Risk factors in the development of postoperative complications after reconstructive surgery on the thoracic aorta.

Aim To determine risk factors responsible for developing postoperative complications after the thoracic aorta reconstructive surgery. Methods Medical records of 100 patients, who had undergone elective or emergency thoracic aorta reconstructive surgery at the Clinic for Cardiovascular Surgery, University Clinical Center Tuzla, were analysed. Intraoperative data as cross-clamp time (CCT), duration of cardiopulmonary bypass (CPBT) and hypothermic circulatory arrest time (HCAT) were evaluated. Univariate analysis was used to show risk factors for developing postoperative cardiac, respiratory, surgical and renal complications. Results Between May 2019 and April 2021, 48 Bentall procedures (BP), 23 ascending aortic replacements (AAR), 20 BP and coronary artery bypass grafting (CABG) and 9 aortic valve replacements (AVR) with AAR were performed. Incidence of postoperative complications in the elective and emergency groups was as follows: respiratory 20% vs 38% (p=0.049), cardiac 18% vs 70% (p=0.015), renal 16% vs 48% (p=0.027) and surgical 4% vs 6% (p>0.05). Intrahospital 30 days morbidity was 44% with mortality rate of 13%. The results showed that CPBT>180 minutes was a risk factor for respiratory (p=0.034), cardiac (p=0.020) and renal (p=0.027) postoperative complications after acute type A aortic dissection surgery. Conclusion CPBT > 180 min is a risk factor for postoperative development of respiratory, cardiac and renal complications. Postoperative cardiac and renal complications were associated with longer HCAT.

Influence of C-reactive protein on the occurrence and assessing of albuminuria severity in diabetics.

Aim To asses relation of serum high sensitive C-reactive protein (hsCRP) level with albumin concentration in daily urine in patients with diabetes mellitus type 2 (T2DM). Methods The prospective study included 69 patients with T2DM, both sexes (24 males, 45 females), aged 30-82 years. They were divided into two groups: patients with T2DM and normoalbuminuria(T2DM-NA; n=40) and patients with T2DM and microalbuminuria (T2DM-MA; n=29). Patients were hospitalized at the Department of Internal Medicine, Cantonal Hospital Zenica, in the period January-April 2014. Immunonephelometry measurement of hsCRP was performed on the Nephelometer Analyzer BN II (Siemens, Germany). Results Frequency of patients in T2DM-NA and T2DM-MA groups was not significantly different in relation to sex and age. There was significant difference in relation to duration of diabetes ( p=0.001). Average glucose and HbA1c levels were significantly higher in T2DM-NA group comparing to T2DM-MA group (p=0.008 and p=0.047, respectively). Serum creatinine (p=0.011),urea (p=0.009) and hsCRP (p=0.005) were significantly higher in T2DM-MA group compared to T2DM-NA group. Urinary albumin showed significantly positive correlation with the hsCRP (rho=0.286; p=0.017), urea (rho=0.503) and creatinine (rho=0.438) (p < 0.0005). A one unit (mg/L) increase in hsCRP concentration was associated with 11.5% increase of odds of microalbuminuria OR=1.115; 95% CI 1.014-1.225; p=0.025). Conclusion Significantly higher values of serum hsCRP in patients with type 2 diabetes mellitus and microalbuminuria in comparison to those with normoalbuminuria as well as the correlation of values of inflammatory marker with urinary albumin implicate a low grade inflammation in the progression of diabetic nephropathy.

Neutrophil-to-lymphocyte Ratio and Its Relation with Markers of Inflammation and Myocardial Necrosis in Patients with Acute Coronary Syndrome.

INTRODUCTION: Inflammation plays an important role in atherosclerosis which is the primary cause of acute coronary syndrome (ACS) that encompasses acute myocardial infarction (AMI) and unstable angina (UA). OBJECTIVE: To investigate and characterize white blood cells (WBC) count, differential blood count in peripheral blood and neutrophil to lymphocyte ratio (NLR) in patients by the type of ACS. PATIENTS AND METHODS: The cross-sectional study included 100 patients with ACS (50 males, 50 females), aged 41 to 91 years, classified into two groups: AMI group (n=50) and UA group (n=50). Patients were hospitalized at the Clinic for Heart Diseases, University Clinical Center of Sarajevo. From patients' medical histories the following data were obtained: WBC, neutrophil, eosinophil and basophil granulocytes count, monocyte and lymphocyte count, levels of high sensitive troponin I (hsTnI), creatine kinase MB (CK-MB) and C-reactive protein (CRP). The results were analyzed using software package SPSS, version 19.0. RESULTS: Average WBC count, neutrophil granulocytes, and monocytes were significantly higher in AMI group than in UA group (p = 0.001, p < 0.0005, p = 0.03, respectively). Eosinophil count was significantly lower in patients with AMI (p = 0.022). NLR was significantly higher in AMI group in relation to patients with UA (p = 0.001). Significantly higher values of hsTnI and CK-MB were established in patients with AMI. NLR correlated significantly positive with the values of hsTnI, CK-MB, CRP, WBC and neutrophil count, and significantly negative with lymphocyte count. CONCLUSION: Average values of NLR were significantly higher in patients with AMI in relation to patients with UA, indicating the importance of this inflammatory marker in discrimination of clinical forms of ACS. A positive correlation was established between NLR and markers of myocardial necrosis, and between NLR and CRP, indicating the importance of NLR in the assessment of the extent of the myocardial lesion and in inflammation intensity assessment in ACS.