The relationship between renal function and outcome from heart valve surgery
Background The prognostic importance of renal function in patients undergoing surgery for valvular heart disease is poorly defined. The current study addresses this issue. Methods Baseline demographic and clinical variables, including the European system for cardiac operative risk evaluation (EuroSC...
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| Veröffentlicht in: | The American heart journal 2008-11, Vol.156 (5), p.893-899 |
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| creator | Gibson, Patrick H., BM BCh Croal, Bernard L., MBChB, MD Cuthbertson, Brian H., MBChB, MD Chiwara, Mildred, MBChB Scott, Anne E., MBChB Buchan, Keith G., MBChB El-Shafei, Hussein, MBChB, MD Gibson, George, MBChB Jeffrey, Robert R., MBChB Hillis, Graham S., MBChB, PhD |
| description | Background The prognostic importance of renal function in patients undergoing surgery for valvular heart disease is poorly defined. The current study addresses this issue. Methods Baseline demographic and clinical variables, including the European system for cardiac operative risk evaluation (EuroSCORE), were recorded prospectively from 514 consecutive patients undergoing heart valve surgery between April 2000 and March 2004. Patients with active infective endocarditis and/or requiring emergency surgery were excluded. The glomerular filtration rate was estimated (eGFR) using the Modification of Diet in Renal Disease equation. The primary outcome was all-cause mortality. Results During a median follow-up of 2 years, 87 patients died. In univariable analysis, both eGFR (hazard ratio [HR] 0.69 per 10 mL/min per 1.73 m2 , P < .001) and creatinine (HR 1.04 per 10 μmol/L, P < .001) predicted mortality. Estimated GFR was a stronger predictor and was used in subsequent multivariable models. It remained a powerful independent predictor of death in a multivariable model including all study variables (HR 0.70 per 10 mL/min per 1.73 m2 increase, P < .001) and in a model including EuroSCORE (HR 0.64 per 10 mL/min per 1.73 m2 increase, P < .001). After correction for preoperative EuroSCORE, an eGFR of |
| doi_str_mv | 10.1016/j.ahj.2008.06.043 |
| format | Article |
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The current study addresses this issue. Methods Baseline demographic and clinical variables, including the European system for cardiac operative risk evaluation (EuroSCORE), were recorded prospectively from 514 consecutive patients undergoing heart valve surgery between April 2000 and March 2004. Patients with active infective endocarditis and/or requiring emergency surgery were excluded. The glomerular filtration rate was estimated (eGFR) using the Modification of Diet in Renal Disease equation. The primary outcome was all-cause mortality. Results During a median follow-up of 2 years, 87 patients died. In univariable analysis, both eGFR (hazard ratio [HR] 0.69 per 10 mL/min per 1.73 m2 , P < .001) and creatinine (HR 1.04 per 10 μmol/L, P < .001) predicted mortality. Estimated GFR was a stronger predictor and was used in subsequent multivariable models. It remained a powerful independent predictor of death in a multivariable model including all study variables (HR 0.70 per 10 mL/min per 1.73 m2 increase, P < .001) and in a model including EuroSCORE (HR 0.64 per 10 mL/min per 1.73 m2 increase, P < .001). After correction for preoperative EuroSCORE, an eGFR of <60 mL/min per 1.73 m2 was associated with an excess hazard of death of 2.31 ( P = .001). Conclusion Renal function, particularly the eGFR, is a powerful predictor of outcome in patients undergoing heart valve surgery. This prognostic utility is independent of other recognized risk factors and the EuroSCORE.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2008.06.043</identifier><identifier>PMID: 19061703</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Aged ; Biological and medical sciences ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Coronary vessels ; Female ; Glomerular Filtration Rate ; Heart attacks ; Heart Valve Diseases - mortality ; Heart Valve Diseases - surgery ; Humans ; Kidney - physiology ; Male ; Medical sciences ; Middle Aged ; Mortality ; Multivariate Analysis ; Prognosis</subject><ispartof>The American heart journal, 2008-11, Vol.156 (5), p.893-899</ispartof><rights>Mosby, Inc.</rights><rights>2008 Mosby, Inc.