Background
Methods
Study design and settings
Patient management, sample collection and biomarker assays
Statistical analysis
Results
Variable | Control (n = 620) | MIRCS (n = 172) | P value |
---|---|---|---|
Age (year) | 61.25 ± 13.16 | 60.45 ± 8.94 | 0.45 |
Gender (male) | 282,45.48% | 85,49.42% | 0.39 |
Weight (kg) | 64.72 ± 11.82 | 66.04 ± 14.23 | 0.22 |
Preoperative LVEF (%) | 49.96 ± 10.60 | 50.45 ± 12.94 | 0.62 |
Preoperative LVDd (cm) | 5.78 ± 0.85 | 5.79 ± 1.17 | 0.91 |
Preoperative cTnT (ug/L) | 0.02 ± 0.02 | 0.02 ± 0.02 | 0.39 |
EuroSCORE | 4.82 ± 3.45 | 4.39 ± 3.29 | 0.13 |
Previous medical history | |||
Myocardial infarction | 3, 0.48% | 0 | 0.36 |
Diabetes Mellitus (n,%) | 45,7.26% | 20,11.63% | 0.07 |
Hypertension (n,%) | 336,54.19% | 79, 45.93% | 0.02 |
Chronic Renal Failure (n,%) | 0 | 3,1.74% | 0.02 |
Liver diseases (n,%) | 51, 8.23% | 13,7.56% | 0.75 |
Previous cardiac operation (n,%) | 34,5.48% | 6, 3.49% | 0.27 |
Immunological diseases (n,%) | 6, 0.97% | 0 | 0.19 |
Atrial fibrillation (n,%) | 334, 53.87% | 68, 39.53% | < 0.01 |
Peripheral vascular diseases (n,%) | 13, 2.10% | 0 | 0.05 |
Blood products transfusion (n,%) | 0 | 0 | – |
Heavily smoking (n,%) | 72,11.61% | 0 | < 0.01 |
Excessive alcohol (n,%) | 24, 3.87% | 3,1.74% | 0.24 |
Type of cardiac surgery (n,%) | 0.02 | ||
AVR | 21,3.39% | 0 | |
MVR | 340, 54.84% | 82, 47.67% | |
AVR + MVR | 202, 32.58% | 69, 40.12% | |
Aortic operation + AVR | 57, 9.19% | 21, 12.21% | |
Intraoperative AF ablation (n,%) | 306, 49.35% | 66, 38.37% | 0.01 |
CPB time (minutes) | 161.13 ± 74.83 | 169.86 ± 51.57 | 0.08 |
ACC time (minutes) | 119.84 ± 65.42 | 127.51 ± 46.44 | 0.09 |
Variable | Control (n = 620) | MIRCS (n = 172) | P value |
---|---|---|---|
Adverse complications | |||
Death (n, %) | 0 | 10, 5.81% | < 0.01 |
ECMO use (n, %) | 0 | 12, 6.98% | < 0.01 |
CRRT use (n, %) | 95, 15.32% | 95, 55.23% | < 0.01 |
Ventricular arrhythmias (n, %) | 47, 7.58% | 44, 25.58% | < 0.01 |
VIS > 40 more than 4 h (n, %) | 149, 24.03% | 172, 100% | < 0.01 |
Other outcomes | |||
Pneumonia (n, %) | 8, 1.29% | 45, 26.16% | < 0.01 |
Sepsis (n, %) | 0 | 5, 2.91% | < 0.01 |
Re-intubation (n, %) | 8, 1.29% | 20, 11.63% | < 0.01 |
Re-operation (n, %) | 8, 1.29% | 14, 8.14% | < 0.01 |
MV time (hour) | 9 (5, 16) | 70 (65, 82) | < 0.01 |
Length of ICU stay (day) | 3(2, 7) | 19 (18, 23) | < 0.01 |
Variables | Control (n = 620) | MIRCS (n = 172) | P Value |
---|---|---|---|
HBP before aortic cross-clamping | |||
HBPCS1 (ng/ml) | 56.21 ± 33.56 | 56.94 ± 26.37 | 0.79 |
HBPCPB1 (ng/ml) | 40.65 ± 25.95 | 42.53 ± 28.97 | 0.41 |
HBP after aortic declamping (5 min) | |||
HBPCS2 (ng/ml) | 163.13 ± 70.30 | 266.58 ± 114.24 | < 0.01 |
HBPCPB2 (ng/ml) | 151.97 ± 75.69 | 193.52 ± 69.50 | < 0.01 |
Related variables | |||
HBPCS1 - HBPCPB1 (ng/ml) | 10.02(5.10, 22.01) | 7.01(0, 25.02) | 0.52 |
HBPCS2 - HBPCPB2 (ng/ml) | 11.01(−2.00, 22.50) | 53.01(2.62, 84.75) | < 0.01 |
(HBPCS2 - HBPCS1) / HBPCS1 (%) | 2.15(1.37, 3.23) | 3.50(2.62, 5.39) | < 0.01 |
(HBPCPB2 - HBPCPB1) / HBPCPB1 (%) | 3.03(1.91, 4.78) | 4.36(2.18, 9.94) | < 0.01 |
HPB(CS-CPB) ratio (%) | −0.14(−1.09, 1.22) | 0.95(−0.59, 7.54) | < 0.01 |
CI wean from CPB (L/min·m2) | 3.16 ± 0.44 | 1.85 ± 0.26 | < 0.01 |
VIS wean from CPB | 25.42 ± 15.97 | 51.02 ± 12.85 | < 0.01 |
Lactate wean from CPB (mmol/L) | 2.10(1.40, 2.50) | 5.20 (5.10, 6.20) | < 0.01 |
