Biomarcadores renais de lesão glomerular e tubular em pacientes submetidos à cirurgia arterial / Biomarkers of renal glomerular and tubular injuries in patients anesthetized for arterial surgery

Objetivos: Estudar a função renal de pacientes arteriopatas submetidos a cirurgia vascular, avaliando a concordância entre as estimativas do ritmo de filtração glomerular (RFG) obtidos pela aferição da creatinina e cistatina C plasmática, verificando se diabetes, hipertensão e função renal pré-operatórias apresentam relação com função tubular no pós-operatório e investigando a possível influência da hemodiluição na avaliação da função renal por meio da cistatina C. Casuística e métodos: Trata-se de estudo de coorte, prospectivo, incluindo 144 pacientes consecutivos submetidos à anestesia para cirurgia arterial e distribuídos em 4 grupos, sendo (GDH), diabéticos e hipertensos, (GD), diabéticos, (GH), hipertensos e (GN), sem hipertensão ou diabetes. Foram obtidos urina para dosagens laboratoriais de creatinina urinária (Ucr) (mmol , fosfatase alcalina (FA) (U , -glutamiltransferase ( GT) (U e sangue para dosagem de albumina (g/dL), globulina (g/dL) uréia (mg/dL), creatinina (mg/dL), cistatina C (mg/L) e aferida a osmolaridade plasmática (mOsm/L) no pré-operatórios (M1) e após 24 horas do término da cirurgia (M2). As estimativas do RFG foram comparadas pelo método de Bland-Altman...

Objective: The aim of this study was to study the renal function of patients submitted to anaesthesia for arterial surgery, evaluating the agreement between GFR equations by cystatin C and creatinine, checking whether preoperative diabetes, hypertension, and renal function had any relationship with postoperative tubule function, and investigating possible hemodilution influence in cystatin C GFR based equations. Casuistry and Methods: Prospective cohort study including 144 patients submitted to anaesthesia for arterial surgery enrolled consecutively and divided into four groups: (GDH), diabetes and hypertension, (GD), diabetes, (GH), hypertension, and (GN), without hypertension or diabetes. Urine was obtained for laboratory analysis of urinary creatinine (Ucr) (mmol , alkaline phosphatase (AP) (U , -glutamyltransferase ( GT) (U , and blood for albumin (g/dL), globulin (g/dL), urea (mg /dL), creatinine (mg /dL), cystatin C (mg/L), and the plasma osmolarity (mOsm/L), before (M1) and 24h after the end of surgery (M2). Bland and Altman analysis was used to assessing agreement between two methods of GFR of measurements...

Frequency of Concomitant Cardiac Disease and Postoperative Cardiac Events in the Patients Underwent Elective Arterial Surgery: with Reference to Ischemic Heart Disease (IHD)

PURPOSE: Cardiac disease has been known as the most common cause of early and late postoperative mortality following elective arterial surgery. We attempted to investigate the prevalence of concomitant cardiac disease and predictor of postoperative cardiac events in the patients undergoing elective arterial surgery. METHOD: We retrospectively reviewed 300 patients who underwent elective arterial operations at the Department of Surgery, Kyungpook National University Hospital. For preoperative cardiac screening, history taking and physical examination were done with ECG and CK-MB enzyme (OPUS CK-MB, Behring Diagnostic) measurement. Transthoracic echocardiography (145), myocardial perfusion scanning (81, adenosine Tc-99m MIBI or thallium-201 SPECT), and coronary angiography (5) were performed in selective basis. IHD was defined by perfusion defect on myocardial scan and clinical criteria consisting of chest pain, ECG abnormality and serum CK-MB>5%. Possible risk factors including age(> or= 70 years), previous cardiac symptom, aortic clamping, abnormal cardiac function tests, and comorbidities were analyzed to determine the predictor of cardiac events after arterial surgery. RESULT: IHD was associated with in 20.2% of the patients with chronic arterial occlusive disease and 12.8% of patients with abdominal aortic aneurysm. IHD were more commonly associated with diabetes (30.3% vs 15.8%, p=0.014) and hypertension (28.2% vs 11.8%, p=0.0003). After 340 arterial operations for 300 patients, 11 (3.7%) cardiac events (1 congestive heart failure, 10 myocardial infarction or anginal attack and 1 cardiac deaths) were followed. By univariate statistical analysis, postoperative cardiac events occurred more frequently in the patients with prior history of cardiac symptom (9.5% vs 2.7%, p=0.052) and higher CK-MB titer (11.8% vs 3.0%, p=0.038). CONCLUSION: In determining the indications for more detailed preoperative cardiac evaluation, presence of diabetes or hypertension should be considered. To reduce the risk of postoperative cardiac events after elective arterial surgery, more intensive cardiac monitoring is required for the patients with previous cardiac symptoms and/or elevated serum CK-MB.

The Analysis of Operative Mortality for Patients Requiring Arterial Surgery

PURPOSE: The purpose of this study is to investigate the frequencies and causes of operative mortalities in patients who underwent arterial operations for various arterial diseases. METHOD: The preregistered data base of 604 patients (533 men and 71 women, mean age 65 11.9 years ranging 10~88 years) who underwent arterial operations at Department of Surgery, Kyungpook National University Hospital was retrospectively reviewed. Operative mortality included patient death within 30 days after operation or during the same admission period. Frequencies and their causes of operative mortality were analyzed according to the arterial disease, location of the arterial lesion, surgical procedure, timing of their occurrence and associated risk factors. RESULT: Patients with arterial disease comprised of 399 chronic occlusive, 126 acute occlusive and 79 aneurysmal disease. Overall operative mortality rate was 4.5% including 0.8% with chronic arterial occlusive disease, 7.6% with aneurysmal disease, and 14.3% with acute arterial occlusive disease. In the chronic occlusive disease, there was no statistically significant differences in the operative mortality rates by the location of disease, surgical procedures, age or other associated risk factors. Cause of operative mortality in this group was all cardiac origin. Operative mortality rates in the patients with acute arterial occlusive disease were 40% and 10.8% in mesenteric and limb artery occlusive disease respectively, and 16.2% and 11.5% in acute embolism and acute thrombosis, respectively. Preoperative renal dysfunction (serum creatinine> or =1.5 mg/dL) was an independent risk factor for operative mortality in acute arterial occlusive disease (80% vs 11.6% in embolism, p=0.002, 100% vs 8% in thrombosis, p=0.011). The main causes of death were organ failure (55.6%) and cardiac (33.3%). In aneurysmal disease, all mortalities occurred in ruptured aneurysm. Operative mortality rate of ruptured abdominal aortic aneurysm was 20.8%. The main causes of death were exanguination (50%) and later development of organ failure(50%). CONCLLUSION: To reduce operative mortalities after arterial surgery, disease-specific and surgery-specific causes of death should be considered.