Comparison of sequential organ failure assessment score and cardiac surgery score systems for mortality prediction after emergency acute aortic dissection surgery.

BACKGROUND: Acute type A aortic dissection (ATAAD) is one of the most mortal cardiovascular diseases and requires urgent diagnosis and surgery. The patient's clinical findings, complications, and patient's history are closely related to mortality rates. Cardiac surgery score (CASUS) is a scoring system which is calculated by considering the special pathophysiological conditions of patients undergoing cardiac surgery and predicts post-operative results with high accuracy. METHODS: Following the ethical approval from institutional ethics committee (ID: 2021/7/496), the data of consecutive 50 ATAAD patients who underwent emergent surgery in our hospital between January 1, 2019, and December 31, 2020, were evaluated. The Sequential Organ Failure Assessment and CASUS scores were calculated using the worst values of the daily laboratory and neurological status for both in admission to emergency department and during intensive care unit (ICU) follow-up period. The average and the total values of these scores were recorded for pre-operative, post-operative 1st day, and for the categorical data were defined as frequency and percentage. We used the Mann-Whitney U test for the independent continuous data comparisons and Pearson Chi-Square or Fisher exact test for categorical data comparison whole ICU period. Continuous data were presented as median and interquartile ranges (25-75th). RESULTS: The study comprised 50 patients, the rate of death was 34% (n=17). In total group, there were hypertension 72% (n=36), diabetes mellitus 24% (n=12), initial hemoglobin 12.5 g/dL (10.7-14.1, 25-75th), creatinine 1.09 mg/dL (0.85-1.33, 25-75th), and 72% (n=36) of these patients were male. The CASUSmean and SOFAmean scores were higher in the death-group when compared with the group who survived (12.9 [9.5-13.8, 25-75th], 3 [2-5, 25-75th]; 8 [6.1-9.2, 25-75th], 2.6 (2-4.5, 25-75th], p<0.001, respectively]. CASUSmean was independently associated with the 1-month mortality in model 1 (HR 1.25 [1.14-1.37] (p<0.001). CONCLUSION: According to our results increase in CASUS mean was the main predictor of 1 month mortality. When CASUS mean exceeds 8.3 the patient should be followed up more carefully for major adverse events including death.

A Novel Risk Assessment Model Using Urinary System Contrast Blush Grading to Predict Contrast-Induced Acute Kidney Injury in Low-Risk Profile Patients.

Contrast-induced acute kidney injury (CI-AKI) can occur after coronary interventions despite protective measures. We evaluated the effect of urinary system contrast blush grading for predicting post-procedure CI-AKI in 486 patients with chronic coronary artery disease. Patient characteristics and blood samples were collected. Urinary system contrast blush grade was recorded during the coronary angiography and interventions. Post-procedure third to fourth day blood samples were collected for diagnosis of CI-AKI. The median age of the patients was 61 years (53-70, interquartile range), and 194 (39.9%) participants were female. Contrast-induced acute kidney injury occurred in 78 (16%) patients. By comparing full and reduced models with the likelihood ratio test, it was observed that in the reduced model, factors such as age, diabetes mellitus, body weight-adapted contrast media (CM), hemoglobin, and urinary system blush were associated with CI-AKI presence. The probability of CI-AKI presence increased slightly from grade 0 to 1 blush, but it increased sharply grade from 1 to 2 blush. According to our results, an increase in body weight-adapted CM and urinary blush grading were the main predictors of CI-AKI. These findings suggest that when body weight-adapted CM ratio exceeds 3.5 mL/kg and urinary contrast blush reaches grade 2, the patients should be followed up more carefully for the development of CI-AKI.