Association of Critical Value With 28-Day Mortality After Cardiac Surgery
DOI:
https://doi.org/10.1532/hsf.5215Keywords:
cardiac surgery, critical value, predictive modelingAbstract
Objective: The emergence of critical values gives a warning to the medical safety of hospitalized patients, especially Cardiosurgery Intensive Care Unit (CSICU) patients. The aim of this study was to investigate the association between early postoperative critical values and the prognosis of patients after cardiac surgery.
Methods: Clinical data of the patients were obtained from the Cardiac Critical Care Clinical Database of the Cardiovascular Intensive Care Unit of Nanjing First Hospital. A total of 1,598 consecutive patients undergoing cardiac surgery were enrolled in this retrospective cohort study, during the period from July 2019 to December 2020. According to whether critical value occurred within 7 days after cardiac surgery, patients were divided into two groups: the critical value group and control group. COX regression and survival analysis were performed to analyze the clinical data of the two groups. The area under the receiver operating characteristic curve (ROC) was used to assess the critical value's predictive value and determine the optimal cutoff value.
Results: With patients in the critical value group, the 28-day mortality after cardiac surgery was 21.98%, significantly higher than that of the control group (P < 0.05). Logistic regression analysis revealed the APACHE II score (Adjusted HR-1.11, 95% CI-1.043-1.185) and critical value group (Adjusted HR-13.57, 95% CI-6.714-27.435 ) were independent predictors of 28-day mortality after cardiac surgery. The ROC curve showed that the critical value case model (AUC = 0.748 ± 0.052, P < 0.05) could effectively predict the 28-day mortality, and the optimum cutoff was 1 case (sensitivity 52.63%, specificity 95.70%).
Conclusions: One or more reported cases of critical values in the early postoperative period could be an independent risk factor for 28-day mortality in patients undergoing cardiac surgery. The predictive model based on critical value might be effective in clinical therapy and risk stratification.
References
AlSadah K, S El-Masry O, Alzahrani F, et al. 2019. Reporting Clinical Laboratory Critical Values: A Focus On The Recommendations Of The American College Of Pathologists. J Ayub Med Coll Abbottabad. 31:612-618.
Atalay HH, Atalay BG. 2019. Cardiac surgery clinical outcomes in 70 years and over patients. J Pak Med Assoc. 69:1677-1681.
Chinese Medical Doctor Association. 2019. Patient safety goals (2019 Edition). Chinese Hospital Quality Conference.
Daniels J, Flynn BC. 2020. Novel Tool to Predict 1-Year Mortality in Cardiac Surgery: Applying Both Preoperative and Postoperative Data. J Cardiothorac Vasc Anesth. 34:2638-2640.
Du H, Markus C, Metz M, et al. 2018. Derivation of Outcome-Based Pediatric Critical Values. Am J Clin Pathol. 149:324-331.
Expert consensus on the clinical application of critical value in critical diseases (adults). 2013. Chin J Emerg Med. 22:1084-1089.
Lippi G, Mattiuzzi C. 2016. Critical laboratory values communication: summary recommendations from available guidelines. Ann Transl Med. 4:400.
Luthra S, Ramady O, Monge M, et al. 2015. "Knife to skin" time is a poor marker of operating room utilization and efficiency in cardiac surgery. J Card Surg. 30:477-487.
Raut S, Hussain A, Ariyaratnam P, et al. 2020. Validation of Cardiac Surgery Score (CASUS) in Postoperative Cardiac Patients. Semin Cardiothorac Vasc Anesth. 24:304-312.
Schapkaitz E, Levy B. 2015. Critical limits for urgent clinician notification at South African intensive care units. Int Jnl Lab Hem. 37:620-625.
Tan EH, Yang Z, Li Y, Metz MP, et al. 2019. Outcome-Based Critical Result Thresholds in the Adult Patient Population. Am J Clin Pathol. 152:177-184.
The Joint Commission. 2019. 2020 Hospital National Patient Safety Goals. Hospital Accreditation Program.
Ye YY, Zhao HJ, Fei Y, et al. 2017. Critical values in hematology of 862 institutions in China. Int J Lab Hematol. 39:513-520.
Zeng R, Wang W, Wang Z. 2013. National survey on critical values notification of 599 institutions in China. Clin Chem Lab Med. 51:2099-2107.
