Title: Pre-operative Hepatic Dysfunction Could Predict Postoperative Mortality and Morbidities in Patients Undergoing Open-heart Surgery; Utilization of the MELD Scoring System
Abstract: Renal dysfunction is a major adverse event following cardiovascular surgery, which leads to a poor outcome and is a primary reason for prolongation of hospital stay.Therefore, we investigated pre-operative factors associated with requirement of post-operative hemodyarisis/hemodiafiltration (HD/CHDF).We retrospectively analyzed 436 consecutive patients undergoing cardiovascular surgery between January 2013 and October 2013 at our institution.Patients were dichotomize into those with and without postoperative HD/CHDF requirement.Patients who were already on chronic HD before surgery were excluded.A total of 53 patients (12.1%) required HD/CHDF postoperatively.Patients requiring HF/CHDF had lower hemoglobin (11.562.0 vs. 13.061.6g/dL, p!0.0001), albumin (3.660.6 vs. 4.060.5 g/dL, p!0.0001), higher creatinine (3.763.6 vs. 0.860.5 mg/dL, p! 0.0001), BNP (632.56799.6 vs. 150.66281.2pg/mL), and lower ejection fraction by echocardiogram (52.0615.3 vs. 59.2614.7%,p50.0008) before surgery than those without HD/CHDF.In our cohort, indeed, patients requiring HD/CHDF showed longer stay in the intensive care unit (7.466.3 vs. 1.961.8days, p!0.0001), longer intubation time (10.662.0 vs. 54.565.8 hours, p!0.0001) and longer post-operative hospital stay (12.668.9 vs. 27.1622.3days, p!0.0001).When we exclude preoperative creatinine from the multivariate analysis, hemoglobin and BNP showed significant association with postoperative HD/CHDF (OR 0.700 and 1.001, 95% CI 0.541-0.893and 1.000-1.001,p50.0038 and 0.0011, respectively).Patients with anemia and elevated BNP before cardiovascular surgery are at high risk for requiring postoperative renal replacement therapy.