Association of hematological and biochemical tests and complications after cardiovascular surgery
10.15343/0104-7809.202246209220
Keywords:
Cardiovascular Surgical Procedures. Clinical Laboratory Techniques. Postoperative Complications.Abstract
Cardiac surgery has postoperative complications of varying severities. Knowing the predictors of such complications can minimize risks and increase patient survival. However, studies address postoperative complications without any standardization of predictors of such complications. The objective of this study was to evaluate the association of hematological and biochemical parameters in the pre- and postoperative period with general clinical complications and those according to organ affected in the postoperative period of cardiac surgery. This is a cross-sectional, retrospective, analytical and documentary study. Inclusion criteria: Elective myocardial revascularization surgeries and/or valve replacements with a cardiopulmonary bypass from January to December 2017, in patients older than 18 years old, survivors until hospital discharge. Incomplete medical records were excluded. Ethical research precepts were followed. 194 patients were included. Preoperative leukocyte alterations increased the chance of postoperative complications by 8.24 times (p=0.039); high mean INR values in the first postoperative period were associated with complications (p=0.036); changes in creatinine (p=0.020) and INR (p=0.002) in the first and second postoperative period were associated with complications, in addition to changes in hemoglobin associated with cardiac complications on the third postoperative day (p≤0.001). There was an association between: leukocyte alteration prior to surgery and total postoperative complications; postoperative hematological and biochemical changes and complications in general and by affected organ. These results can support the development of risk indicators. This also indicates the need to improve monitoring of leukocyte levels, INR, hemoglobin, and creatinine, perceived as predictors of surgical complications.
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References
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17. Classification and diagnosis of diabetes: standards of medical care in diabetes. Diabetes Care. 2019;42(1):13-28. doi:10.2337/dc19-S002
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21. Cheng B, Chen HC, Chou IW, Tang TW, Hsieh PC. Leveraging early post-injury inflammatory responses to cardiac regeneration. J Biomed Sci. 2017;24(1):7. doi:10.1186/s12929-017-0315-22
22. Bonaventura A, Montecucco F, Dallegri F. Cell recruitment in myocardial ischemia / reperfusion injury. Eur J Clin Invest. 2016;46(6):590-601. doi:10.1111/eci.126333
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24. Laffey JG, Boylan JF, Cheng DC. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology. 2002;97(1):215-52. doi:10.1097/00000542-200207000-00030
25. Jour TY, Soleimani AU, Kiabi AUF, Zeydi AU, Mohammad AU. Can white blood cell count be used as a predictor of atrial fibrillation following cardiac surgery? A short literature review. Anadolu Kardiyol Derg. 2014 (2): 216-7. doi:10.5152/ akd.2014.530
26. Weber CF, Görlinger K, Meininger D, Herrmann E, Bingold T, Moritz A, Cohn LH, Zacharowski K. Point-of-care testing: A prospective randomized clinical trial of efficacy in patients with coagulopathic heart surgery. Anesthesiology 2012; 117 (3): 531-547. doi:10.1097/ALN.0b013e318264c644
27. Whiting P, Maiwenn AI, Westwood M, Corro-Ramos I, Ryder S, Armstrong N, Misso k, Ross J, Severens J, Kleijnenet J. Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and costeffectiveness analysis. Health Technol. 2015;19(58):1-227. doi:10.3310/hta19580.
28. Elizondo LC, Muguercia H, Díaz I. Acquired coagulopathies in patients admitted to the intensive care unit of hermanos ameijeiras clinical-surgical hospital. Cuban J. Med. 2017; 56:26-38. Disponível em: http://scielo.sld.cu/scielo.php?script=sci_ arttext&pid=S0034-75232017000100004&lng=es
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30. Sniecinski RM, Levy JH. Management of anticoagulation associated with cardiopulmonary bypass. Best Pract Res Clin Anaesthesio. 2015; 29 (2): 189-202. doi:10.1016/j.bpa.2015.03.005.
31. Martini FH, Ober W C, Bartholomew EC, Nath JL. Anatomia e fisiologia humana: uma abordagem visual. 1ª ed. São Paulo: Pearson Education do Brasil, 2014.
32. Lin L, Wang X, Yu Z. Ischemia-reperfusion Injury in the Brain: Mechanisms and Potential Therapeutic Strategies. Biochem Pharmacol (Los Angel). 2016;5(4):213. doi:10.4172/2167-0501.1000213.
