Platelet Counts, Acute Kidney Injury, and Mortality after Coronary Artery Bypass Grafting Surgery.
Abstract
BACKGROUND: Cardiac surgery requiring cardiopulmonary bypass is associated with platelet
activation. Because platelets are increasingly recognized as important effectors of
ischemia and end-organ inflammatory injury, the authors explored whether postoperative
nadir platelet counts are associated with acute kidney injury (AKI) and mortality
after coronary artery bypass grafting (CABG) surgery. METHODS: The authors evaluated
4,217 adult patients who underwent CABG surgery. Postoperative nadir platelet counts
were defined as the lowest in-hospital values and were used as a continuous predictor
of postoperative AKI and mortality. Nadir values in the lowest 10th percentile were
also used as a categorical predictor. Multivariable logistic regression and Cox proportional
hazard models examined the association between postoperative platelet counts, postoperative
AKI, and mortality. RESULTS: The median postoperative nadir platelet count was 121
× 10/l. The incidence of postoperative AKI was 54%, including 9.5% (215 patients)
and 3.4% (76 patients) who experienced stages II and III AKI, respectively. For every
30 × 10/l decrease in platelet counts, the risk for postoperative AKI increased by
14% (adjusted odds ratio, 1.14; 95% CI, 1.09 to 1.20; P < 0.0001). Patients with platelet
counts in the lowest 10th percentile were three times more likely to progress to a
higher severity of postoperative AKI (adjusted proportional odds ratio, 3.04; 95%
CI, 2.26 to 4.07; P < 0.0001) and had associated increased risk for mortality immediately
after surgery (adjusted hazard ratio, 5.46; 95% CI, 3.79 to 7.89; P < 0.0001). CONCLUSION:
The authors found a significant association between postoperative nadir platelet counts
and AKI and short-term mortality after CABG surgery.
Type
Journal articleSubject
Acute Kidney InjuryCoronary Artery Bypass
Hospital Mortality
Humans
Incidence
Kaplan-Meier Estimate
North Carolina
Platelet Count
Postoperative Complications
Proportional Hazards Models
Retrospective Studies
Risk Factors
Treatment Outcome
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https://hdl.handle.net/10161/11161Published Version (Please cite this version)
10.1097/ALN.0000000000000959Publication Info
Kertai, Miklos D; Zhou, Shan; Karhausen, Jörn A; Cooter, Mary; Jooste, Edmund; Li,
Yi-Ju; ... Fontes, Manuel L (2016). Platelet Counts, Acute Kidney Injury, and Mortality after Coronary Artery Bypass Grafting
Surgery. Anesthesiology, 124(2). pp. 339-352. 10.1097/ALN.0000000000000959. Retrieved from https://hdl.handle.net/10161/11161.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Solomon Aronson
Professor Emeritus of Anesthesiology
Solomon Aronson, MD, MBA, FACC, FACCP, FAHA, FASE
Solomon Aronson is a tenured professor at Duke University and Executive Vice Chairman
in the Department of Anesthesiology.
Dr. Aronson earned his BS in molecular biology with distinction at the University
of Wisconsin in Madison, and his MD with honors in research at the Medical College
of Wisconsin in Milwaukee. After completing an anesthesiology residency including
a year as chief resident at the Univer
Jeffrey Giles Gaca
Associate Professor of Surgery
Edmund Hilton Jooste
Professor of Anesthesiology
Dr Jooste’s initial research focus was in the investigation of the smooth muscle
airway effects of various non-depolarizing muscle relaxants. Recently, Dr Jooste has
been involved in clinical research, investigating the pharmacokinetics and pharmacodynamics
of anesthetic agents in children and in particular the cardiovascular effects of dexmedetomidine.
His clinical practice focuses on the anesthesia care of children with congenital cardiac
disease.
Jorn Karhausen
Adjunct Associate Professor in the Department of Anesthesiology
Miklos David Kertai
Associate Professor of Anesthesiology
Jerrold Henry Levy
Professor of Anesthesiology
Jerrold Levy is Professor of Anesthesiology, Critical Care, and Surgery (Cardiothoracic)
at Duke University Medical Center in Durham, NC. He obtained his medical degree from
the University of Miami, where he was an intern in internal medicine, and undertook
his residency in the Department of Anesthesiology of the Massachusetts General Hospital
and Harvard Medical School in Boston, where he was also Chief Resident, and completed
fellowships in both Respiratory ICU and Cardiac Anesthesiology. 
Yi-Ju Li
Professor of Biostatistics & Bioinformatics
My research interest is in statistical genetics, including statistical method development
and its application for understanding the genetic predisposition of human complex
diseases. Here is the list of research topics:
Statistical genetics: development of family-based association methods for quantitative
traits with or without censoring and for detecting X-linked genes for disease risk.
With the availability of next generation sequencing data, we have ongoing projects
to d
Joseph P. Mathew
Jerry Reves, M.D. Distinguished Professor of Cardiac Anesthesiology
Current research interests include:1. The relationship between white matter patency,
functional connectivity (fMRI) and neurocognitive function following cardiac surgery.2.
The relationship between global and regional cortical beta-amyloid deposition and
postoperative cognitive decline.3. The effect of lidocaine infusion upon neurocognitive
function following cardiac surgery.4. The association between genotype and outcome
after cardiac surgery.5. Atrial fibrillation
Mihai V. Podgoreanu
Associate Professor of Anesthesiology
Basic-Translational: 1. Systems biology approaches to modeling perioperative cardiovascular
injury and adaptation. 2. Mechanisms of perioperative myocardial injury; functional
genomics applied to perioperative myocardial injury. 3. Metabolic consequences of
perioperative myocardial ischemia-reperfusion injury. 4. Animal models and comparative
genomic approaches to study perioperative myocardial ischemia-reperfusion injury.
5. Functional genomics of vein graft diseas
Mark Stafford-Smith
Professor Emeritus of Anesthesiology
My research interests are in the area of Cardiothoracic Anesthesiology. The main focus
of my research is towards the understanding and prevention of acute kidney injury
after cardiac and other major surgeries. Secondary interests include the study of
analgesic strategies after cardiothoracic surgical procedures, performance of clinical
trials, and perioperative transfusion and hemostasis.
Ian James Welsby
Professor of Anesthesiology
As a practicing cardiothoracic anesthesiologist, I have contributed to the better
understanding of the management and of perioperative thrombosis (particularly HIT).
This has been as a Duke site PI for the Rare Thrombotic Diseases Consortium led by
Dr T.L Ortel and a clinical collaborator with the basic and translational science
approach to HIT led by Dr G Arepally. I have also championed novel approaches to dealing
with perioperative HIT such as plasmaperesis.Similarly, I have be
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