Background
Methods
Study patients
Data collection
Postoperative outcomes and data definition
Statistical analysis
Result
Patient characteristics
Variables | Value |
---|---|
Preoperative | |
Age (years) | 52.11 ± 9.28 |
Male, n (%) | 53 (35.6%) |
Hypertension, n (%) | 11 (7.4%) |
Diabetes, n (%) | 2 (1.3%) |
Atrial fibrillation, n (%) | 53 (35.6%) |
eGFR (ml/min) | 67.05 ± 15.06 |
CKD (eGFR < 60 ml/min) | 45 (30.2%) |
Stage 3 (30 ml/min ≤ eGFR < 60 ml/min) | 43 (28.9%) |
Stage 4 (15 ml/min ≤ eGFR < 30 ml/min) | 1 (0.7%) |
Stage 5 (eGFR < 15 ml/min | 1 (0.7%) |
EuroSCORE II | 1.8 ± 1.3 |
APACHE II score | 6.29 ± 2.78 |
MELD score | 9.88 ± 4.47 |
SOFA score | 1.87 ± 1.54 |
MAP (mmHg) | 86.95 ± 12.14 |
TB (µmol/l) | 28.86 ± 15.93 |
WBC (109/l) | 6.20 ± 2.21 |
Hb (g/l) | 136.30 ± 19.33 |
PLT (109 /l) | 168.87 ± 58.26 |
Cr (µmol/l) | 98.80 ± 38.05 |
Cys-C (mg/l) | 1.169 ± 0.537 |
PT (s) | 13.49 ± 4.36 |
Intra-operative | |
Type of surgery | |
Single aortic valve, n (%) | 9 (6.0%) |
Single mitral valve, n (%) | 25 (16.8%) |
Single tricuspid valve, n (%) | 3 (2.0%) |
Aortic valve + mitral valve, n (%) | 19 (12.8%) |
Aortic valve + tricuspid valve, n (%) | 1 (0.7%) |
Mitral valve + tricuspid valve, n (%) | 28 (18.8%) |
Aortic valve + mitral valve + tricuspid valve, n (%) | 63 (42.3%) |
Valve + CABG, n (%) | 3 (2.0%) |
Operation duration (h) | 4.32 ± 1.48 |
CPB time (min) | 161.16 ± 60.46 |
ACC time (min) | 89.40 ± 35.04 |
Blood transfusion requirement (U) | 4.86 ± 7.08 |
Number of valve replacements | 2.14 ± 0.83 |
Postoperative | |
APACHE II score | 17.77 ± 1.92 |
SOFA score | 11.38 ± 2.44 |
MELD score | 16.48 ± 4.49 |
TB (µmol /l) | 69.80 ± 28.11 |
CB (µmol /l) | 29.72 ± 13.02 |
WBC (109/l) | 14.48 ± 5.35 |
Hb (g/l) | 119.41 ± 19.07 |
PLT (109/l) | 124.39 ± 52.73 |
Cr (µmol/l) | 137.07 ± 35.24 |
PT (s) | 13.60 ± 2.43 |
Peak TB level (µmol/l) | 155.34 ± 82.11 |
Peak direct bilirubin level (µmol/l) | 98.10 ± 65.90 |
Peak indirect bilirubin level (µmol/l) | 57.24 ± 29.00 |
Time to peak TB (d) | 4.18 ± 3.42 |
Postoperative AKI
Variable | Value |
---|---|
In-hospital mortality, n (%) | 45 (30.2%) |
Cause of death | |
Multiple organ failure, n (%) | 25 (55.6%) |
Heart failure, n (%) | 16 (35.6%) |
Hemorrhagic shock, n (%) | 2 (4.4%) |
Sepsis, n (%) | 2 (4.4%) |
In hospital time (d) | 16.20 ± 4.90 |
Onset time of hyperbilirubinemia (d) | 2.32 ± 1.57 |
ICU stay time (d) | 5.09 ± 5.47 |
Postoperative AKI, n (%) | 120 (80.5%) |
Stage of AKI | |
Stage 1, n (%) | 69 (46.3%) |
Stage 2, n (%) | 20 (13.4%) |
Stage 3, n (%) | 31 (20.8%) |
CRRT, n (%) | 27 (18.1%) |
Use of ECMO, n (%) | 9 (6.0%) |
Use of IABP, n (%) | 4 (2.7%) |
Use of tracheotomy, n (%) | 5 (3.4%) |
Use of vasoactive agent, n (%) | 109 (73.2%) |
Duration of mechanical ventilation (d) | 2.83 ± 3.14 |
The amount of blood transfusion (U) | 31.32 ± 33.60 |
Postoperative CRRT
In-hospital and 30-day mortality
Characteristic | Univariate logistic regression | Multivariate logistic regression (model 1) | Multivariate logistic regression (model 2) | |||
---|---|---|---|---|---|---|
