Absent Metabolic Transition from the Early to the Late Period in Non-Survivors Post Cardiac Surgery
Abstract
:1. Introduction
2. Methods and Materials
2.1. Ethical Approval
2.2. Study Design and Patients
2.3. Statistical Analysis
2.4. Data Availability
3. Results
3.1. Absent Metabolic Transition in Non-Survivors from the Early ‘Ebb Phase to the Late ‘Flow’ Phase
3.2. Increased SvO2 and Reduced CCO, VO2, REE, O2ER and DO2 Levels in Non-Survivors Compared with Survivors over the First Seven Days
3.3. Increased 30-Day, 1-Year and 6-Year Mortality in Patients with a Reduced REE
3.4. Univariate and Multivariate Cox Regression Analyses for 30 Days, 1 Year and 6 Years after Cardiac Surgery
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Conflicts of Interest
References
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Determinants | |
---|---|
CvO2 | =Hb × 1.37 × SvO2 + 0.003 × PvO2 |
CaO2 | =Hb × 1.37 × SaO2 + 0.003 × PaO2 |
DO2 | =CO × CaO2 × 10 |
VO2 | =CO × (CaO2 − CvO2) × 10 |
O2ER | =VO2/DO2 |
REE meas | =VO2 × 4.83 kcal/L × 1.44 |
REE pred | =20 kcal/kg/day |
Percent increase | =(REE meas − REE pred)/REE pred × 100 |
Demographic Data n | Total 566 | Survivors 517 | Non-Survivors 49 | p-Value |
---|---|---|---|---|
Gender | ||||
Male, n (%) | 422 (74) | 389 (75) | 33 (67) | |
Female, n (%) | 144 (25) | 128 (25) | 16 (33) | 0.266 |
Age, mean ± SD | 63 ± 12 | 63 ± 12 | 66 ± 9 | 0.118 |
BMI, mean ± SD | 26 ± 4 | 26 ± 4 | 26 ± 5 | 0.594 |
Surgical procedure | ||||
Valve procedure, n (%) | 156 (27) | 148 (28) | 8 (16) | |
CABG, n (%) | 68 (12) | 64 (12) | 4 (8) | |
CABG and valve, n (%) | 96 (17) | 89 (17) | 7 (14) | |
Vascular graft, n (%) | 15 (3) | 15 (3) | 0 (0) | |
LVAD, n (%) | 93 (16) | 76 (14) | 17 (34) | |
HTX, n (%) | 114 (20) | 105 (20) | 9 (18) | |
Others, n (%) | 24 (4) | 20 (4) | 4 (8) | <0.001 |
Perioperative data | ||||
Lactate max, mean ± SD | 3.9 ± 1.9 | 3.8 ± 1.7 | 5.2 ± 2.8 | <0.001 |
HB min, mean ± SD | 8.1 ± 1.3 | 8.2 ± 1.4 | 7.9 ± 1.1 | 0.071 |
PRBC count, mean ± SD | 3.8 ± 3.0 | 3.5 ± 2.8 | 5.9 ± 3.9 | <0.001 |
FFP count, mean ± SD | 1124 ± 878 | 5.5 ± 4.3 | 6.4 ± 3.7 | 0.313 |
Blood loss mL, mean ± SD | 494 ± 601 | 475 ± 586 | 786 ± 826 | 0.045 |
ECC min, mean ± SD | 177 ± 77 | 173 ± 73 | 232 ± 114 | 0.002 |
XCT min, mean ± SD | 104 ± 45 | 102 ± 43 | 131 ± 67 | 0.020 |
Cox Regression Analyses | |||||||
---|---|---|---|---|---|---|---|
