Predictors of outcomes of patients ≥ 80 years old admitted to intensive care units in Poland - a post-hoc analysis of the VIP2 prospective observational study.

INTRODUCTION: Elderly patients pose a significant challenge to intensive care unit (ICU) clinicians. In this study we attempted to characterise the population of patients over 80 years old admitted to ICUs in Poland and identify associations between clinical features and short-term outcomes. MATERIAL AND METHODS: The study is a post-hoc analysis of the Polish cohort of the VIP2 European prospective observational study enrolling patients > 80 years old admitted to ICUs over a 6-month period. Data including clinical features, clinical frailty scale (CFS), geriatric scales, interventions within the ICU, and outcomes (30-day and ICU mortality and length of stay) were gathered. Univariate analyses comparing frail (CFS > 4) to non-frail patients and survivors to non-survivors were performed. Multivariable models with CFS, activities of daily living score (ADL), and the cognitive decline questionnaire IQCODE as predictors and ICU or 30-day mortality as outcomes were formed. RESULTS: A total of 371 patients from 27 ICUs were enrolled. Frail patients had significantly higher ICU (58% vs. 44.45%, P = 0.03) and 30-day (65.61% vs. 54.14%, P = 0.01) mortality compared to non-frail counterparts. The survivors had significantly lower SOFA score, CFS, ADL, and IQCODE than non-survivors. In multivariable analysis CFS (OR 1.15, 95% CI: 1.00-1.34) and SOFA score (OR 1.29, 95% CI: 1.19-1.41) were identified as significant predictors for ICU mortality; however, CFS was not a predictor for 30-day mortality ( P = 0.07). No statistical significance was found for ADL, IQCODE, polypharmacy, or comorbidities. CONCLUSIONS: We found a positive correlation between CFS and ICU mortality, which might point to the value of assessing the score for every patient admitted to the ICU. The older Polish ICU patients were characterised by higher mortality compared to the other European countries.

Mortality and major postoperative complications within 1 year after vascular surgery: a prospective cohort study.

INTRODUCTION: Patients undergoing vascular procedures are prone to developing postoperative complications affecting their short­term mortality. Prospective reports describing the incidence of long­term complications after vascular surgery are lacking. OBJECTIVES: We aimed to describe the incidence of complications 1 year after vascular surgery and to evaluate an association between myocardial injury after noncardiac surgery (MINS) and 1­year mortality. PATIENTS AND METHODS: This is a substudy of a large prospective cohort study Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION). Recruitment took place in 28 centers across 14 countries from August 2007 to November 2013. We enrolled patients aged 45 years or older undergoing vascular surgery, receiving general or regional anesthesia, and hospitalized for at least 1 night postoperatively. Plasma cardiac troponin T concentration was measured before the surgery and on the first, second, and third postoperative day. The patients or their relatives were contacted 1 year after the procedure to assess the incidence of major postoperative complications. RESULTS: We enrolled 2641 patients who underwent vascular surgery, 2534 (95.9%) of whom completed 1­year follow­up. Their mean (SD) age was 68.2 (9.8) years, and the cohort was predominantly male (77.5%). The most frequent 1­year complications were myocardial infarction (224/2534, 8.8%), amputation (187/2534, 7.4%), and congestive heart failure (67/2534, 2.6%). The 1­year mortality rate was 8.8% (223/2534). MINS occurred in 633 patients (24%) and was associated with an increased 1­year mortality (hazard ratio, 2.82; 95% CI, 2.14-3.72; P <0.001). CONCLUSIONS: The incidence of major postoperative complications after vascular surgery is high. The occurrence of MINS is associated with a nearly 3­fold increase in 1­year mortality.

The incidence of cardiovascular and other major complications after open abdominal aortic surgery.

BACKGROUND: Abdominal aortic aneurysms (AAAs) and peripheral artery disease significantly increase the risk of perioperative complications. AIM: The study aimed to determine the incidence of myocardial injury after noncardiac surgery (MINS), its association with 30-day mortality, as well as predictors of postoperative acute kidney injury (pAKI) and bleeding independently associated with mortality (BIMS) in patients undergoing open vascular surgeries involving the abdominal aorta. METHODS: We performed a retrospective cohort study using a sample of consecutive patients who underwent open abdominal aortic surgery due to infrarenal AAA and/or aortoiliac occlusive disease in a single tertiary center. In each patient, at least two postoperative troponin measurements were performed (on the first and second postoperative day). Creatinine and hemoglobin levels were measured preoperatively and at least twice postoperatively. The outcomes included MINS (primary outcome), pAKI, and BIMS (secondary outcomes). We assessed the associations between them and 30-day mortality and performed multivariable analysis to identify risk factors for these outcomes. RESULTS: The study group comprised 553 patients. The mean age was 67.6 years, and 82.5% of patients were male. The incidence of MINS, pAKI, and BIMS was 43.8%, 17.2%, and 45.8%, respectively. The 30-day mortality rate was higher in patients who developed MINS (12.0% vs. 2.3%; P <0.001), pAKI (32.6% vs. 1.1%; P <0.001), or BIMS (12.3% vs. 1.7%; P <0.001) compared to patients who did not develop these complications. CONCLUSION: This study demonstrated that MINS, pAKI, and BIMS are common complications after open aortic surgeries, and they are related to a substantial increase in the 30-day mortality rate.