OR (95%CI) | P value | OR (95%CI) | P value | OR (95%CI) | P value | |
Age | 1.55 (1.011–1.101) | 0.014 | ||||
Preoperative | ||||||
APACHE II score | 1.194 (1.051–1.356) | 0.006 | ||||
CKD (eGFR < 60 ml/min) | 1.233 (0.582–2.614) | 0.584 | ||||
EuroSCORE II | 1.435 (1.103–1.867) | 0.007 | ||||
Intraoperative | ||||||
Operative time | 1.570 (1.208 – 2.041) | 0.001 | ||||
CPB time | 1.007 (1.001–1.013) | 0.018 | ||||
Amount of blood transfusion | 1.078 (1.021 – 1.139) | 0.007 | 1.078 (1.000–1.162) | 0.049 | ||
Postoperative | ||||||
MAP | 0.962 (0.927–0.998) | 0.038 | ||||
The total amount of blood transfusion | 1.077 (1.050–1.103) | < 0.001 | ||||
Mechanical ventilation time | 2.734 (1.903–3.928) | < 0.001 | ||||
SOFA score | 1.538 (1.283–1.845) | < 0.001 | ||||
Hb | 0.976 (0.957–0.995) | 0.015 | ||||
PLT | 0.985 (0.977–0.993) | < 0.001 | ||||
AKI | 7.539 (1.709–33.251) | 0.008 | ||||
Advanced AKI | 29.732 (11.507–76.821) | < 0.001 | 19.408 (6.553–57.482) | < 0.001 | 16.560 (5.154–53.212) | < 0.001 |
Use of CRRT | 18.939 (6.485 – 55.313) | 0.001 | ||||
Use of PE/BA | 15.846 (1.848 – 135.879) | 0.012 | ||||
Use of ECMO | 22.270 (2.693–184.155) | 0.004 | ||||
Peak TB concentration | 1.018 (1.001–1.025) | < 0.001 | ||||
Peak direct bilirubin concentration | 1.024 (1.015–1.033) | < 0.001 | ||||
Peak indirect bilirubin concentration | 1.013 (1.001–1.026) | 0.035 | ||||
Time to peak TB concentration | 1.808 (1.458–2.242) | < 0.001 | 1.557 (1.259–1.926) | < 0.001 | ||
Time to peak TB concentration ≥ 5 days | 25.850 (10.218–65.399) | < 0.001 | 22.384 (6.767–74.035) | < 0.001 | ||
ICU stay time | 1.285 (1.152–1.433) | < 0.001 |
Long-term mortality
Variables | Univariate Cox regression | Multivariate Cox regression | ||
---|---|---|---|---|
HR (95%CI) | P value | HR (95%CI) | P value | |
Preoperative | ||||
Age | 1.014 (1.011–1.073) | 0.008 | ||
APACHE II score | 1.122 (1.060–1.188) | < 0.001 | ||
CKD (eGFR < 60 ml/min) | 0.914 (0.511–1.636) | 0.763 | ||
EuroSCORE II | 1.325 (1.110–1.583) | 0.002 | ||
Intraoperative | ||||
Operation duration | 1.248 (1.098–1.414) | 0.001 | ||
CPB time | 1.005 (1.002–1.008) | 0.001 | ||
The amount of blood transfusion | 1.704 (1.037–1.112) | < 0.001 | 1.051 (1.012–1.091) | 0.01 |
Postoperative | ||||
SOFA score | 1.356 (1.202–1.531) | < 0.001 | ||
MELD score | 1.086 (1.009–1.169) | 0.028 | ||
Hb | 0.981 (0.968–0.995) | 0.008 | ||
PLT | 0.991 (0.986–0.997) | 0.002 | ||
Cr | 1.009 (1.002–1.016) | 0.008 | ||
Peak TB level | 1.005 (1.003–1.008) | < 0.001 | ||
Time to peak TB level | 1.142 (1.089–1.198) | < 0.001 | ||
AKI | 5.19 (1.620–16.628) | 0.006 | ||
Advanced AKI | 10.374 (5.606–19.199) | < 0.001 | 7.379 (3.791–14.364) | < 0.001 |
CRRT | 5.64 (3.259–9.763) | < 0.001 | ||
Use of ECMO | 4.641 (2.240–9.612) | < 0.001 | ||
PE/BA | 2.791 (1.186–6.597) | 0.019 | ||
Onset time of hyperbilirubinemia | 1.218 (1.119–1.326) | < 0.001 | ||
Duration of mechanical ventilation | 1.186 (1.128–1.246) | < 0.001 | 1.078 (1.017–1.143) | 0.011 |
The total amount of blood transfusion | 1.019 (1.014–1.024) | < 0.001 | ||
ICU stay time | 1.044 (1.019–1.070) | 0.001 |