Univariate Model | Multivariate Model | ||||||
HR | CI 95% | p-Value | HR | CI 95% | p-Value | ||
30-day all-cause mortality | |||||||
REE | >1640 kcal/d # | 1.0 | |||||
≤1640 kcal/d | 3.5 | 1.3–9.5 | 0.013 | 3.2 | 1.1–8.7 | 0.021 | |
Gender | Male # | 1.0 | |||||
Female | 1.6 | 0.7–4.0 | 0.235 | ||||
Age | <55 years # | 1.0 | |||||
55–65 years | 1.8 | 0.4–7.3 | 0.354 | ||||
66–75 years | 2.0 | 0.5–7.6 | 0.271 | ||||
>75 years | 1.4 | 0.2–7.1 | 0.652 | ||||
BMI | <25 kg/m2# | 1.0 | |||||
25–30 kg/m2 | 0.9 | 0.3–2.4 | 0.885 | ||||
>30 kg/m2 | 0.6 | 0.1–2.4 | 0.550 | ||||
Missing | 1.0 | 0.2–4.7 | 0.984 | ||||
ECC time | ≤170 min # | 1.0 | |||||
>170 min | 3.8 | 1.0–13.7 | 0.040 | 3.7 | 1.0–13.3 | 0.043 | |
Missing | 9.2 | 2.4–34.7 | 0.001 | 8.3 | 2.2–31.5 | 0.002 | |
Hb min | ≥8 g/dL # | 1.0 | |||||
<8 g/dL | 1.5 | 0.6–3.6 | 0.332 | ||||
Missing | 1.2 | 0.1–9.8 | 0.834 | ||||
Lac max | ≤3.6 mmol/L # | 1.0 | |||||
>3.6 mmol/L | 2.0 | 0.8–4.9 | 0.124 | ||||
PRBCs | ≤3 units | 1.0 | |||||
>3 units | 2.2 | 0.8–5.6 | 0.091 | ||||
Missing/no PRBCs | 0.5 | 0.1–1.9 | 0.334 | ||||
FFPs | ≤4 units # | 1.0 | |||||
>4 units | 3.6 | 0.7–17.8 | 0.103 | ||||
Missing/no FFPs | 1.1 | 0.2–4.8 | 0.895 | ||||
1-year all-cause mortality | |||||||
REE | >1640 kcal/d # | 1.0 | |||||
≤1640 kcal/d | 2.5 | 1.6–3.8 | <0.001 | 2.0 | 1.3–3.1 | 0.001 | |
Gender | Male # | 1.0 | |||||
Female | 1.4 | 0.9–2.1 | 0.103 | ||||
Age | <55 years # | 1.0 | |||||
55–65 years | 2.5 | 1.2–5.0 | 0.007 | 2.8 | 1.4–5.6 | 0.003 | |
66–75 years | 2.1 | 1.1–4.3 | 0.026 | 2.7 | 1.3–5.4 | 0.005 | |
>75 years | 2.9 | 1.4–6.1 | 0.003 | 3.1 | 1.4–6.6 | 0.003 | |
BMI | <25 kg/m2# | 1.0 | |||||
25–30 kg/m2 | 0.7 | 0.4–1.1 | 0.207 | ||||
>30 kg/m2 | 0.8 | 0.5–1.5 | 0.700 | ||||
Missing | 0.7 | 0.5–1.6 | 0.456 | ||||
ECC time | ≤170 min # | 1.0 | |||||
>170 min | 1.7 | 1.1–2.6 | 0.017 | 1.5 | 0.9–2.3 | 0.080 | |
Missing | 1.8 | 1.0–3.3 | 0.048 | 2.1 | 1.1–4.1 | 0.017 | |
Hb min | ≥8 g/dL # | 1.0 | |||||
<8 g/dL | 1.7 | 1.1–2.6 | 0.005 | 1.1 | 0.7–1.8 | 0.624 | |
Missing | 0.2 | 0.03–1.9 | 0.201 | 0.2 | 0.0–2.0 | 0.017 | |
Lac max | ≤3.6 mmol/L # | 1.0 | |||||
>3.6 mmol/L | 1.9 | 1.2–2.9 | 0.002 | 1.4 | 0.9–2.2 | 0.102 | |
PRBCs | ≤3 units | 1.0 | |||||
>3 units | 2.6 | 1.6–4.0 | <0.001 | 2.4 | 1.5–3.9 | <0.001 | |
Missing/no PRBCs | 0.5 | 0.2–1.0 | 0.063 | 0.7 | 0.3–1.3 | 0.298 | |