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34. Joslin J, Ostermmann M. Care of the critically ill emergency department patient with acute kidney injury. Emerg Med Int. 2012; 2012:760623. doi:10.1155/2012/7606233
35. Gündüz E, Aydoğdu Titiz T. Kardiyak cerrahi ile ilişkili akut böbrek hasarı ve saptanmasında biyomarkerlar, GKDA Derg. 2019;25(2):79-88. doi:10.5222/GKDAD.2019.63497
36. Singbartl K, Kellum JA. AKI in the ICU: definition, epidemiology, risk stratification, and outcomes. Kidney Int. 2012; 81:819- 25. doi:10.1038/ki.2011.339
37. Mann DL, Zipes DP, Libby P, Bonow RO. Braunwald: Tratado de Doenças Cardiovasculares. 10ª ed. Rio de Janeiro: Elsevier; 2017. Disponível em: https://eu-ireland-custom-media-prod.s3-eu-west-1.amazonaws.com/Brasil/Downloads/e-sample%20MANN-9788535283174.pdf
38. Wang R, Neuenschwander FC, Nascimento BR. Inflamação pós-Infarto Agudo do Miocárdio: “Médico ou Monstro”. Arq. Bras. Cardiol. 2020;115(6):1-2. Disponível em: https://abccardiol.org/wp-content/uploads/articles_xml/0066-782X-abc-115- 06-1112/0066-782X-abc-115-06-1112.x44344.pdf
39. Benedetto U, Ng C, Frati G, Biondi-Zoccai G, Vitulli P, Zeinah M, Raja SG. Miniaturized cardiopulmonary bypass versus myocardial revascularization without cardiopulmonary bypass: a meta-analysis of randomized controlled trials. Int. J. Surgery. 2015; 14:96-104. doi:10.1016/j.ijsu.2014.12.021.
40. Fadini GP, Marcuzzo L, Marescotti MC, Kreutzenberg SV, Avogaro U. Elevated white blood cell count is associated with prevalence and development of the metabolic syndrome and its components in the general population. Acta diabetol. 2012; 49(6): 445–51. doi:10.1007/s00592-012-0402-5.
2. Brasil. Ministério da Saúde. Departamento de Informática do SUS (DATASUS). Procedimentos Hospitalares do SUS: por local de internação: Brasil. Brasília. Ministério da Saúde; 2018. Disponível em: http://tabnet.datasus.gov.br/cgi/deftohtm. exe?sih/cnv/qiuf.def
3. Dordetto PR, Pinto GC, Camargo RTCS. Pacientes submetidos à cirurgia cardíaca: caracterização sociodemográfica, perfil clínico-epidemiológico e complicações. Revista da Fac. Ciênc. Méd. Sorocaba. 2016;18(3):144-149. doi: 10.5327/Z1984- 4840201625868
4.Altınkaya Çavuş M, Gökbulut Bektaş Ş, Demir A. Postoperative renal damage in heart surgery. GKDA Derg. 2019;25(2):126- 132. doi:10.5222/GKDAD.2019.29200
5. Hussain, SMA, Amer H. Complications of coronary artery bypass grafting. Int. J. Med. Rev. 2019;6(1):1-5. doi:10.29252/ IJMR-060101
6. Goldfarb M, Drudi L, Almohammadi M, Langlois Y, Noiseux N, Perrault L, Piazza N, Afilalo J. Outcome reporting in cardiac surgery trials: systematic review and critical appraisal. J. Am. Heart Association. 2015 Aug 17;4(8): e002204. doi.10.1161/ JAHA.115.002204
7. Balci E, Aykut A, Demir A, Sabuncu Ü, Koçulu R, Karadeniz Ü. In-hospital mortality and complications following coronary artery bypass surgery; is it possible to predict with preoperative values? JARSS. 2019;27(1):56-62. doi:10.5222/jarss.2019.32042
8. Aydinli B, Demir A, Ozmen H, Vezir Ö, Ünal U, Özdemir M. Can preoperative HbA1c values in coronary surgery be a predictor of mortality? Turk. J. Anesthesiol Reamin. 2018; 46 (3): 184-190. doi:10.5152/TJAR.2018.46667
9. Biomarcadores em Cardiologia - Parte 1 – Na insuficiência Cardíaca e nas Cardiomiopatias Específicas. Arq. Bras. Cardiol. [Internet]. 2014;103(6):451-459. doi:10.5935/abc.20140184
10. Khan F, Hashmi S, Naeem SS, Fatima B, Hanif H, Khan MZ, Fatimi SH. Perio-perative determinants of prolonged CICU stay after coronary artery bypass graft surgery in elderly at a private tertiary care hospital: A case control study. J Pak Med Assoc. 2016; 66 (10):19-23. Disponível em: https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1121&context=pakistan_fhs_mc_ surg_surg
11. Arthur CP, Mejia OA, Osternack D, Nakazone MA, Goncharov M, Lisboa LA, Dallan LA, Pomerantzeff PM, Jatene FB, de Estudo REPLICCAR G. É Necessário Personalizar a Avaliação da Função Renal na Estratificação de Pacientes Submetidos à Cirurgia Cardíaca? Arq Bras Cardiol. 2017;109(4):290-298. doi:10.5935/abc.20170129
12. Azevedo MR. Hematologia Básica: Fisiopatologia e Diagnóstico Laboratorial. 6a ed. Rio de Janeiro: Thieme Revinter; 2019.
