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Platelet Counts, Acute Kidney Injury, and Mortality after Coronary Artery Bypass Grafting Surgery.

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Date
2016-02
Authors
Kertai, Miklos D
Zhou, Shan
Karhausen, Jörn A
Cooter, Mary
Jooste, Edmund
Li, Yi-Ju
White, William D
Aronson, Solomon
Podgoreanu, Mihai V
Gaca, Jeffrey
Welsby, Ian J
Levy, Jerrold H
Stafford-Smith, Mark
Mathew, Joseph P
Fontes, Manuel L
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(15 total)
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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 article
Subject
Acute Kidney Injury
Coronary Artery Bypass
Hospital Mortality
Humans
Incidence
Kaplan-Meier Estimate
North Carolina
Platelet Count
Postoperative Complications
Proportional Hazards Models
Retrospective Studies
Risk Factors
Treatment Outcome
Permalink
https://hdl.handle.net/10161/11161
Published Version (Please cite this version)
10.1097/ALN.0000000000000959
Publication 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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Scholars@Duke

Aronson

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
Gaca

Jeffrey Giles Gaca

Associate Professor of Surgery
Jooste

Edmund Hilton Jooste

Professor of Anesthesiology
Dr Jooste&#8217;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.
Karhausen

Jorn Karhausen

Adjunct Associate Professor in the Department of Anesthesiology

Miklos David Kertai

Associate Professor of Anesthesiology
Levy

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.&nbsp
Li

Yi-Ju Li

Professor of Biostatistics & Bioinformatics
My research interest is in statistical genetics, primarily in statistical method development and its application for genetic research of human complex diseases. Here is the list of research topics: Statistical genetics:  I have involved in the development of several family-based association methods for quantitative traits with or without censoring, and for detecting X-linked genes. With the availability of next generation sequencing data, we have ongoing projects to develop
Mathew

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
Podgoreanu

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
Stafford-Smith

Mark Stafford-Smith

Professor 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.
Welsby

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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