cTnTCS2 (ug/L) | 1.19(0.98, 1.75) | 2.05(1.30, 2.76) | < 0.01 |
Peripheral arterial cTnT (ug/L) | |||
5 min after aortic declamping | 0.52(0.19, 0.81) | 0.82 (0.51, 1.50) | < 0.01 |
At the end of surgery (T0) | 0.53(0.20, 0.83) | 0.93 (0.55, 1.29) | < 0.01 |
At the 3rd hour after surgery (T3) | 0.71(0.39, 0.96) | 0.98 (0.98, 1.30) | < 0.01 |
At the 24th hour after surgery (T24) | 0.68(0.56, 0.97) | 1.17 (0.91, 1.61) | < 0.01 |
At the 48th hour after surgery (T48) | 0.61 (0.47, 0.73) | 1.28 (1.11, 1.63) | < 0.01 |
At the 72nd hour after surgery (T72) | 0.51 (0.42, 0.75) | 1.11 (0.92, 1.37) | < 0.01 |
Peripheral arterial HBP (ng/ml) | |||
At T0 | 125.22 ± 28.17 | 135.87 ± 32.67 | < 0.01 |
At T3 | 112.11 ± 31.25 | 120.35 ± 25.35 | 0.03 |
At T24 | 91.17 ± 22.17 | 119.82 ± 40.87 | < 0.01 |
At T48 | 84.04 ± 34.61 | 116.06 ± 35.25 | < 0.01 |
Receiver operator characteristic curves and multivariate logistic regression analysis
Variables | AUC | 95%CI | Cut-off value | Sensitivity | Specificity |
---|---|---|---|---|---|
HBPCS2 | 0.85 | 0.81–0.89 | 220 | 0.92 | 0.70 |
HBPCPB2 | 0.71 | 0.64–0.77 | 140 | 0.88 | 0.46 |
HBPCS2 - HBPCPB2 | 0.85 | 0.81–0.90 | 30 | 0.71 | 0.99 |
(HBPCS2 - HBPCS1) / HBPCS1 | 0.75 | 0.69–0.81 | 3.38 | 0.65 | 0.81 |
(HBPCPB2 - HBPCPB1) / HBPCPB1 | 0.65 | 0.58–0.71 | 6.54 | 0.39 | 0.96 |
HPB(CS-CPB) ratio | 0.62 | 0.55–0.69 | 6.67 | 0.28 | 0.99 |
Peripheral arterial HBP at T0 | 0.64 | 0.59–0.68 | 114 | 0.85 | 0.44 |
Peripheral arterial HBP at T3 | 0.63 | 0.58–0.68 | 108 | 0.68 | 0.59 |
Peripheral arterial HBP at T24 | 0.71 | 0.67–0.75 | 87 | 0.84 | 0.53 |
Peripheral arterial HBP at T48 | 0.78 | 0.75–0.82 | 76 | 0.95 | 0.58 |
cTnTCS2 | 0.76 | 0.70–0.82 | 1.71 | 0.65 | 0.82 |
Peripheral arterial cTnT | |||||
At 5 min after aortic declamping | 0.70 | 0.64–0.77 | 0.42 | 0.92 | 0.41 |
At the end of surgery (T0) | 0.75 | 0.69–0.81 | 0.78 | 0.64 | 0.70 |
At the 3rd hour after surgery (T3) | 0.75 | 0.68–0.81 | 0.77 | 0.79 | 0.62 |
At the 24th hour after surgery (T24) | 0.88 | 0.84–0.93 | 0.85 | 0.92 | 0.70 |
At the 48th hour after surgery (T48) | 0.99 | 0.97–1.00 | 0.92 | 0.99 | 0.95 |
At the 72nd hour after surgery (T72) | 0.96 | 0.94–0.98 | 0.76 | 0.99 | 0.82 |
Cardiac index wean from CPB | 0.99 | 0.99–1.00 | 2.20 | 1.00 | 0.99 |
VIS wean from CPB | 0.93 | 0.89–0.97 | 40 | 0.99 | 0.88 |
Lactate wean from CPB | 0.92 | 0.88–0.97 | 4.45 | 0.99 | 0.92 |
Variables | Odds ratio | 95% CI | P value |
---|---|---|---|
HBPCS2 > 220 ng/ml | 7.65 | 4.86–12.06 | < 0.01 |
Peripheral arterial HBP | |||
At the end of surgery (T0) > 114 ng/ml | 1.50 | 0.93–2.42 | 0.10 |
At the 3rd hour after surgery (T3) > 108 ng/ml | 1.23 | 0.79–1.92 | 0.35 |
At the 24th hour after surgery(T24) > 87 ng/ml | 1.84 | 1.12–3.02 | 0.02 |
At the 48th hour after surgery(T48) > 76 ng/ml | 1.54 | 1.00–2.37 | 0.05* |
Previous Medical History | |||
Diabetes Mellitus | 0.93 | 0.29–3.00 | 0.90 |
Hypertension | 0.90 | 0.57–1.43 | 0.66 |
Atrial fibrillation | 0.89 | 0.54–1.49 | 0.67 |
Preoperative LVEF | 0.99 | 0.97–1.01 | 0.39 |
EuroSCORE | 0.96 | 0.85–1.07 | 0.44 |
Intraoperative AF ablation | 0.93 | 0.56–1.54 | 0.77 |
Type of cardiac surgery | |||
AVR | Reference | ||
MVR | 0.88 | 0.46–1.71 | 0.71 |
AVR + MVR | 1.81 | 0.83–3.94 | 0.14 |
Aortic operation + AVR | 1.87 | 0.71–4.91 | 0.20 |
CPB time | 0.99 | 0.99–1.00 | 0.37 |