Effects of plasma atherogenic index and plasma osmolality on arteriovenous fistula patency in hemodialysis patients.

BACKGROUND: The purpose of the present study was to investigate the effects of Plasma atherogenic index (AIP) and plasma osmolality (PO) values on arteriovenous fistula (AVF) patency in patients with chronic renal failure. METHODS: The patients with primary AVF between December 2012 and March 2020 with the diagnosis of end-stage renal disease in our clinic were included in the study. The patient data were collected retrospectively in digital medium. Diabetic patients were not included in the study. The Triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), sodium (Na), fasting blood glucose, and blood urea nitrogen (BUN) values were found and recorded from the files. AIP and PO were calculated with special formulas. Fistula patency rate in 6th, 12th, and 24th months were evaluated in 2-year follow-ups. RESULTS: According to the results of two-year follow-ups of the 162 patients, who underwent primary AVF, 21 (13%) patients were found to have thrombosis in the 6th month, 33 (20.4%) patients in the 12th month; however,141 (87%) and 129 (79.6%) patients actively used AVF in the 6th and 12th months, respectively. The AIP and PO values that were calculated in the patient group with AVF thrombosis were significantly higher (p = 0.001, p < 0.001; respectively). In the multivariate logistic regression analysis, Na, BUN, and HDL-C variables were found to be independent predictive factors for AVF thrombosis (OR (Odds Ratio): 1.169, 95% CI (Confidence interval)): 1.056-1.294, p = 0.003; OR: 1.108, 95% CI: 1.043-1.176, p = 0.001; OR: 0.874, 95% CI: 0.820-0.932, p < 0.001; respectively). It was also found that the patency rate was 64.2% (104 patients) in the 24th month. CONCLUSION: AIP, PO, Na, and BUN values are positively associated with AVF thrombosis. Checking AIP, Na, and BUN values will be useful in patients with end-term renal failure, who already have difficulties in renal replacement methods and vascular access.

Early and late predictors of postoperative neurocognitive dysfunction in cardiac surgery.

Background and purpose: Postoperative cognitive dysfunction (POCD) is a multifactorial image characterized by insufficiency in features such as the ability to perform tasks requiring high brain functions. Cognitive dysfunction such as memory loss and decreased concentration, confusion, and delirium are common conditions in some patients in the early period after major surgical interventions such as cardiac surgery. POCD causes delays in postoperative recovery, long return-to-work times, and decreased quality of life. This study aims to demonstrate POCD in early and late stages in patients undergoing cardiac surgery through the Montreal Cognitive Assessment (MoCA) and the Mini Mental Test (MMT). In addition, we aim to determine predictive factors with these neurocognitive tests. Methods: MMT and MoCA tests were applied to the patients included in the study before cardiac surgery, on the sixth postoperative day and third month. Neuro-cognitive dysfunction detected on the sixth postoperative day was accepted as an early period, its detection in the postoperative third month was accepted as a late period. Results: 127 patients without neurocognitive dysfunction in the preoperative period were included in the study. For early neurocognitive impairment, age, mean platelet volume (MPV), New York Heart Association (NYHA) classification, x-clamp time, cardio-pulmonary bypass (CPB) time, postoperative intensive care and hospital stay duration, and an event of acute myocardial infarction (AMI) in the preoperative period were determined as predictive factors. In addition, in late-period of neurocognitive dysfunction age, MPV, NYHA classification, x-clamp duration, CPB time, postoperative intensive care and hospital stay duration were shown as predictors of neurocognitive dysfunction. Conclusion: The results of our study support the literature findings showing that delirium is associated with a decline in cognitive functions three months after cardiac surgery. As a result, the lack of agreed diagnostic tests in the definition of POCD makes it difficult to standardize and interpret the research in this area. Therefore, a consensus to be reached in the diagnosis of POCD will ensure the use and correct interpretation of neurophysiological tests. In our study, advanced age and long hospital and intensive care stays were shown as predictive factors for both early and late neurocognitive dysfunctions. Furthermore, smoking was shown as a predictive factor only for late neurocognitive dysfunction.

Relationship of triglyceride-glucose index with chronic limb-threatening ischemia in lower extremity peripheral artery disease.

