Dataset Information

Serum creatinine as a predictor of mortality in patients readmitted to the intensive care unit after cardiac surgery: a retrospective cohort study in China.

ABSTRACT:

Background

Patients readmitted to the intensive care unit (ICU) after cardiac surgery have a high mortality rate. The relationship between renal function and in-hospital mortality in readmitted patients has not been well demonstrated.

Methods

We retrospectively evaluated cardiac surgery patients who were readmitted to the ICU at least once. Data on serum creatinine levels before surgery and on the day of ICU readmission were collected. The estimated glomerular filtration rate (eGFR) was calculated according to the creatinine-based Chronic Kidney Disease-Epidemiology Collaboration equation. We used logistic regression models and restricted cubic spline curves with four knots (5%, 35%, 65%, 95%) to investigate the relationship between renal function indicators and mortality.

Results

Of the 184 patients evaluated, 30 patients died during hospitalization, yielding a mortality rate of 16.30%. Cardiac dysfunction (n=84, 45.65%) and respiration disorder (n=51, 27.72%) were the most common reasons for ICU readmission. Creatinine [odds ratio (OR): 1.14, 95% confidence interval (CI): 1.07-1.25] and eGFR (OR: 0.95, 95% CI: 0.93-0.98) were independently associated with in-hospital mortality after adjusting for various confounders. Both creatinine level and eGFR had a linear association with in-hospital mortality (P for non-linearity ˃0.05).

Conclusion

Renal function is significantly associated with the in-hospital mortality of patients readmitted to the ICU after cardiac surgery, as evidenced by the independent correlation of both creatinine and eGFR with in-hospital mortality.

SUBMITTER: Zhong J

PROVIDER: S-EPMC8024843 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Publications

Serum creatinine as a predictor of mortality in patients readmitted to the intensive care unit after cardiac surgery: a retrospective cohort study in China.

Zhong Jun J Gao Jian J Luo Jing-Chao JC Zheng Ji-Li JL Tu Guo-Wei GW Xue Yan Y

Journal of thoracic disease 20210301 3

<h4>Background</h4>Patients readmitted to the intensive care unit (ICU) after cardiac surgery have a high mortality rate. The relationship between renal function and in-hospital mortality in readmitted patients has not been well demonstrated.<h4>Methods</h4>We retrospectively evaluated cardiac surgery patients who were readmitted to the ICU at least once. Data on serum creatinine levels before surgery and on the day of ICU readmission were collected. The estimated glomerular filtration rate (eGF ...[more]

PMID: 33841963

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Project description:BackgroundCreatinine-to-albumin ratio (CAR) has been recognized as a predictive indicator in the postoperative setting. However, its relationship with outcomes in patients receiving cardiac surgery remains elusive. This study aimed to discuss the link between CAR and 28-day mortality in patients admitted to intensive care unit (ICU) following cardiac surgery, hoping to provide some insights for targeted interventions for improvement of patient outcomes.MethodsMIMIC-IV database was searched to obtain data of patients admitted to ICU following cardiac surgery. Retrieved patients were split into three groups based on CAR levels. The 28-day ICU mortality in each group was evaluated and compared using Kaplan-Meier analysis. Subgroup analysis, multivariate Cox regression and restricted cubic spline (RCS) analysis were used to further examine the relationship between CAR and outcomes. Receiver operating characteristic (ROC) curves were used to assess the predictive ability of CAR. Mediation analysis was conducted to investigate the potential mechanism by which CAR affects 28-day ICU mortality.ResultsA total of 5,670 patients were included and divided into three groups. Patients with high CAR values (CAR ≥ 0.31) had a significantly increased rate of 28-day ICU mortality (11.4%), as compared to those with low CAR levels (CAR < 0.23, 1.83%). In addition, patients with high CAR values (CAR ≥ 0.31) had a lowest survival rate than the other two groups (p < 0.0001). ROC curve analysis showed that CAR exhibited a moderate predictive power (AUC = 0.748). Moreover, CAR was identified as a strong risk factor for 28-day ICU mortality, and a significant dose-response association was presented. Further subgroup analysis revealed pronounced mortality risks in females and patients without chronic conditions such as chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). Mediation analysis indicated that CAR affected 28-day ICU mortality through biomarkers like chloride (39.8%), glucose (11.8%), potassium (24.4%), and sodium (28.3%).ConclusionCAR served as a risk factor for 28-day ICU mortality in patients receiving cardiac surgery, and it showed a complex dose-response and subgroup-specific association with 28-day ICU mortality. Additionally, CAR affected 28-day ICU mortality through multiple key biomarkers, providing some insights for targeted interventions.

Project description:BackgroundThe serum albumin creatinine ratio (sACR) has been established as a potential indicator for heart disease, however, its relationship with prognosis in intensive care unit (ICU) patients with heart failure remains uncertain. This study aimed to investigate the association between sACR levels and all-cause mortality ICU patients with heart failure.MethodsClinical data from MIMIC-Ⅳ database was utilized for the analysis of ICU patients with heart failure. Patients were categorized into quartiles (Q1-Q4) based on sACR levels. Kaplan-Meier survival analysis and multivariate adjusted Cox regression models were employed to assess the association between sACR levels and mortality outcomes within 365 days. Subgroup analysis was used to evaluate the prognostic impact of sACR across diverse populations. Restricted cubic spline curves and threshold effect analysis were utilized to quantify the dose-response relationship between sACR levels and risk of all-cause mortality. Mediating effects analysis was conducted to present the involvement of albumin and creatinine in the association between sACR and outcomes.ResultsThe analysis encompassed a cohort of 4,506 patients, with Kaplan-Meier curves indicating that individuals with lower sACR levels exhibited an elevated risk of all-cause mortality (log-rank p < 0.001). Multivariate adjusted Cox regression and subgroup analysis demonstrated that individuals in Q2 [hazard ratio (HR) 0.82, 95%CI 0.71∼0.96], Q3 (HR 0.76, 95%CI 0.64∼0.91) and Q4 (HR 0.62, 95%CI 0.50∼0.76) had a decreased risk of mortality compared to individuals in Q1 (lower levels of sACR) (p for trend < 0.001), and this inverse relationship was consistently observed across various subgroups. Subsequent restricted cubic spline analysis revealed a negative yet nonlinear relationship between sACR and all-cause mortality (p for nonlinear < 0.001), and threshold effect analysis indicated an effect threshold of 3.75. Additionally, mediating effects analysis emphasized that sACR influenced the outcome not only through serum albumin and creatinine pathways, but also through direct mechanisms.ConclusionThe study found that low levels of sACR were independently associated with an increased risk of one-year all-cause mortality in ICU patients with heart failure, with a threshold effect, which could potentially serve as an early warning indicator for high-risk populations.

Dataset Information

Serum creatinine as a predictor of mortality in patients readmitted to the intensive care unit after cardiac surgery: a retrospective cohort study in China.

Background

Methods

Results

Conclusion

Publications

Serum creatinine as a predictor of mortality in patients readmitted to the intensive care unit after cardiac surgery: a retrospective cohort study in China.

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