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首页> 外文期刊>Journal of Clinical and Diagnostic Research >Prediction of Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) after Thoracic Surgery- The Role of Estimated GFR UC13-UC16
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Prediction of Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) after Thoracic Surgery- The Role of Estimated GFR UC13-UC16

机译：胸外科手术后重大不良心脑血管事件（MACCE）的预测-估计GFR UC13-UC16的作用

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Introducton: Little is known about the prognostic utility of preoperative estimated GFR (eGFR) on perioperative Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) in apparently lower risk patients undergoing moderate risk surgeries like thoracotomy.Aim: The current study sought to identify a clinically relevant cut off value of eGFR for identifying thoracotomy patients at higher risk for MACCE.Materials and Methods: Between July 2012 and July 2016, 436 consecutive patients were retrospectively studied after elective thoracotomy in a single institution. Patients were classified into six groups according to the calculated Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPI) eGFR (ml min -11.73 m -2): Stage 1, eGFR >90; Stage 2, eGFR=60?89.9; Stage 3a, eGFR=45?59.9; Stage 3b, eGFR=30?44.9; Stage 4, eGFR=15?29.9; Stage 5, eGFR <15. All the eGFR groups were analysed for perioperative MACCE, length of hospital stay, and mortality.Results: The incidence of perioperative MACCE in our study was 4.24%. The mean eGFR in our study as calculated by the CKD-EPI equation was 83 ml min-11.73 m-2. With the exception of nonfatal cardiac arrest which was not seen in any patient, the incidence of all MACCE increased with progressively worsening preoperative eGFR. It was seen by logistic regression analysis that the occurrence of any perioperative MACCE increased significantly with worsening eGFR (p<0.001).The increase in MACCE was particularly marked from Stage 3b onwards to the later stages (OR 1.9 in 3a vs. 3.6 in 3b). The two mortalities observed in the study were in Stages 4 and 5 with no deaths seen in the better eGFR subgroups. There was also an increased length of hospital stay with declining eGFR.Conclusion: Preoperative eGFR is a predictor of perioperative MACCE in homogenous moderate risk elective surgical population like thoracic surgeries. There is an inverse relationship between eGFR and MACCE, particularly manifested at eGFR values <45 ml/min/1.73. Routine use of preoperative eGFR for cardiovascular and cerebrovascular risk assessment in patients undergoing moderate risk surgeries like thoracotomy would be beneficial.
机译：简介：术前估计的GFR（eGFR）对明显降低了接受中等风险手术（如开胸手术）的低风险患者围手术期重大不良心血管事件（MACCE）的预后效用知之甚少。目的：本研究旨在确定临床相关的材料和方法：2012年7月至2016年7月，在单一机构进行选择性开胸手术后，对436例连续患者进行了回顾性研究。根据计算的慢性肾脏病流行病学协作方程（CKD-EPI）eGFR（ml min -11.73 m -2）将患者分为六组：第一阶段，eGFR> 90;第2阶段，eGFR = 60？89.9;阶段3a，eGFR = 45？59.9;阶段3b，eGFR = 30？44.9;阶段4，eGFR ＝ 15-29.9;阶段5，eGFR <15。所有eGFR组均进行围手术期MACCE，住院时间和死亡率的分析。结果：本研究围手术期MACCE的发生率为4.24％。通过CKD-EPI公式计算出的本研究中的平均eGFR为83 ml min-11.73 m-2。除了在所有患者中均未发生过的非致命性心脏骤停外，术前eGFR逐渐恶化，所有MACCE的发生率均增加。通过逻辑回归分析发现，围手术期MACCE的发生率随着eGFR的恶化而显着增加（p <0.001）.MACCE的增加尤其明显，从3b期开始到后期（OR 3中为1.9,3b中为3.6）。 ）。在研究中观察到的两种死亡率分别在第4和第5阶段，在更好的eGFR亚组中未见死亡。结论：术前eGFR是同等中等风险择期手术人群（如胸外科）围手术期MACCE的预测指标。 eGFR与MACCE之间存在反比关系，特别是在eGFR值<45 ml / min / 1.73时表现出来。对于接受中等风险手术（如开胸手术）的患者，常规使用术前eGFR进行心血管和脑血管风险评估将是有益的。

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