OBJECTIVES: Triglyceride-glucose index (TyG index), which is defined as the simple and novel marker of insulin resistance, is becoming increasingly important as a promising predictive marker for atherosclerotic diseases. Chronic limb-threatening ischemia is defined as the most advanced stage of the lower extremity peripheral artery disease, whose main cause is atherosclerosis and is associated in this respect with amputation, impaired quality of life, and mortality. The main purpose of the present study was to investigate the relation between the calculated TyG index values and chronic limb-threatening ischemia development. METHODS: A total of 296 patients who were diagnosed with lower extremity peripheral artery disease in our outpatient clinic between October 2018 and October 2020 were included in this study retrospectively. Two groups were formed by clinically staging the patients according to Rutherford Classification. Patients who did not develop chronic limb-threatening ischemia were classified as "Group 1" (n = 224) and those who developed were classified as "Group 2" (n = 72). RESULTS: The mean TyG index values that were calculated in Group 2 were significantly higher than in Group 1 (9.27 ± 0.31 vs. 9.00 ± 0.34, p < 0.001). In the multivariate logistic regression analysis conducted to determine the predictors of chronic limb-threatening ischemia development, C-reactive protein (OR [Odds Ratio]: 1.220, 95% CI [confidence interval]: 1.092-1.363, p < 0.001), high-density lipoprotein cholesterol (OR: 0.775, 95% CI: 0.715-0.839, p < 0.001) and TyG index (OR: 5.796, 95% CI: 2.050-16.382, p = 0.001) were identified as independent predictors. Receiver operating characteristic analysis revealed that the cut-off value of TyG index was 9.13 (area under the curve: 0.721, p < 0.001) with 70.8% sensitivity and 65.2% specificity. The TyG index was significantly correlated with Rutherford category, high-density lipoprotein cholesterol and mean platelet volume. CONCLUSIONS: Chronic limb-threatening ischemia development may be predicted with the TyG index value, which is calculated easily from routine biochemical parameters, in patients diagnosed with lower extremity peripheral artery disease.

Comparison of Microplegia Solution and Del Nido Cardioplegia Solution in Coronary Artery Bypass Grafting Surgery: Which One is More Effective?

BACKGROUND: The aim of this study is to compare the efficacy of the microplegia solution and Del Nido cardioplegia solution in coronary artery bypass surgery with clinical, biochemical, and echocardiographic data. METHODS: Three hundred patients, who underwent coronary artery bypass surgery between January 2017 and January 2020, by the same surgical team were included in the study. Preoperative, operative and postoperative data (cardiac biomarker levels, cross-clamp and CPB times, echocardiographic measurements, etc.) of the patients were compared. RESULTS: In the study, cross-clamp time was significantly shorter in the DN cardioplegia group (55.60 ± 13.49 min/75.58 ± 12.43 min, P = 0.024). No significant difference was observed between the two groups in terms of intensive care stay, extubation time, hospital stay, and cardiopulmonary bypass time. In our study, it was shown that both the left and right ventricular ejection fraction was better protected in the Del Nido cardioplegia group (5.34±3.03 vs. 3.40±2.84, P = 0.017 and 3.82±1.19 vs. 2.28±1.87, P = 0.047, respectively), and the need for inotrope support was lower in this group (28% vs. 44%, P < 0.021). There was no significant difference between the groups, in terms of blood transfusion rates, IABP requirement. CONCLUSION: In light of short-term results, we can say that Del Nido cardioplegia provides better myocardial protection than microplegia. In addition, Del Nido cardioplegia can be given as a single dose for 90 minutes of cross-clamp time and therefore can be preferred to increase surgical comfort and reduce cross-clamp times.

Effect of calculated plasma osmolality and atherogenic index of plasma on carotid artery blood flow velocities.

OBJECTIVES: The increase in carotid artery blood flow velocity is a measure of the severity of the carotid artery stenosis caused by atherosclerosis. Carotid artery stenosis is progressive and is of great importance due to the risk of stroke it creates. As an alternative to radiological examinations in these patients, patient follow-up can be facilitated by associating novel laboratory parameters with the severity of stenosis. In this study, we aimed to investigate the effect of the calculated plasma osmolality and atherogenic index of plasma on carotid artery blood flow velocities in patients with carotid artery stenosis. METHODS: A total of 161 patients diagnosed with carotid artery stenosis who admitted to our clinic between May 2018 and May 2020 were retrospectively analyzed. According to the carotid artery blood flow velocities measured with the Doppler ultrasonography, the patients were divided into two groups as "Normal flow velocity group" (n = 62) and "Increased flow velocity group" (n = 99). RESULTS: The calculated plasma osmolality, atherogenic index of plasma, and mean platelet volume were significantly associated with increased carotid artery blood flow velocity (p < 0.001, p < 0.001, p = 0.006; respectively). Calculated plasma osmolality and atherogenic index of plasma were identified as independent predictors of increase in carotid artery blood flow velocity (p < 0.001, p < 0.001; respectively). In the Receiver Operating Characteristic curve analysis, the plasma osmolality cut-off value, which predicts the increase in carotid artery blood flow velocity was found to be 291.45 mOsm/kg (Area Under the Curve: 0.746, p < 0.001, 65.7% sensitivity, and 67.7% specificity), and atherogenic index of plasma cut-off value was 0.20 (Area Under the Curve: 0.735, p < 0.001, 65.7% sensitivity, and 66.1% specificity). CONCLUSION: There was a significant relationship between the increase in carotid artery blood flow velocity and the increase in plasma osmolality and atherogenic index of plasma values. As a result, we can predict the increase in carotid artery blood flow velocity, that is, the increase in the severity of the carotid artery stenosis, with plasma osmolality and atherogenic index of plasma values that can be calculated simply from routine biochemical tests.

