risk factors, occult renal dysfunction was confirmed to be an independent predictor of mortality (odds ratio, 1.72), postoperative renal dysfunction (odds ratio, 1.9), dialysis (odds ratio, 1.82), stroke (odds ratio, 2.6) arrhythmia (odds ratio, 1.42), and hospital stay > 7 days (odds ratio, 1.65).CONCLUSIONS: Occult renal dysfunction is an independent risk factor for early mortality and morbidity in patients undergoing coronary artery bypass grafting.

KW - Aged

KW - Arrhythmias, Cardiac

KW - Biomarkers

KW - Chi-Square Distribution

KW - Coronary Artery Bypass

KW - Coronary Artery Disease

KW - Creatinine

KW - England

KW - Female

KW - Glomerular Filtration Rate

KW - Hospital Mortality

KW - Humans

KW - Kidney

KW - Kidney Diseases

KW - Length of Stay

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Odds Ratio

KW - Propensity Score

KW - Renal Dialysis

KW - Retrospective Studies

KW - Risk Assessment

KW - Risk Factors

KW - Stroke

KW - Time Factors

KW - Treatment Outcome

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1016/j.jtcvs.2010.08.016

DO - 10.1016/j.jtcvs.2010.08.016

M3 - Article (Academic Journal)

C2 - 20884025

VL - 141

SP - 771

EP - 776

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 3

ER -

Occult renal dysfunction: a mortality and morbidity risk factor in coronary artery bypass grafting surgery

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