Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Original article / research
Year : 2017 | Month : September | Volume : 11 | Issue : 9 | Page : UC13 - UC16

Prediction of Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) after Thoracic Surgery- The Role of Estimated GFR

Shibani Padhy, Prachi kar, Gopinath Ramachandran

1. Assistant Professor, Department of Anaesthesiology, Nizams Institute of Mecial Sciences, Hyderabad, Telengana, India. 2. Assistant Professor, Department of Anaesthesiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India. 3. Professor, Department of Anaesthesiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India.

Correspondence Address :
Dr. Shibani Padhy,
Flat No. 307, Shreemukh Kontham Towers, Brahman wadi, Begunpet-500016, Hyderabad, Telengana, India.
E-mail: drshibanipadhy@gm ail.com

Abstract

Introducton: Little is known about the prognostic utility of preoperative estimated GFR (eGFR) on perioperative Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) in apparently lower risk patients undergoing moderate risk surgeries like thoracotomy.

Aim: The current study sought to identify a clinically relevant cut-off value of eGFR for identifying thoracotomy patients at higher risk for MACCE.

Materials and Methods: Between July 2012 and July 2016, 436 consecutive patients were retrospectively studied after elective thoracotomy in a single institution. Patients were classified into six groups according to the calculated Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPI) eGFR (ml min -11.73 m -2): Stage 1, eGFR >90; Stage 2, eGFR=6089.9; Stage 3a, eGFR=4559.9; Stage 3b, eGFR=3044.9; Stage 4, eGFR=1529.9; Stage 5, eGFR <15. All the eGFR groups were analysed for perioperative MACCE, length of hospital stay, and mortality.

Results: The incidence of perioperative MACCE in our study was 4.24%. The mean eGFR in our study as calculated by the CKD-EPI equation was 83 ml min-11.73 m-2. With the exception of nonfatal cardiac arrest which was not seen in any patient, the incidence of all MACCE increased with progressively worsening preoperative eGFR. It was seen by logistic regression analysis that the occurrence of any perioperative MACCE increased significantly with worsening eGFR (p<0.001). The increase in MACCE was particularly marked from Stage 3b onwards to the later stages (OR 1.9 in 3a vs. 3.6 in 3b). The two mortalities observed in the study were in Stages 4 and 5 with no deaths seen in the better eGFR subgroups. There was also an increased length of hospital stay with declining eGFR.

Conclusion: Preoperative eGFR is a predictor of perioperative MACCE in homogenous moderate risk elective surgical population like thoracic surgeries. There is an inverse relationship between eGFR and MACCE, particularly manifested at eGFR values <45 ml/min/1.73. Routine use of preoperative eGFR for cardiovascular and cerebrovascular risk assessment in patients undergoing moderate risk surgeries like thoracotomy would be beneficial.

Keywords

Cardiovascular, Cerebrovascular risk, Estimated glomerular filtration rate, Thoracotomy

How to cite this article :

Shibani Padhy, Prachi kar, Gopinath Ramachandran. PREDICTION OF MAJOR ADVERSE CARDIOVASCULAR AND CEREBROVASCULAR EVENTS (MACCE) AFTER THORACIC SURGERY- THE ROLE OF ESTIMATED GFR. Journal of Clinical and Diagnostic Research [serial online] 2017 September [cited: 2018 Jan 19 ]; 11:UC13-UC16. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2017&month=September&volume=11&issue=9&page=UC13-UC16&id=10616

DOI and Others

DOI: 10.7860/JCDR/2017/27428.10616

Date of Submission: Feb 14, 2017
Date of Peer Review: Apr 06, 2017
Date of Acceptance: Jun 22, 2017
Date of Publishing: Sep 01, 2017

FINANCIAL OR OTHER COMPETING INTERESTS: None.

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