The Investigation of the Causes of Hepatic Dysfunction in the Postoperative Period During Open-heart Surgeries
Ключови думи
Резюме
Описание
There are a series of pathophysiological changes in patients undergoing open-heart surgeries with cardiopulmonary bypass (CPB) that causes liver hypoperfusion, centrilobular sinusoid ischemia, and subsequent reperfusion injuries, hemolysis, or systemic inflammatory response. These events may eventually lead to various forms of hepatic dysfunction in patients during the postoperative period after open-heart surgeries. An increased incidence of liver function test abnormalities were reported, and the rates vary between 10 % and 40%. The occurrence of postoperative hyperbilirubinemia is crucial in increased morbidity and mortality after open-heart surgery with CPB. There are several reports of the possible risk factors that are associated with hepatic dysfunction. In previous studies, the incidence of postoperative hyperbilirubinemia was between the range of 20% up to 51% in open-heart surgeries with CPB. The causes of this higher incidence were related to the presence of various possible risk factors, and these include; valvular heart disease and related low cardiac output states, and low ejection fraction. Other important risk factors for postoperative hepatic dysfunction after open-heart surgery with CPB were longer operative time and a larger volume of blood transfusion. However, CPB itself is not a significant constituent in the postoperative development of hyperbilirubinemia. Splanchnic ischemia before or during operation and in the postoperative period appears to be an essential cause. Other risk factors that were identified as possible risk factors for postoperative hepatic dysfunction. We can list these factors as; poor preoperative heart function, hemodynamic instability, emergency surgery, and preoperative liver dysfunction. Our goal was to determine the possible risk factors associated with hepatic dysfunction in patients undergoing open-heart surgery with CPB.
Дати
| Последна проверка: | 01/31/2020 |
| Първо изпратено: | 02/10/2020 |
| Очаквано записване подадено: | 02/12/2020 |
| Първо публикувано: | 02/16/2020 |
| Изпратена последна актуализация: | 02/17/2020 |
| Последна актуализация публикувана: | 02/19/2020 |
| Действителна начална дата на проучването: | 12/31/2011 |
| Приблизителна дата на първично завършване: | 06/30/2012 |
| Очаквана дата на завършване на проучването: | 08/31/2012 |
Състояние или заболяване
Интервенция / лечение
Procedure: Open-heart surgery
Other: Open-heart surgery
Other: Open-heart surgery
Фаза
Групи за ръце
| Arm | Интервенция / лечение |
|---|---|
| Open-heart surgery Patients undergoing open-heart surgery with cardiopulmonary bypass | Procedure: Open-heart surgery In a single group of patients including 340 patients undergoing open-heart surgery during a period of nine months, the collected parameters include; alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), total bilirubin (TBIL), and gamma-glutamyl transpeptidase (GGT) and albumin preoperatively and on postoperative days of 1, 3 and 7. All patients were divided into two groups as with or without hyperbilirubinemia, and this was defined by the occurrence of a plasma total bilirubin concentration of more than 34 µmol/L (2 mg/dL) in any measurement during the postoperative period. For each diagnostic test, a comparison within the group for different time points was statistically evaluated by analysis of variance tests. |
Критерии за допустимост
| Възрасти, отговарящи на условията за проучване | 19 Years Да се 19 Years |
| Полове, допустими за проучване | All |
| Метод за вземане на проби | Probability Sample |
| Приема здрави доброволци | Да |
| Критерии | Inclusion Criteria: - Patients undergoing open-heart surgery with CPB, - Patients between the ages of 19 to 80, - American Society of Anesthesiologist (ASA) status of 2 and 3, - Preoperative ejection fraction (EF) greater than 30%. - There were five different open-heart surgery group of patients in this study. The groups include; coronary artery bypass grafting (CABG), mitral valvular replacement, aortic valvular replacement, combined mitral and aortic valve replacement, combined mitral, aortic and/or tricuspid valve replacements. Exclusion Criteria: - Both CABG and valve replacement, - Resection of a ventricular or aortic aneurysm, - Transplantation or another surgical procedure, - Reoperation of valvular repair surgery, patients with preoperative ejection fraction less than 30%, - Preoperative hyperbilirubinemia defined as total bilirubin concentration of more than 3 mg/dL, - Preoperative congestive heart failure, preoperative renal dysfunction (serum creatinine greater than 1.3 mg/dL), - Chronic oliguria/anuria requiring dialysis, - Preoperative American Society of Anesthesiologist (ASA) status of 4, - History of pancreatitis or current corticosteroid treatment. |
Резултат
Първични изходни мерки
1. Comparison of serum total bilirubin values on postoperative day 1. [Preoperative one day before surgery and postoperative day 1.]
2. Comparison of serum total bilirubin values on postoperative day 3. [Preoperative one day before surgery and postoperative day 3.]
3. Comparison of serum total bilirubin values on postoperative day 7. [Preoperative one day before surgery and postoperative day 7.]