13. Yun SH, Sim EH, Goh RY, Park JI, Han JY. Ativação de Plaquetas: os Mecanismos e Potenciais Biomarcadores. Biomed Res. Int. 2016;2016: 1-5. doi:10.1155/2016/9060143
14. Amaral COF, Nascimento FM, Pereira FD, Parizi AGS, Straioto FG, Amaral MSP. Bases para interpretação de exames laboratoriais na prática odontológica. Cient. Ciênc. Biol. Saúde. 2014;16(3):37-229. Disponível em: https://journalhealthscience. pgsskroton.com.br/article/view/459
15. Pereira JPM, Faustino SMM, Rodrigues ÁSN. Análise dos problemas encontrados na execução do coagulograma em laboratórios da cidade de Macapá-Amapá. Ciênc. Equatorial. 2011;1(1):1-8. Disponível em: https://periodicos.unifap.br/index. php/cienciaequatorial/article/viewFile/396/247
16. Dusse LMS, Rios DRA, Sousa LPN Moraes RMMS, Domingueti CP, Gomes KB. Biomarcadores da função renal: do que dispomos atualmente? Rer. bras. anal. clin. 2017;49(1): 41-51. doi:10.21877/2448-3877.201600427
17. Classification and diagnosis of diabetes: standards of medical care in diabetes. Diabetes Care. 2019;42(1):13-28. doi:10.2337/dc19-S002
18. Johansson T, Fritsch G, Flamm M, Hansbauer B, Bachofner N, Mann E, Bock M, Sönnichsen AC. Effectiveness of non-cardiac preoperative testing in non-cardiac elective surgery: systematic review. Br J Anaesth. 2013;110(6):926-939. doi.10.1093/bja/ aet071.
19. Bekler A, Erbag G, Sen H, Gazi E, Ozcan S. Predictive value of elevated neutrophil-lymphocyte ratio for left ventricular systolic dysfunction in patients with non ST-elevated acute coronary syndrome. Pak J Med Sci 2015;31(1):159-163. doi:10.12669/pjms.311.59677
20. Wang J, Song J, Wu J, He C, Xu C, Liu Y. Leukocyte count and leukocyte subsets reveal compensatory mechanisms in coronary heart disease. Clin. Chim. Acta 2013; 418: 79-85. doi: 10.1016/j.cca.2012.12.028
21. Cheng B, Chen HC, Chou IW, Tang TW, Hsieh PC. Leveraging early post-injury inflammatory responses to cardiac regeneration. J Biomed Sci. 2017;24(1):7. doi:10.1186/s12929-017-0315-22
22. Bonaventura A, Montecucco F, Dallegri F. Cell recruitment in myocardial ischemia / reperfusion injury. Eur J Clin Invest. 2016;46(6):590-601. doi:10.1111/eci.126333
23. Gabriel EA, Locali RF, Matsuoka PK, Cherbo T, Buffolo E. Cirurgia de revascularização do miocárdio com circulação extracorpórea: características bioquímicas, hormonais e celulares. Braz J Cardiovasc Surg. 2011;26(4):525-531. doi:10.5935/1678-9741.20110041
24. Laffey JG, Boylan JF, Cheng DC. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology. 2002;97(1):215-52. doi:10.1097/00000542-200207000-00030
25. Jour TY, Soleimani AU, Kiabi AUF, Zeydi AU, Mohammad AU. Can white blood cell count be used as a predictor of atrial fibrillation following cardiac surgery? A short literature review. Anadolu Kardiyol Derg. 2014 (2): 216-7. doi:10.5152/ akd.2014.530
26. Weber CF, Görlinger K, Meininger D, Herrmann E, Bingold T, Moritz A, Cohn LH, Zacharowski K. Point-of-care testing: A prospective randomized clinical trial of efficacy in patients with coagulopathic heart surgery. Anesthesiology 2012; 117 (3): 531-547. doi:10.1097/ALN.0b013e318264c644
27. Whiting P, Maiwenn AI, Westwood M, Corro-Ramos I, Ryder S, Armstrong N, Misso k, Ross J, Severens J, Kleijnenet J. Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and costeffectiveness analysis. Health Technol. 2015;19(58):1-227. doi:10.3310/hta19580.
