Do We Need to Personalize Renal Function Assessment in the Stratification of Patients Undergoing Cardiac Surgery?
Abstract Background: Renal dysfunction is an independent predictor of morbidity and mortality in cardiac surgery. For a better assessment of renal function, calculation of creatinine clearance (CC) may be necessary. Objective: To objectively evaluate whether CC is a better risk predictor than seru...
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Sociedade Brasileira de Cardiologia (SBC)
2017-09-01
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doaj-6a0bc02cad9349b690dcfc6e1fef63882020-11-25T00:40:04ZengSociedade Brasileira de Cardiologia (SBC)Arquivos Brasileiros de Cardiologia1678-41702017-09-01010.5935/abc.20170129S0066-782X2017005017103Do We Need to Personalize Renal Function Assessment in the Stratification of Patients Undergoing Cardiac Surgery?Camila P. S. ArthurOmar A. V. MejiaDiogo OsternackMarcelo Arruda NakazoneMaxim GoncharovLuiz A. F. LisboaLuís A. O. DallanPablo M. A. PomerantzeffFabio B. JateneAbstract Background: Renal dysfunction is an independent predictor of morbidity and mortality in cardiac surgery. For a better assessment of renal function, calculation of creatinine clearance (CC) may be necessary. Objective: To objectively evaluate whether CC is a better risk predictor than serum creatinine (SC) in patients undergoing cardiac surgery. Methods: Analysis of 3,285 patients registered in a prospective, consecutive and mandatory manner in the Sao Paulo Registry of Cardiovascular Surgery (REPLICCAR) between November 2013 and January 2015. Values of SC, CC (Cockcroft-Gault) and EuroSCORE II were obtained. Association analysis of SC and CC with morbidity and mortality was performed by calibration and discrimination tests. Independent multivariate models with SC and CC were generated by multiple logistic regression to predict morbidity and mortality following cardiac surgery. Results: Despite the association between SC and mortality, it did not calibrate properly the risk groups. There was an association between CC and mortality with good calibration of risk groups. In mortality risk prediction, SC was uncalibrated with values > 1.35 mg /dL (p < 0.001). The ROC curve showed that CC is better than SC in predicting both morbidity and mortality risk. In the multivariate model without CC, SC was the only predictor of morbidity, whereas in the model without SC, CC was not only a mortality predictor, but also the only morbidity predictor. Conclusion: Compared with SC, CC is a better parameter of renal function in risk stratification of patients undergoing cardiac surgery.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2017005017103&lng=en&tlng=enRenal Insufficiency/prevention & controlMyocardial RevascularizationHospital MortalityCreatinine/analysisIndicators of Morbidity and MortalityRisk Factors |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Camila P. S. Arthur Omar A. V. Mejia Diogo Osternack Marcelo Arruda Nakazone Maxim Goncharov Luiz A. F. Lisboa Luís A. O. Dallan Pablo M. A. Pomerantzeff Fabio B. Jatene |
spellingShingle |
Camila P. S. Arthur Omar A. V. Mejia Diogo Osternack Marcelo Arruda Nakazone Maxim Goncharov Luiz A. F. Lisboa Luís A. O. Dallan Pablo M. A. Pomerantzeff Fabio B. Jatene Do We Need to Personalize Renal Function Assessment in the Stratification of Patients Undergoing Cardiac Surgery? Arquivos Brasileiros de Cardiologia Renal Insufficiency/prevention & control Myocardial Revascularization Hospital Mortality Creatinine/analysis Indicators of Morbidity and Mortality Risk Factors |
author_facet |
Camila P. S. Arthur Omar A. V. Mejia Diogo Osternack Marcelo Arruda Nakazone Maxim Goncharov Luiz A. F. Lisboa Luís A. O. Dallan Pablo M. A. Pomerantzeff Fabio B. Jatene |
author_sort |
Camila P. S. Arthur |
title |
Do We Need to Personalize Renal Function Assessment in the Stratification of Patients Undergoing Cardiac Surgery? |
title_short |
Do We Need to Personalize Renal Function Assessment in the Stratification of Patients Undergoing Cardiac Surgery? |
title_full |
Do We Need to Personalize Renal Function Assessment in the Stratification of Patients Undergoing Cardiac Surgery? |
title_fullStr |
Do We Need to Personalize Renal Function Assessment in the Stratification of Patients Undergoing Cardiac Surgery? |
title_full_unstemmed |
Do We Need to Personalize Renal Function Assessment in the Stratification of Patients Undergoing Cardiac Surgery? |
title_sort |
do we need to personalize renal function assessment in the stratification of patients undergoing cardiac surgery? |
publisher |
Sociedade Brasileira de Cardiologia (SBC) |
series |
Arquivos Brasileiros de Cardiologia |
issn |
1678-4170 |
publishDate |
2017-09-01 |
description |
Abstract Background: Renal dysfunction is an independent predictor of morbidity and mortality in cardiac surgery. For a better assessment of renal function, calculation of creatinine clearance (CC) may be necessary. Objective: To objectively evaluate whether CC is a better risk predictor than serum creatinine (SC) in patients undergoing cardiac surgery. Methods: Analysis of 3,285 patients registered in a prospective, consecutive and mandatory manner in the Sao Paulo Registry of Cardiovascular Surgery (REPLICCAR) between November 2013 and January 2015. Values of SC, CC (Cockcroft-Gault) and EuroSCORE II were obtained. Association analysis of SC and CC with morbidity and mortality was performed by calibration and discrimination tests. Independent multivariate models with SC and CC were generated by multiple logistic regression to predict morbidity and mortality following cardiac surgery. Results: Despite the association between SC and mortality, it did not calibrate properly the risk groups. There was an association between CC and mortality with good calibration of risk groups. In mortality risk prediction, SC was uncalibrated with values > 1.35 mg /dL (p < 0.001). The ROC curve showed that CC is better than SC in predicting both morbidity and mortality risk. In the multivariate model without CC, SC was the only predictor of morbidity, whereas in the model without SC, CC was not only a mortality predictor, but also the only morbidity predictor. Conclusion: Compared with SC, CC is a better parameter of renal function in risk stratification of patients undergoing cardiac surgery. |
topic |
Renal Insufficiency/prevention & control Myocardial Revascularization Hospital Mortality Creatinine/analysis Indicators of Morbidity and Mortality Risk Factors |
url |
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2017005017103&lng=en&tlng=en |
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