4. Comparison of all serum total bilirubin values at all collected times. [Preoperatively one day before surgery and on postoperative days of 1, 3 and 7.]
5. Comparison of serum albumin values on postoperative day 1. [Preoperative one day before surgery and postoperative day 1.]
6. Comparison of serum albumin values on postoperative day 3. [Preoperative one day before surgery and postoperative day 3.]
7. Comparison of serum albumin values on postoperative day 7. [Preoperative one day before surgery and postoperative day 7.]
8. Comparison of all serum albumin values at all collected times. [Preoperatively one day before surgery and on postoperative days of 1, 3 and 7.]
9. Comparison of serum alkaline phosphatase (ALP) values on postoperative day 1. [Preoperative one day before surgery and on postoperative day of 1.]
10. Comparison of serum alkaline phosphatase (ALP) values on postoperative day 3. [Preoperative one day before surgery and on postoperative day of 3.]
11. Comparison of serum alkaline phosphatase (ALP) values on postoperative day 7. [Preoperative one day before surgery and on postoperative day of 7.]
12. Comparison of all serum alkaline phosphatase (ALP) values at all collected times. [Preoperatively one day before surgery and on postoperative days of 1, 3 and 7.]
13. Comparison of serum alanine transaminase (ALT) values on postoperative day 1. [Preoperatively one day before surgery and on postoperative day of 1.]
14. Comparison of serum alanine transaminase (ALT) values on postoperative day 3. [Preoperatively one day before surgery and on postoperative day of 3.]
15. Comparison of serum alanine transaminase (ALT) values on postoperative day 7. [Preoperatively one day before surgery and on postoperative day of 7.]
16. Comparison of all serum alanine transaminase (ALT) values at all collected times. [Preoperatively one day before surgery and on postoperative days of 1, 3 and 7.]
17. Comparison of serum aspartate transaminase (AST) values on postoperative day 1. [Preoperatively one day before surgery and on postoperative day of 1.]
18. Comparison of serum aspartate transaminase (AST) values on postoperative day 3. [Preoperatively one day before surgery and on postoperative day of 3.]
19. Comparison of serum aspartate transaminase (AST)values on postoperative day 7. [Preoperatively one day before surgery and on postoperative day of 7.]
20. Comparison of all serum aspartate transaminase (AST) values at all collected times. [Preoperatively one day before surgery and on postoperative days of 1, 3 and 7.]
21. Comparison of serum lactate dehydrogenase (LDH) values on postoperative day 1. [Preoperatively one day before surgery and on postoperative day of 1.]
22. Comparison of serum lactate dehydrogenase (LDH) values on postoperative day 3. [Preoperatively one day before surgery and on postoperative day of 3.]
23. Comparison of serum lactate dehydrogenase (LDH) values on postoperative day 7. [Preoperatively one day before surgery and on postoperative day of 7.]
24. Comparison of all serum lactate dehydrogenase (LDH) values at collected times. [Preoperatively one day before surgery and on postoperative days of 1, 3 and 7.]
25. Comparison of serum glutamyl transpeptidase (GGT) values on postoperative day 1. [Preoperatively one day before surgery and on postoperative day of 1.]
26. Comparison of serum glutamyl transpeptidase (GGT) values on postoperative day 3. [Preoperatively one day before surgery and on postoperative day of 3.]
27. Comparison of serum glutamyl transpeptidase (GGT) values on postoperative day 7. [Preoperatively one day before surgery and on postoperative day of 7.]
28. Comparison of all serum glutamyl transpeptidase (GGT) values at collected times. [Preoperatively one day before surgery and on postoperative days of 1, 3 and 7.]
Вторични изходни мерки
1. Use of aortic cross-clamp time; as a risk factor [During intraoperative time]
2. Use of cardiopulmonary bypass time; as a risk factor [During intraoperative time]
3. Use of inotropic support; as a risk factor [During intraoperative time and in the first 10 days of postoperative period]
4. Use of intra-aortic balloon pump; as a risk factor [During intraoperative time and in the first 10 days of postoperative period]
5. Use of prolonged mechanical ventilation; as a risk factor [During the first 30 days of postoperative period]
6. Development of pneumonia; as a risk factor [During the first 10 days of postoperative period]
7. Development of perioperative heart attack; a rsik factor [During intraoperative time and in the first 10 days of postoperative period]
8. Cerebrovascular event; a risk factor [During the first 10 days of postoperative period]
9. Presence of rhythm disturbance; a risk factor [During intraoperative time and in the first 10 days of postoperative period]
10. Need of renal replacement therapy; a risk factor [During the first 10 days of postoperative period]
11. Need of reoperation; a risk factor [During the first 10 days of postoperative period]
12. Presence of other adverse events; a risk factor [During the first 10 days of postoperative period]
13. Duration of intensive care unit stay; a risk factor [During the first 10 days of postoperative period]
14. Duration of in-hospital stay; a risk factor [During the first 30 days of postoperative period]
