Faculty Collaboration Database

Acute renal failure after cardiac surgery for carcinoid heart disease: incidence, risk factors, and prognosis. Am J Kidney Dis 2005 May;45(5):826-32

Date

04/30/2005

Pubmed ID

15861347

DOI

10.1053/j.ajkd.2005.02.009

Scopus ID

2-s2.0-26944442077 (requires institutional sign-in at Scopus site)   30 Citations

Abstract

BACKGROUND: Cardiac surgery for carcinoid heart disease may be associated with acute renal failure (ARF) and multiorgan dysfunction postoperatively. This study was performed to determine the incidence, risk factors, and prognosis of ARF after cardiac surgery for carcinoid heart disease.

METHODS: This is a case-control study of 86 consecutive patients who underwent cardiac surgery for carcinoid heart disease. ARF is defined as hemodialysis requirement or serum creatinine level 50% greater than baseline, resulting in an estimated creatinine clearance less than 40 mL/min (0.67 mL/s). Preoperative, operative, and postoperative characteristics were examined and compared between groups to determine risk factors and prognosis of ARF.

RESULTS: ARF occurred in 22% of cases (19 of 86 patients). Preoperative characteristics and type of procedure did not differ between groups. Operative variables associated with ARF by means of univariate analysis included longer surgical and bypass times, intra-aortic balloon pump use, and perioperative epinephrine requirement. Postoperatively, ARF was associated with epinephrine use, prolonged mechanical ventilation, prolonged intensive care unit admission, and higher Acute Physiology and Chronic Health Evaluation II scores. Perioperative mortality in the ARF group was 47% versus 4.5% in the control group (odds ratio, 36.1; 95% confidence interval, 8.0 to 261.8).

CONCLUSION: ARF developed in a relatively high proportion of this cohort, but traditional preoperative risks failed to predict post-cardiac surgery ARF. Variables closely related to perioperative hemodynamic compromise were associated with ARF. ARF portends a particularly poor prognosis in this cohort that is explained largely by multiorgan failure syndrome.

Author List

Regner KR, Connolly HM, Schaff HV, Albright RC

Author

Kevin R. Regner MD Interim Chair, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

APACHE
Acute Kidney Injury
Aged
Carcinoid Heart Disease
Cardiac Surgical Procedures
Cardiopulmonary Bypass
Cohort Studies
Comorbidity
Female
Heart Valve Prosthesis Implantation
Hospital Mortality
Humans
Incidence
Male
Middle Aged
Minnesota
Multiple Organ Failure
Postoperative Complications
Prognosis
Renal Dialysis
Retrospective Studies
Risk Factors
Sepsis
Treatment Outcome
Tricuspid Valve Insufficiency