Fluid overload and changes in serum creatinine after cardiac surgery: predictors of mortality and longer intensive care stay. A prospective cohort study

Fluid overload and changes in serum creatinine after cardiac surgery: predictors of mortality and longer intensive care stay. A prospective cohort study

Author Stein, Anna Autor UNIFESP Google Scholar
Souza, Lucas Vieira de Google Scholar
Belettini, Cassian Rodrigues Google Scholar
Menegazzo, Willian Roberto Google Scholar
Viegas, Julio Rosales Google Scholar
Pereira, Edemar Manuel Costa Google Scholar
Eick, Renato Google Scholar
Araujo, Lilian Google Scholar
Consolim-Colombo, Fernanda Google Scholar
Irigoyen, Maria Claudia Autor UNIFESP Google Scholar
Institution Fundacao Univ Cardiol IC FUC
Universidade Federal de São Paulo (UNIFESP)
Heart Inst INCOR
Nove de Julho Univ
Abstract Introduction: Fluid overload is a clinical problem frequently related to cardiac and renal dysfunction. the aim of this study was to evaluate fluid overload and changes in serum creatinine as predictors of cardiovascular mortality and morbidity after cardiac surgery.Methods: Patients submitted to heart surgery were prospectively enrolled in this study from September 2010 through August 2011. Clinical and laboratory data were collected from each patient at preoperative and trans-operative moments and fluid overload and creatinine levels were recorded daily after cardiac surgery during their ICU stay. Fluid overload was calculated according to the following formula: (Sum of daily fluid received (L) - total amount of fluid eliminated (L)/preoperative weight (kg) x 100). Preoperative demographic and risk indicators, intra-operative parameters and postoperative information were obtained from medical records. Patients were monitored from surgery until death or discharge from the ICU. We also evaluated the survival status at discharge from the ICU and the length of ICU stay (days) of each patient.Results: A total of 502 patients were enrolled in this study. Both fluid overload and changes in serum creatinine correlated with mortality (odds ratio (OR) 1.59; confidence interval (CI): 95% 1.18 to 2.14, P = 0.002 and OR 2.91; CI: 95% 1.92 to 4.40, P <0.001, respectively). Fluid overload played a more important role in the length of intensive care stay than changes in serum creatinine. Fluid overload (%): b coefficient = 0.17; beta coefficient = 0.55, P <0.001); change in creatinine (mg/dL): b coefficient = 0.01; beta coefficient = 0.11, P = 0.003).Conclusions: Although both fluid overload and changes in serum creatinine are prognostic markers after cardiac surgery, it seems that progressive fluid overload may be an earlier and more sensitive marker of renal dysfunction affecting heart function and, as such, it would allow earlier intervention and more effective control in post cardiac surgery patients.
Language English
Date 2012-01-01
Published in Critical Care. London: Biomed Central Ltd, v. 16, n. 3, 9 p., 2012.
ISSN 1466-609X (Sherpa/Romeo, impact factor)
Publisher Biomed Central Ltd
Extent 9
Origin http://dx.doi.org/10.1186/cc11368
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000313197500029
URI http://repositorio.unifesp.br/handle/11600/34391

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