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Predictors of peri-operative cardiac events and development of a scoring tool for patients with chronic kidney disease undergoing non-cardiac surgeries: A prospective observational multicentre study
BACKGROUND AND AIMS: Cardiovascular diseases are the leading causes of morbidity and mortality in chronic kidney disease (CKD) patients. Our aim was to derive predictors of cardiac morbidity, mortality, cardiac complications and to develop/validate a scoring tool in patients with CKD undergoing non-...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9159394/ https://www.ncbi.nlm.nih.gov/pubmed/35663210 http://dx.doi.org/10.4103/ija.ija_1031_21 |
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author | Deo, Alka Sachin Kashyapi, Rijuta Joshi, Veena Balakundi, Parimala Raman, Padmalatha |
author_facet | Deo, Alka Sachin Kashyapi, Rijuta Joshi, Veena Balakundi, Parimala Raman, Padmalatha |
author_sort | Deo, Alka Sachin |
collection | PubMed |
description | BACKGROUND AND AIMS: Cardiovascular diseases are the leading causes of morbidity and mortality in chronic kidney disease (CKD) patients. Our aim was to derive predictors of cardiac morbidity, mortality, cardiac complications and to develop/validate a scoring tool in patients with CKD undergoing non-cardiac surgery. METHODS: A prospective observational multicentre study was done on 770 patients with CKD. The primary outcome (“Event”) was one or more than one of sudden cardiac death, pulmonary oedema, acute coronary syndrome, arrhythmia and 30-day mortality. Secondary outcome was hypertension and hypotension. Predictors of cardiac risk were identified. A scoring tool was developed on the 2018 dataset and was validated on the 2019 dataset. RESULTS: The overall incidence of cardiac events was 290 (37.66%) whereas the incidence of major adverse cardiac and cerebrovascular events was 15.04%. Mortality due to cardiac cause was 13 (1.68%). On multivariate regression analysis, seven perioperative variables had significant association with increased risk of events: age > 65 years (P = 0.004), metabolic equivalents (METS) ≤4 (P≤0.032), emergency surgery (P =0.032), mean arterial pressure >119 (P = 0.001), echocardiographic scoring (P = 0.054), type of anaesthesia (P ≤ 0.0001) and type of surgery (P = 0.056). Using these variables, a risk stratification tool was developed. C statistics showed favourable predictive accuracy (0.714) and the model showed good calibration. CONCLUSION: This risk scoring tool based on preoperative variables will help to predict the risk of events in high-risk CKD patients undergoing non-cardiac surgery. This will help in better counselling and optimisation. |
format | Online Article Text |
id | pubmed-9159394 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-91593942022-06-02 Predictors of peri-operative cardiac events and development of a scoring tool for patients with chronic kidney disease undergoing non-cardiac surgeries: A prospective observational multicentre study Deo, Alka Sachin Kashyapi, Rijuta Joshi, Veena Balakundi, Parimala Raman, Padmalatha Indian J Anaesth Original Article BACKGROUND AND AIMS: Cardiovascular diseases are the leading causes of morbidity and mortality in chronic kidney disease (CKD) patients. Our aim was to derive predictors of cardiac morbidity, mortality, cardiac complications and to develop/validate a scoring tool in patients with CKD undergoing non-cardiac surgery. METHODS: A prospective observational multicentre study was done on 770 patients with CKD. The primary outcome (“Event”) was one or more than one of sudden cardiac death, pulmonary oedema, acute coronary syndrome, arrhythmia and 30-day mortality. Secondary outcome was hypertension and hypotension. Predictors of cardiac risk were identified. A scoring tool was developed on the 2018 dataset and was validated on the 2019 dataset. RESULTS: The overall incidence of cardiac events was 290 (37.66%) whereas the incidence of major adverse cardiac and cerebrovascular events was 15.04%. Mortality due to cardiac cause was 13 (1.68%). On multivariate regression analysis, seven perioperative variables had significant association with increased risk of events: age > 65 years (P = 0.004), metabolic equivalents (METS) ≤4 (P≤0.032), emergency surgery (P =0.032), mean arterial pressure >119 (P = 0.001), echocardiographic scoring (P = 0.054), type of anaesthesia (P ≤ 0.0001) and type of surgery (P = 0.056). Using these variables, a risk stratification tool was developed. C statistics showed favourable predictive accuracy (0.714) and the model showed good calibration. CONCLUSION: This risk scoring tool based on preoperative variables will help to predict the risk of events in high-risk CKD patients undergoing non-cardiac surgery. This will help in better counselling and optimisation. Wolters Kluwer - Medknow 2022-04 2022-04-20 /pmc/articles/PMC9159394/ /pubmed/35663210 http://dx.doi.org/10.4103/ija.ija_1031_21 Text en Copyright: © 2022 Indian Journal of Anaesthesia https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Deo, Alka Sachin Kashyapi, Rijuta Joshi, Veena Balakundi, Parimala Raman, Padmalatha Predictors of peri-operative cardiac events and development of a scoring tool for patients with chronic kidney disease undergoing non-cardiac surgeries: A prospective observational multicentre study |
title | Predictors of peri-operative cardiac events and development of a scoring tool for patients with chronic kidney disease undergoing non-cardiac surgeries: A prospective observational multicentre study |
title_full | Predictors of peri-operative cardiac events and development of a scoring tool for patients with chronic kidney disease undergoing non-cardiac surgeries: A prospective observational multicentre study |
title_fullStr | Predictors of peri-operative cardiac events and development of a scoring tool for patients with chronic kidney disease undergoing non-cardiac surgeries: A prospective observational multicentre study |
title_full_unstemmed | Predictors of peri-operative cardiac events and development of a scoring tool for patients with chronic kidney disease undergoing non-cardiac surgeries: A prospective observational multicentre study |
title_short | Predictors of peri-operative cardiac events and development of a scoring tool for patients with chronic kidney disease undergoing non-cardiac surgeries: A prospective observational multicentre study |
title_sort | predictors of peri-operative cardiac events and development of a scoring tool for patients with chronic kidney disease undergoing non-cardiac surgeries: a prospective observational multicentre study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9159394/ https://www.ncbi.nlm.nih.gov/pubmed/35663210 http://dx.doi.org/10.4103/ija.ija_1031_21 |
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