Is the Mean Platelet Volume a Predictive Factor for Atrial Fibrillation Developing After Coronary Artery Bypass Grafting in Elderly Patients?

BACKGROUND: Postoperative atrial fibrillation (PoAF) is the most common arrhythmic complication detected after coronary artery bypass grafting (CABG). It is associated with increased morbidity and mortality, especially in elderly patients. Mean platelet volume (MPV) shows the activation of platelets effective in the inflammatory and thrombotic process. The purpose of the present study was to investigate the relations between the preoperative MPV levels and development of PoAF in isolated CABG in elderly patients. METHODS: A total of 103 elderly patients (aged ≥ 65 years), who underwent isolated CABG and were at preoperative sinus rhythm, were included in the study. Patients who did not have PoAF were identified as Group 1 (N = 74), and those with PoAF were identified as Group 2 (N = 29). RESULTS: PoAF incidence was 28.2%. Preoperative MPV level was 8.41 ± 1.13 fL in Group 1, and 9.28 ± 1.00 fL in Group 2. The difference was statistically significant (P < .001). Multivariate logistic regression analysis revealed that age, preoperative hemoglobin, and preoperative MPV were independent predictive factors for PoAF development (OR [odds ratio]: 1.149, 95% CI [confidence interval]: 1.043-1.265, P = .005; OR: 1.334, 95% CI: 1.013-1.758, P = .040; OR: 2.103, 95% CI: 1.324-3.339, P = .002, respectively). The cut-off value for MPV as the predictor of PoAF development was found to be 8.43 (sensitivity: 82.8% and specificity: 55.4%). CONCLUSION: This study showed that MPV levels are associated with PoAF development in elderly patients, and other independent predictive factors include age and preoperative hemoglobin levels for POAF development.

Can Continuous Local Anesthetic Infusion After Median Sternotomy Reduce Opioid Use?

Introduction Effective treatment of postoperative pain due to median sternotomy speeds up hemodynamic healing of patients. For this purpose, opioids with a wide range of side effects are widely used at high doses. The aim of this study is to investigate the effect of continuous local anesthetic (bupivacaine) infusion on opioid use on cardiac surgery patients undergoing median sternotomy. Methods A total of 215 patients undergoing isolated coronary artery bypass grafting surgery were included in the study; and 105 patients who underwent parasternal continuous local anesthetic infusion (0.5% bupivacaine at 4 mL/h, for 48h) were determined as local anesthesia group and other patients were as control group. The primary outcomes evaluated between the groups in the postoperative period were pain scores (VAS: Visual Analogic Score, PHHPS: Prince Henry Hospital Pain Score) and the number of opioids used. Secondary outcomes were mechanical ventilation time, intensive care unit and hospital stay duration, development of atrial fibrillation and atelectasis. Results Postoperative pain was found to be significantly lower in the local anesthesia group compared to the control group (VAS: 3 ± 1.9 vs 6.4 ± 1.8, p < 0.001; PHHPS: 0.9 ± 0.8 vs 1.62 ± 0.82, p < 0.001). As a result of this, opioid drug use was significantly lower in the local anesthesia group compared to the control group (0 (0 - 4) vs 1 (0 - 8), p < 0.001). Mechanical ventilation time, intensive care unit and hospital stay duration, and development of atelectasis were significantly lower in the local anesthesia group. In terms of the development of atrial fibrillation, no significant difference was found between the groups. Conclusion Parasternal continuous local anesthetic infusion reduces postoperative opioid use and speeds up hemodynamic healing by preventing possible side effects of opioids. It is a simple and effective method in the treatment of postoperative pain due to median sternotomy.