Investigation of the relationship between prolonged ventilation and the Glasgow Prognostic Score after elective isolated coronary bypass surgeries in advanced-age patients

Yıl 2023, Cilt: 9 Sayı: 2, 445 - 453, 04.03.2023

Orhan Güvenç , Mesut Engin , Irem Iris Kan , Senol Yavuz

https://doi.org/10.18621/eurj.1256509

Öz

Objectives: Coronary artery bypass graft (CABG) surgeries are the most beneficial treatment method for atherosclerotic heart disease. Prolonged ventilation is a significant condition that poses risks such as infection, renal failure, prolongs hospital stays, and increases treatment costs. In this current study, we aimed to reveal the relationship between prolonged mechanical ventilation and Glasgow Prognostic Score (GPS), in patients aged 65 years and older who underwent isolated CABG.

Methods: Patients aged 65 years and over who underwent elective isolated coronary bypass surgery with cardiopulmonary bypass in our clinic, between June 2017 and June 2022, were included in the study retrospectively. The patients who were extubated within eight hours of the surgeries were determined as Group 1, whereas those who were extubated after 8 hours were determined as Group 2.

Results: Prolonged ventilation occurred in 101 (20.7%) patients (Group 2). The median age of the 385 patients included in Group 1 and 101 patients in Group 2 was 68 (66 to 91) and 71 (66 to 88) years, respectively (p = 0.216). The two groups were similar in regards to gender, hypertension, smoking, diabetes mellitus, body mass index, history of cerebrovascular accident and left ventricular ejection fraction rates. In the multivariate analysis, left ventricular ejection fraction <35% (OR: 1.136, 95% CI: 1.065-1.652, p = 0.029), total perfusion time (OR: 1.190, 95% CI: 1.040-1.659, p = 0.012), and GPS = 2 (OR: 1.479, 95% CI: 1.130-2.169, p = 0.004) were determined as independent predictors for prolonged ventilation.

Conclusions: GPS value calculated preoperatively in elderly patients is a parameter that indicates the increased ventilation need. With the GPS score evaluation, patient groups at risk for prolonged ventilation can be identified and necessary precautions can be undertaken.

Anahtar Kelimeler

Glasgow Prognostic Score, coronary artery bypass graft, morbidity, postoperative term, prolonged ventilation