Prognostic value of preoperative electrocardiography in predicting myocardial injury after vascular surgery.

BACKGROUND: The current European guidelines recommend that a preoperative electrocardiogram (ECG) should be performed routinely in patients scheduled for high-risk surgery. However, the evidence regarding ECG as a predictor of perioperative cardiac complications is weak. AIM: To evaluate the association of preoperative ECG with short- and long-term outcomes in patients undergoing high-risk vascular procedures. METHODS: This was a substudy of the international Vascular events In noncardiac Surgery patIents cohort evaluatioN (VISION) Study and included consecutive patients undergoing vascular procedures in a single tertiary center. In each patient, a preoperative 12-lead ECG was evaluated by two experienced clinicians following the Polish Cardiac Society recommendations. We performed routine perioperative troponin monitoring at five time points (one preoperative and four postoperative measurements) to evaluate whether preoperative ECG abnormalities are associated with myocardial injury after noncardiac surgery (MINS) and 1-year major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, and stroke. RESULTS: The study group comprised 348 patients, 80.5% of whom were male and the median age (interquartile range [IQR]) was 65 (59-72) years. The incidence of MINS and 1-year MACE was 18.7% and 14.4%, respectively. Multivariable analysis showed that none of the predefined ECG abnormalities (ST depression, left axis deviation, atrial fibrillation, and bundle branch block) was associated with the incidence of MINS or 1-year MACE. CONCLUSION: This study confirmed that preoperative ECG abnormalities are frequent in patients undergoing high-risk vascular surgery. However, we did not find evidence supporting the relation between preoperative ECG abnormalities and postoperative adverse cardiac outcomes in high-risk patients.

Prevalence of Renal Masses Suspected of Malignancy and Adrenal Incidentalomas in Patients With Abdominal Aortic Aneurysm.

OBJECTIVE: The aim of our study was to assess the prevalence of renal masses suspected of malignancy and adrenal incidentalomas in patients with abdominal aortic aneurysm based on the computed tomography angiography (CTA). METHODS: In the retrospective cross-sectional study, the CTA scans of patients with abdominal aortic aneurysms and thoraco-abdominal aortic aneurysms type II-IV were assessed. Patients with thoraco-abdominal aortic aneurysms type I and V and history of abdominal aortic surgery were excluded from the study. RESULTS: Study group comprised 937 patients with a median age of 73.0 years, 83.8% of whom were male. CTA revealed renal tumors in 11 patients (1.2% of the study population) with a median size of 26 mm (interquartile range 20-50). Adrenal incidentalomas were found in 61 patients (6.5% of the study population). In 20 patients (2.1%) adrenal lesions were found bilaterally. CONCLUSION: In the described cohort, the renal and adrenal tumors were relatively common findings among patients with abdominal aortic aneurysm and thoraco-abdominal aortic aneurysms type II-IV. Both anaesthesiologists and surgeons should be vigilant about the possibility of such coexistence in order to provide the patients with the best possible perioperative care and an optimal surgical modality.

Incidence and predictors of myocardial and kidney injury following endovascular aortic repair: a retrospective cohort study.

PURPOSE: We performed a retrospective cohort study in patients who underwent endovascular aneurysm repair (EVAR) to determine the incidence and predictors of myocardial injury and acute kidney injury (AKI). METHODS: We included 267 consecutive patients who underwent EVAR at two tertiary centres in Canada and Poland. The primary outcome was myocardial injury during hospital stay after EVAR defined as a troponin elevation (ultra-sensitivity troponin I Vidas ≥ 19 ng·L-1, non-high-sensitivity troponin I Vidas ≥ 0.01 µg·L-1, high-sensitivity troponin T ≥ 20 ng·L-1, non-high-sensitivity troponin T ≥ 0.03 ng·mL-1). The secondary outcome was AKI defined using the stage 1 of the Acute Kidney Injury Network criteria. RESULTS: Myocardial injury occurred in 78/267 patients (29%; 95% confidence interval [CI], 24.1 to 34.9) and with AKI occurring in 25/267 (9.4%; 95% CI, 6.4 to 13.5). In a multivariable analysis, the following variables were associated with an increased risk of myocardial injury: age (adjusted odds ratio [aOR], 1.65 per ten-year increase; 95% CI, 1.09 to 2.49), Revised Cardiac Risk Index score ≥3 (aOR, 2.85; 95% CI, 1.26 to 6.41), The American Society of Anesthesiology physical status score 4 (aOR, 2.24; 95% CI, 1.12 to 4.47), duration of surgery (aOR, 1.27 per each hour; 95% CI, 1.00 to 1.61), and perioperative drop in hemoglobin (aOR, 3.35 per 10 g·dL-1 decrease; 95% CI, 1.00 to 11.3). Predictors of AKI were duration of surgery (aOR, 1.72 per hour; 95% CI, 1.36 to 2.17), a preoperative estimated glomerular filtration rate (eGFR) of 30-59 mL·min-1 (aOR, 3.82; 95% CI, 1.42 to 10.3), and an eGFR < 30 mL·min-1 (aOR, 37.0; 95% CI, 7.1 to 193.8). CONCLUSION: Myocardial injury and AKI are frequent during hospital stay after EVAR and warrant further investigation in prospective studies.