28. Elizondo LC, Muguercia H, Díaz I. Acquired coagulopathies in patients admitted to the intensive care unit of hermanos ameijeiras clinical-surgical hospital. Cuban J. Med. 2017; 56:26-38. Disponível em: http://scielo.sld.cu/scielo.php?script=sci_ arttext&pid=S0034-75232017000100004&lng=es
29. Lorga Filho, A M et al. Diretrizes brasileiras de antiagregantes plaquetários e anticoagulantes em cardiologia. Arq. Bras. Cardiol. 2013; 101(3): 01-95. doi:10.5935/abc.2013S009.
30. Sniecinski RM, Levy JH. Management of anticoagulation associated with cardiopulmonary bypass. Best Pract Res Clin Anaesthesio. 2015; 29 (2): 189-202. doi:10.1016/j.bpa.2015.03.005.
31. Martini FH, Ober W C, Bartholomew EC, Nath JL. Anatomia e fisiologia humana: uma abordagem visual. 1ª ed. São Paulo: Pearson Education do Brasil, 2014.
32. Lin L, Wang X, Yu Z. Ischemia-reperfusion Injury in the Brain: Mechanisms and Potential Therapeutic Strategies. Biochem Pharmacol (Los Angel). 2016;5(4):213. doi:10.4172/2167-0501.1000213.
33. Santos CA, Barboza OMA, Brandi AC, Husseini BPH, Menin BJC, Santos MA, Fernandes GM, Braile DM. Fatores de risco para mortalidade de pacientes submetidos à revascularização miocárdica Rer. Bras. Cir. Cardiovas. 2014; 29(4): 513-520. doi:10.5935/1678-9741.20140073.
34. Joslin J, Ostermmann M. Care of the critically ill emergency department patient with acute kidney injury. Emerg Med Int. 2012; 2012:760623. doi:10.1155/2012/7606233
35. Gündüz E, Aydoğdu Titiz T. Kardiyak cerrahi ile ilişkili akut böbrek hasarı ve saptanmasında biyomarkerlar, GKDA Derg. 2019;25(2):79-88. doi:10.5222/GKDAD.2019.63497
36. Singbartl K, Kellum JA. AKI in the ICU: definition, epidemiology, risk stratification, and outcomes. Kidney Int. 2012; 81:819- 25. doi:10.1038/ki.2011.339
37. Mann DL, Zipes DP, Libby P, Bonow RO. Braunwald: Tratado de Doenças Cardiovasculares. 10ª ed. Rio de Janeiro: Elsevier; 2017. Disponível em: https://eu-ireland-custom-media-prod.s3-eu-west-1.amazonaws.com/Brasil/Downloads/e-sample%20MANN-9788535283174.pdf
38. Wang R, Neuenschwander FC, Nascimento BR. Inflamação pós-Infarto Agudo do Miocárdio: “Médico ou Monstro”. Arq. Bras. Cardiol. 2020;115(6):1-2. Disponível em: https://abccardiol.org/wp-content/uploads/articles_xml/0066-782X-abc-115- 06-1112/0066-782X-abc-115-06-1112.x44344.pdf
39. Benedetto U, Ng C, Frati G, Biondi-Zoccai G, Vitulli P, Zeinah M, Raja SG. Miniaturized cardiopulmonary bypass versus myocardial revascularization without cardiopulmonary bypass: a meta-analysis of randomized controlled trials. Int. J. Surgery. 2015; 14:96-104. doi:10.1016/j.ijsu.2014.12.021.
40. Fadini GP, Marcuzzo L, Marescotti MC, Kreutzenberg SV, Avogaro U. Elevated white blood cell count is associated with prevalence and development of the metabolic syndrome and its components in the general population. Acta diabetol. 2012; 49(6): 445–51. doi:10.1007/s00592-012-0402-5.
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Published
2022-08-03
How to Cite
Leontina Graube, S., Okaseski, K. R., Felipin Ludvig, B., Agnolleto Bewanger, S., Lemes Lobo Bittencourt, V., Colet, C. de F., & Roseli Winkelmann, E. (2022). Association of hematological and biochemical tests and complications after cardiovascular surgery: 10.15343/0104-7809.202246209220. O Mundo Da Saúde, 46, 209–220. Retrieved from https://revistamundodasaude.emnuvens.com.br/mundodasaude/article/view/1379
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