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Minerva Cardioangiologica 2016 April;64(2):101-13

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Five-year mortality in cardiac surgery patients with low cardiac output syndrome treated with levosimendan: prognostic evaluation of NT-proBNP and C-reactive protein

Herminia TORRADO 1, Juan C. LÓPEZ-DELGADO 1, Elisabet FARRERO 1, David RODRÍGUEZ-CASTRO 1, María J. CASTRO 2, Elisabet PERICHE 1, Maria L. CARRIÓ 1, Jacobo E. TOSCANO 3, Alain PINSEAU 1, Casimiro JAVIERRE 4, Josep L. VENTURA 1

1 Department of Intensive Care, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain; 2 Laboratory of Biochemistry, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain; 3 Department of Cardiac Surgery, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain; 4 Department of Physiology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain


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BACKGROUND: To determine the clinical risk factors predictive of the 5-year mortality in patients with low cardiac output syndrome (LCOS) after cardiac surgery. In addition, to assess the influence of inflammation and myocardial dysfunction severity, as measured by C-reactive protein (CRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations, on outcome.
METHODS: We studied 30 patients who underwent cardiac surgery and developed postoperative LCOS requiring inotropic support for longer than 48 hours after intensive care unit (ICU) admission. All patients received a 24-hour infusion of levosimendan after study enrolment. We measured the following at baseline, 24 h, 48 h and 7 days: clinical data, serum NT-proBNP and serum CRP levels. Patients were followed-up at 5 years for death by any cause. A risk-adjusted Cox proportional hazards regression model was used for statistical analysis. Hazard ratios and their 95% confidence intervals (CI) are presented.
RESULTS: The 5-year mortality was 36.6% (n.=11). The predictors of 5-year mortality were the presence of dilated cardiomyopathy (HR=36.909; 95% CI: 1.901-716.747; P=0.017), a higher central venous pressure (CVP) at 48 hours (HR=2.686; 95% CI: 1.383–5.214; P=0.004), and lower CRP levels on day 7 (HR=0.963; 95% CI: 0.933-0.994; P=0.021). NT-proBNP levels showed a trend to higher initial levels in survivors without statistical significance, but were not associated with 5-year mortality.
CONCLUSIONS: The presence of dilated cardiomyopathy, elevated CVP at 48 h and reduced CRP levels on day 7 predicted 5-year mortality in patients who developed postoperative LCOS after cardiac surgery. NT-proBNP levels in the first postoperative week were not predictors of long-term outcomes.

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