Infrarenal versus Suprarenal Abdominal Aortic Aneurysms: Comparison of Associated Aneurysms and Renal Artery Stenosis.

BACKGROUND: The aim of our study is to assess the prevalence of concomitant arterial abnormalities (true aneurysms of iliac, common femoral, renal, visceral arteries and stenoses of iliac and renal arteries) in patients with abdominal aortic aneurysm, and to evaluate whether the type of the aneurysm (suprarenal versus solely infrarenal) is associated with this prevalence. METHODS: In this retrospective cross-sectional study, we assessed computed tomography angiography scans of 933 patients with abdominal aortic aneurysm, including thoracoabdominal aortic aneurysms type II-IV, with no history of abdominal aortic surgery. We compared 2 groups of patients: group 1 (n = 859) with solely infrarenal abdominal aortic aneurysm and group 2 (n = 74) with the suprarenal aneurysm component. Patients with history of aortic dissection or thoracoabdominal aortic aneurysms type I and V were excluded from the study. All computed tomography angiography scans were visually assessed by 2 independent experienced physicians. RESULTS: Study group comprised 933 patients with the median age of 73.0 years, 83.8% of whom were male. We observed higher prevalence of common iliac artery aneurysms (44.6% vs. 30.6%, P = 0.013), internal iliac artery aneurysms (28.4% vs. 18.0%, P = 0.03), common femoral artery aneurysms (13.5% vs. 4.4%, P < 0.001), visceral artery aneurysms (5.4% vs. 1.2%, P = 0.019), renal artery stenosis (20.3% vs. 5.2%, P < 0.001), renal atrophy (6.7% vs. 1.1%, P = 0.004), and severe chronic kidney disease (14.1% vs. 1.8%, P < 0.001) in group 2 compared to group 1. There were no significant differences in the prevalence of iliac arterial stenoses between the groups. CONCLUSIONS: Among patients with abdominal aortic aneurysm, concomitant aneurysms and renal artery stenosis are more common in patients with suprarenal component when compared to those with solely infrarenal presentation.

[Cardio-vascular risk factors control in elderly patients with peripheral artery disease]. / Kontrola czynników ryzyka sercowo-naczyniowego u starszych pacjentów z choroba tetnic obwodowych.

OBJECTIVE: The assessment of control of modifiable risk factors among elderly patients with peripheral artery disease (PAD) admitted to the hospital angiology ward. METHODS: The results of treatment of dyslipidemia (DL), hypertension (HT), diabetes mellitus (DM) and prevalence of cigarette smoking were assessed among older (>65 years old, group I) and younger patients (group II) with PAD in a admission day to hospital. RESULTS: The study population included 154 patients (I--92 and II--65 subjects) aged 67.4 ± 9.4 years, 69.5% men. The study groups presented similar grades of PAD classification by Rutherford. Group I was older (73.5 ± 6.4 vs 58.3 ± 4.7 yrs, p < 0.001), had lower frequency of current smokers (21.7 vs 48.4%, P < 0.001) than group II. Diagnosis of DL, HT and DM were equally frequent in both groups. However, coronary heart disease was diagnosed more frequently in group I than II (52.2 vs 29.0%, p = 0.004). Both groups were similar according to systolic blood pressure (BP) values and levels of glucose and HDL cholesterol. Group I had lower diastolic BP than group II (69.5 ± 11.1 vs 74.0 ± 9.9 mmHg, p = 0.02), but control of HT was similar in both groups (71.7 vs 67.7%). LDL cholesterol levels were lower in a group I than II (2.2 ± 1.0 vs 2.5 ± 1.1 mmol/l, p = 0.04), but LDL cholesterol values < 1.8 mmol/l were observed with similar frequency in both groups (40.2 vs 27.4%). CONCLUSIONS: Patient's age seems to have no important impact on the control of atherosclerosis risk factors in patients with PAD.