ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Marzia Leacche
Subroto Paul
Daniel Unic
James D. Rawn
Lawrence H. Cohn
John G. Byrne
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Leacche, M.
Right arrow Articles by Byrne, J. G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Leacche, M.
Right arrow Articles by Byrne, J. G.
Related Collections
Right arrow Cardiac - other

Ann Thorac Surg 2006;81:1385-1392
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Predicting Survival in Patients Requiring Renal Replacement Therapy After Cardiac Surgery

Marzia Leacche, MD a , Wolfgang C. Winkelmayer, MD, ScD b , c , Subroto Paul, MD a , Julie Lin, MD c , Daniel Unic, MD a , James D. Rawn, MD a , Lawrence H. Cohn, MD a , John G. Byrne, MD a , *

a Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
b Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
c Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

Accepted for publication October 10, 2005.

* Address correspondence to Dr Byrne, Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-8815 (Email: john.byrne{at}vanderbilt.edu).

BACKGROUND: We sought to develop and internally validate a prediction score for all-cause in-hospital mortality in patients who have acute renal failure and require renal replacement therapy after cardiac surgery.

METHODS: From January 1992 to July 2001, 136 of 14,000 patients (0.9%) had acute renal failure requiring renal replacement therapy after cardiac surgery. Multivariate logistic regression analysis, based on pre–renal replacement therapy variables, was used to construct a predictive score for all causes of in-hospital mortality. Subsequently, the score was validated in 27 patients who underwent surgery between August 2001 and March 2003.

RESULTS: In-hospital mortality was 58% (79 of 136). From the logistic regression model, we assigned a score (range, 0 to 6) based on the presence of independent predictors of operative mortality (preoperative creatinine ≤ 1.5 mg/dL [odds ratio (OR) = 5.0], hypertension [OR = 4.4], predialysis coma [OR = 9.6], sepsis [OR = 6.4], and total bilirubin ≥ 2 mg/dL [OR = 5.6]). Higher scores strongly predicted mortality: patients who scored 3 or higher before the initiation dialysis (n = 54), had a mortality rate of 94% (51 of 54). In contrast, patients who scored 1 or less on this scale (n = 36), had a mortality of 16% (6 of 36). In the validation cohort, the sensitivity of the new score at the cutoff of 2 or fewer points versus 3 or more points was 0.71, the specificity was 0.90, the positive predictive value was 0.92, and the negative predictive value was 0.64.

CONCLUSIONS: The prediction score represents a simple and accurate tool for predicting in-hospital mortality associated with renal replacement therapy for cardiac surgery patients before the institution of this resource-intensive treatment.




This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
G. J. Arnaoutakis, A. Bihorac, T. D. Martin, P. J. Hess Jr, C. T. Klodell, A. A. Ejaz, C. Garvan, C. G. Tribble, and T. M. Beaver
RIFLE criteria for acute kidney injury in aortic arch surgery.
J. Thorac. Cardiovasc. Surg., December 1, 2007; 134(6): 1554 - 1561.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
D. G. Healy, A. E. Wood, A. O'Neill, J. F. McCarthy, J. M. Fitzpatrick, and R. W. Watson
Can preoperative modelling of individual neutrophil adhesion responses predict renal morbidity?
Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1088 - 1093.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. M. Cunningham
Definition of Coma in Postoperative Cardiac Surgery Patients Requiring Renal Replacement Therapy
Ann. Thorac. Surg., March 1, 2007; 83(3): 1232 - 1232.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Leacche and J. G. Byrne
Reply
Ann. Thorac. Surg., March 1, 2007; 83(3): 1232 - 1232.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2006 by The Society of Thoracic Surgeons.