FFPs | ≤4 units # | 1.0 | |||||
>4 units | 1.7 | 0.9–3.4 | 0.099 | ||||
Missing/no FFPs | 0.7 | 0.4–1.2 | 0.280 | ||||
6-year all-cause mortality | |||||||
REE | >1640 kcal/d # | 1.0 | |||||
≤1640 kcal/d | 1.5 | 1.1–2.0 | 0.001 | 1.3 | 1.0–1.8 | 0.031 | |
Gender | Male # | 1.0 | |||||
Female | 1.0 | 0.7–1.4 | 0.649 | ||||
Age | <55 years # | ||||||
55–65 years | 1.7 | 1.1–2.6 | 0.014 | 1.9 | 1.2–2.9 | 0.003 | |
66–75 years | 2.0 | 1.3–3.1 | <0.001 | 2.4 | 1.6–3.7 | <0.001 | |
>75 years | 2.3 | 1.5–3.7 | <0.001 | 2.5 | 1.6–4.1 | <0.001 | |
BMI | <25 kg/m2# | 1.0 | |||||
25–30 kg/m2 | 0.7 | 0.5–0.9 | 0.040 | 0.7 | 0.5–1.0 | 0.067 | |
>30 kg/m2 | 1.0 | 0.7–1.5 | 0.687 | 1.3 | 0.9–1.9 | 0.113 | |
Missing | 0.6 | 0.3–1.1 | 0.174 | 0.7 | 0.4–1.2 | 0.742 | |
ECC time | ≤170 min # | 1.0 | |||||
>170 min | 1.0 | 0.7–1.3 | 0.857 | 2.1 | 1.5–2.8 | <0.001 | |
Missing | 1.8 | 1.2–2.6 | 0.001 | 0.8 | 0.5–1.1 | 0.297 | |
Hb min | ≥8 g/dL # | 1.0 | |||||
<8 g/dL | 1.3 | 1.0–1.8 | 0.014 | 0.9 | 0.7–1.2 | 0.792 | |
Missing | 0.7 | 0.3–1.5 | 0.377 | 0.5 | 0.2–1.2 | 0.142 | |
Lac max | ≤3.6 mmol/L # | 1.0 | |||||
>3.6 mmol/L | 1.2 | 0.9–1.6 | 0.116 | ||||
PRBCs | ≤3 units | 1.0 | |||||
>3 units | 1.8 | 1.3–2.5 | <0.001 | 2.1 | 1.5–2.8 | <0.001 | |
Missing/no PRBCs | 0.7 | 0.5–1.0 | 0.148 | 0.8 | 0.5–1.1 | 0.297 | |
FFPs | ≤4 units # | 1.0 | |||||
>4 units | 1.5 | 0.9–2.6 | 0.087 | ||||
Missing/no FFPs | 0.7 | 0.6–1.6 | 0.784 |
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Veraar, C.; Fischer, A.; Bernardi, M.H.; Sulz, I.; Mouhieddine, M.; Dworschak, M.; Tschernko, E.; Lassnigg, A.; Hiesmayr, M. Absent Metabolic Transition from the Early to the Late Period in Non-Survivors Post Cardiac Surgery. Nutrients 2022, 14, 3366. https://doi.org/10.3390/nu14163366
Veraar C, Fischer A, Bernardi MH, Sulz I, Mouhieddine M, Dworschak M, Tschernko E, Lassnigg A, Hiesmayr M. Absent Metabolic Transition from the Early to the Late Period in Non-Survivors Post Cardiac Surgery. Nutrients. 2022; 14(16):3366. https://doi.org/10.3390/nu14163366
Chicago/Turabian StyleVeraar, Cecilia, Arabella Fischer, Martin H. Bernardi, Isabella Sulz, Mohamed Mouhieddine, Martin Dworschak, Edda Tschernko, Andrea Lassnigg, and Michael Hiesmayr. 2022. "Absent Metabolic Transition from the Early to the Late Period in Non-Survivors Post Cardiac Surgery" Nutrients 14, no. 16: 3366. https://doi.org/10.3390/nu14163366