</rights><rights>2008 INIST-CNRS</rights><rights>Copyright Elsevier Limited Nov 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c530t-92afa3469a3beeb0bfbf46c2e76498d8093bff75585b2bd6939cba8e619814473</citedby><cites>FETCH-LOGICAL-c530t-92afa3469a3beeb0bfbf46c2e76498d8093bff75585b2bd6939cba8e619814473</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002870308006285$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20833443$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19061703$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gibson, Patrick H., BM BCh</creatorcontrib><creatorcontrib>Croal, Bernard L., MBChB, MD</creatorcontrib><creatorcontrib>Cuthbertson, Brian H., MBChB, MD</creatorcontrib><creatorcontrib>Chiwara, Mildred, MBChB</creatorcontrib><creatorcontrib>Scott, Anne E., MBChB</creatorcontrib><creatorcontrib>Buchan, Keith G., MBChB</creatorcontrib><creatorcontrib>El-Shafei, Hussein, MBChB, MD</creatorcontrib><creatorcontrib>Gibson, George, MBChB</creatorcontrib><creatorcontrib>Jeffrey, Robert R., MBChB</creatorcontrib><creatorcontrib>Hillis, Graham S., MBChB, PhD</creatorcontrib><title>The relationship between renal function and outcome from heart valve surgery</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Background The prognostic importance of renal function in patients undergoing surgery for valvular heart disease is poorly defined. The current study addresses this issue. Methods Baseline demographic and clinical variables, including the European system for cardiac operative risk evaluation (EuroSCORE), were recorded prospectively from 514 consecutive patients undergoing heart valve surgery between April 2000 and March 2004. Patients with active infective endocarditis and/or requiring emergency surgery were excluded. The glomerular filtration rate was estimated (eGFR) using the Modification of Diet in Renal Disease equation. The primary outcome was all-cause mortality. Results During a median follow-up of 2 years, 87 patients died. In univariable analysis, both eGFR (hazard ratio [HR] 0.69 per 10 mL/min per 1.73 m2 , P < .001) and creatinine (HR 1.04 per 10 μmol/L, P < .001) predicted mortality. Estimated GFR was a stronger predictor and was used in subsequent multivariable models. It remained a powerful independent predictor of death in a multivariable model including all study variables (HR 0.70 per 10 mL/min per 1.73 m2 increase, P < .001) and in a model including EuroSCORE (HR 0.64 per 10 mL/min per 1.73 m2 increase, P < .001). After correction for preoperative EuroSCORE, an eGFR of <60 mL/min per 1.73 m2 was associated with an excess hazard of death of 2.31 ( P = .001). Conclusion Renal function, particularly the eGFR, is a powerful predictor of outcome in patients undergoing heart valve surgery. This prognostic utility is independent of other recognized risk factors and the EuroSCORE.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Coronary vessels</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Heart attacks</subject><subject>Heart Valve Diseases - mortality</subject><subject>Heart Valve Diseases - surgery</subject><subject>Humans</subject><subject>Kidney - physiology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Prognosis</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kt2L1DAQwIMo3rr6B_giBdG31knTpgnCgRx-wYIPns8hSSduaj_WpF3Z_970dvHgHsxLyOQ3k8yPIeQlhYIC5e-6Qu-7ogQQBfACKvaIbCjIJudNVT0mGwAoc9EAuyLPYuzSkZeCPyVXVAKnKb4hu9s9ZgF7PftpjHt_yAzOfxDHFBx1n7lltOtVpsc2m5bZTgNmLkxDtkcd5uyo-yNmcQk_MZyekydO9xFfXPYt-fHp4-3Nl3z37fPXmw-73NYM5lyW2mlWcamZQTRgnHEVtyU2vJKiFSCZca6pa1Gb0rRcMmmNFsipFLSqGrYlb891D2H6vWCc1eCjxb7XI05LVFyuTae1Ja8fgN20hNRXVLSGqpbAap4oeqZsmGIM6NQh-EGHk6KgVtGqU0m0WkUr4CqJTjmvLpUXM2B7n3Exm4A3F0BHq3sX9Gh9_MeVIBir7gq9P3OYhB09BhWtx9Fi6wPaWbWT_-83rh9k296PPj34C08Y77tVsVSgvq8TsboBcTcLNfsLlLyvJw</recordid><startdate>20081101</startdate><enddate>20081101</enddate><creator>Gibson, Patrick H., BM BCh</creator><creator>Croal, Bernard L., MBChB, MD</creator><creator>Cuthbertson, Brian H., MBChB, MD</creator><creator>Chiwara, Mildred, MBChB</creator><creator>Scott, Anne E., MBChB</creator><creator>Buchan, Keith G., MBChB</creator><creator>El-Shafei, Hussein, MBChB, MD</creator><creator>Gibson, George, MBChB</creator><creator>Jeffrey, Robert R., MBChB</creator><creator>Hillis, Graham S., MBChB, PhD</creator><general>Mosby, Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20081101</creationdate><title>The relationship between renal function and outcome from heart valve surgery</title><author>Gibson, Patrick H., BM BCh ; Croal, Bernard L., MBChB, MD ; Cuthbertson, Brian H., MBChB, MD ; Chiwara, Mildred, MBChB ; Scott, Anne E., MBChB ; Buchan, Keith G., MBChB ; El-Shafei, Hussein, MBChB, MD ; Gibson, George, MBChB ; Jeffrey, Robert R., MBChB ; Hillis, Graham S., MBChB, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c530t-92afa3469a3beeb0bfbf46c2e76498d8093bff75585b2bd6939cba8e619814473</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Coronary vessels</topic><topic>Female</topic><topic>Glomerular Filtration Rate</topic><topic>Heart attacks</topic><topic>Heart Valve Diseases - mortality</topic><topic>Heart Valve Diseases - surgery</topic><topic>Humans</topic><topic>Kidney - physiology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Prognosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gibson, Patrick H., BM BCh</creatorcontrib><creatorcontrib>Croal, Bernard L., MBChB, MD</creatorcontrib><creatorcontrib>Cuthbertson, Brian H., MBChB, MD</creatorcontrib><creatorcontrib>Chiwara, Mildred, MBChB</creatorcontrib><creatorcontrib>Scott, Anne E., MBChB</creatorcontrib><creatorcontrib>Buchan, Keith G., MBChB</creatorcontrib><creatorcontrib>El-Shafei, Hussein, MBChB, MD</creatorcontrib><creatorcontrib>Gibson, George, MBChB</creatorcontrib><creatorcontrib>Jeffrey, Robert R., MBChB</creatorcontrib><creatorcontrib>Hillis, Graham S., MBChB, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health Medical collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>ProQuest research library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gibson, Patrick H., BM BCh</au><au>Croal, Bernard L., MBChB, MD</au><au>Cuthbertson, Brian H., MBChB, MD</au><au>Chiwara, Mildred, MBChB</au><au>Scott, Anne E., MBChB</au><au>Buchan, Keith G., MBChB</au><au>El-Shafei, Hussein, MBChB, MD</au><au>Gibson, George, MBChB</au><au>Jeffrey, Robert R., MBChB</au><au>Hillis, Graham S., MBChB, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The relationship between renal function and outcome from heart valve surgery</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2008-11-01</date><risdate>2008</risdate><volume>156</volume><issue>5</issue><spage>893</spage><epage>899</epage><pages>893-899</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Background The prognostic importance of renal function in patients undergoing surgery for valvular heart disease is poorly defined. The current study addresses this issue. Methods Baseline demographic and clinical variables, including the European system for cardiac operative risk evaluation (EuroSCORE), were recorded prospectively from 514 consecutive patients undergoing heart valve surgery between April 2000 and March 2004. Patients with active infective endocarditis and/or requiring emergency surgery were excluded. The glomerular filtration rate was estimated (eGFR) using the Modification of Diet in Renal Disease equation. The primary outcome was all-cause mortality. Results During a median follow-up of 2 years, 87 patients died. In univariable analysis, both eGFR (hazard ratio [HR] 0.69 per 10 mL/min per 1.73 m2 , P < .001) and creatinine (HR 1.04 per 10 μmol/L, P < .001) predicted mortality. Estimated GFR was a stronger predictor and was used in subsequent multivariable models. It remained a powerful independent predictor of death in a multivariable model including all study variables (HR 0.70 per 10 mL/min per 1.73 m2 increase, P < .001) and in a model including EuroSCORE (HR 0.64 per 10 mL/min per 1.73 m2 increase, P < .001). After correction for preoperative EuroSCORE, an eGFR of <60 mL/min per 1.73 m2 was associated with an excess hazard of death of 2.31 ( P = .001). Conclusion Renal function, particularly the eGFR, is a powerful predictor of outcome in patients undergoing heart valve surgery. This prognostic utility is independent of other recognized risk factors and the EuroSCORE.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>19061703</pmid><doi>10.1016/j.ahj.2008.06.043</doi><tpages>7</tpages></addata></record> |
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| ispartof | The American heart journal, 2008-11, Vol.156 (5), p.893-899 |
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| subjects | Aged Biological and medical sciences Cardiology Cardiology. Vascular system Cardiovascular Coronary vessels Female Glomerular Filtration Rate Heart attacks Heart Valve Diseases - mortality Heart Valve Diseases - surgery Humans Kidney - physiology Male Medical sciences Middle Aged Mortality Multivariate Analysis Prognosis |
| title | The relationship between renal function and outcome from heart valve surgery |
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