Kaynakça

• 1. As AK, Engin M, Türk T. Early-term results of early coronary artery bypass graft surgery in patients undergoing primary percutaneous coronary intervention due to acute coronary syndrome. Eur Res J 2020;7:59-65.
• 2. Abanoz M, Engin M. The effect of the relationship between post-cardiotomy neutrophil/lymphocyte ratio and platelet counts on early major adverse events after isolated coronary artery bypass grafting. Turk Gogus Kalp Damar Cerrahisi Derg 2021;29:36-44.
• 3. Doering LV, Imperial-Perez F, Monsein S, Esmailian F. Preoperative and postoperative predictors of early and delayed extubation after coronary artery bypass surgery. Am J Crit Care 1998;7:37-44.
• 4. Aksoy R, Karakoc AZ, Cevirme D, Elibol A, Yigit F, Yilmaz Ü, Rabus MB. Predictive factors of prolonged ventilation following cardiac surgery with cardiopulmonary bypass. Braz J Cardiovasc Surg 2021;36:780-7.
• 5. Yıldızeli SO, Eryüksel E, Arıkan H, Karakurt S, Çelikel T. [Clinical case solution: prolonged ventilatory support and weaning after coronary artery bypass graft surgery]. Yoğun Bakım Derg 2016;7:67-72. [Article in Turkish]
• 6. Myles PS, Daly DJ, Djaiani G, Lee A, Cheng DC. A systematic review of the safety and effectiveness of fast-track cardiac anesthesia. Anesthesiology 2003;99:982-7.
• 7. Abuş S. C-reactive protein to albumin ratio in atrial fibrillation. Eur Res J 2022 Sep 27. doi: 10.18621/eurj.1038532.
• 8. Yang J, Li C, Zheng Y, Gao J, Liu YP, Wang JJ, et al. The Association between high-sensitivity C-reactive protein/albumin ratio and cardiovascular prognosis in patients undergoing percutaneous coronary intervention. Angiology 2022;73:818-26.
• 9. Karabacak K, Kubat E, Akyol FB, Kadan M, Erol G, Doğancı S, et al. The C-reactive protein/albumin ratio as a new predictor for postoperative atrial fibrillation after coronary artery bypass graft surgery. J Card Surg 2020;35:2747-53.
• 10. Bae BK, Lee SH, Han SK, Yeom SR, Cho SJ, Park SW, et al. Serial measurements of C-reactive protein and albumin levels in prediction of prolonged mechanical ventilation in pesticide-intoxicated patients. J Korean Soc Emerg Med 2012;23:665-72.
• 11. Abacioglu OO, Koyunsever NY, Kilic S, Yildirim A, Kurt IH. Glasgow Prognostic Score as a marker of mortality after TAVI. Braz J Cardiovasc Surg 2021;36:796-801.
• 12. McCarthy C, Fletcher N. Early extubation in enhanced from cardiac surgery. Crit Care Clin. 2020;36:663-74.
• 13. Lyons O, Whelan B, Bennett K, O’Riordan D, Silke B. Serum albumin as an outcome predictor in hospital emergency medical admissions. Eur J Intern Med 2010;21:17-20.
• 14. Arques S, Ambrosi P. Human serum albumin in the clinical syndrome of heart failure. J Card Fail 2011;17:451-8.
• 15. Chien SC, Chen CY, Leu HB, Su CH, Yin WH, Tseng WK, et al. Association of low serum albumin concentration and adverse cardiovascular events in stable coronary heart disease. Int J Cardiol 2017;241:1-5.
• 16. de la Cruz KI, Bakaeen FG, Wang XL, Huh J, LeMaire SA, Coselli JS, et al. Hypoalbuminemia and long-term survival after coronary artery bypass: a propensity score analysis. Ann Thorac Surg 2011;91:671-5.
• 17. Engin M, Ozsin KK, Savran M, Guvenc O, Yavuz S, Ozyazicioglu AF. Visceral adiposity index and prognostic nutritional index in predicting atrial fibrillation after on-pump coronary artery bypass operations: a prospective study. Braz J Cardiovasc Surg 2021;36:522-9.
• 18. Solomon J, Moss E, Morin JF, Langlois Y, Cecere R, de Varennes B, et al. The essential frailty toolset in older adults undergoing coronary artery bypass surgery. J Am Heart Assoc 2021;10:e020219.
• 19. Melnikov IS, Kozlov SG, Saburova OS, Avtaeva YN, Prokofieva LV, Gabbasov ZA. Current position on the role of monomeric C-reactive protein in vascular pathology and atherothrombosis. Curr Pharm Des 2020;26:37-43.
• 20. Balciunas M, Bagdonaite L, Samalavicius R, Griskevicius L, Vuylsteke A. Pre-operative high sensitive C-reactive protein predicts cardiovascular events after coronary artery bypass grafting surgery: a prospective observational study. Ann Card Anaesth 2009;12:127-32.
• 21. Nam K, Jeon Y, Kim TK, Kim KB, Hwang HY, Cho YJ. Intraoperative transfusion and an increased preoperative C-reactive protein level are associated with higher mortality after off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 2020;159:558-65.
• 22. Manoglu B, Sokmen S, Bisgin T, Semiz HS, Görken IB, Ellidokuz H. Inflammation-based prognostic scores in geriatric patients with rectal cancer. Tech Coloproctol 2022 Oct 5. doi: 10.1007/s10151-022-02710-0.
• 23. Yeh KY, Wang CH, Ling HH, Peng CL, Chen ZS, Hsia S. Pretreatment Glasgow Prognostic Score correlated with serum histidine level and three-year mortality of patients with locally advanced head and neck squamous cell carcinoma and optimal performance status. Nutrients 2022;14:3475.
• 24. Xu X, Cai L, Chen T, Ding S, Zhang F, Gao B, et al. Predictive value of inflammation-based Glasgow prognostic score, platelet-lymphocyte ratio, and global registry of acute coronary events score for major cardiovascular and cerebrovascular events during hospitalization in patients with acute myocardial infarction. Aging (Albany NY). 2021;13:18274-86.
• 25. Cho A, Arfsten H, Goliasch G, Bartko PE, Wurm R, Strunk G, et al. The inflammation-based modified Glasgow prognostic score is associated with survival in stable heart failure patients. ESC Heart Fail 2020;7:654-62.
• 26. Altay S, Gürdoğan M, Keskin M, Kardaş F, Çakır B. The inflammation-based Glasgow Prognostic Score as a prognostic factor in patients with intensive Cardiovascular Care Unit. Medicina (Kaunas) 2019;55:139.
• 27. Hessels L, Coulson TG, Seevanayagam S, Young P, Pilcher D, Marhoon N, et al. Development and validation of a score to identify cardiac surgery patients at high risk of prolonged mechanical ventilation. J Cardiothorac Vasc Anesth 2019;33:2709-16.
• 28. Gumus F, Polat A, Yektas A, Totoz T, Bagci M, Erentug V, et al. Prolonged mechanical ventilation after CABG: risk factor analysis. J Cardiothorac Vasc Anesth 2015;29:52-8.