title: Impact of preoperative renal dysfunction on in-hospital mortality after solitary valve and combined valve and coronary procedures.
abstract: BACKGROUND
  Limited information exists on the influence of preoperative renal dysfunction on in-hospital mortality after valve and combined valve and coronary procedures. The impact of preoperative renal dysfunction on patient outcome was investigated.
  
  
  METHODS
  This was a retrospective observational study of 916 patients who underwent solitary valve or combined procedures. Primary outcome was in-hospital mortality. Preoperative estimated glomerular filtration rate (eGFR) was calculated with the abbreviated Modification of Diet in Renal Disease formula.
  
  
  RESULTS
  Independent predictors of death were prolonged stay in the intensive care unit (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01 to 1.05), preoperative atrial fibrillation (OR, 1.61; 95% CI, 1.02 to 2.54), chronic obstructive pulmonary disease (OR, 2.2; 95% CI, 1.06 to 4.55), and prolonged operation time (OR, 1.01; 95% CI, 1.00 to 1.01). Each unit of the eGFR (mL/min/1.73 m(2)) above average exerted a renoprotective effect (OR, 0.97; 95% CI, 0.96 to 0.98). The final regression model showed no lack of fit (Hosmer-Lemeshow test, p = 0.38) and a good discrimination performance in a receiver operating characteristic analysis (area under the curve, 0.84; 95% CI, 0.80 to 0.88). The lower the preoperative eGFR rate, the longer the postoperative stay at the intensive care unit.
  
  
  CONCLUSIONS
  Renal dysfunction is an important independent predictor of in-hospital mortality in adult patients after valve and combined valve and coronary procedures.
authors.affiliation: Department of Cardiothoracic Surgery, University Regensburg, Regensburg, Germany. claudius.diez@t-online.de
authors.forename: Claudius
authors.initials: C
authors.lastname: Diez
authors.forename: Peter
authors.initials: P
authors.lastname: Mohr
authors.forename: Oliver
authors.initials: O
authors.lastname: Kuss
authors.forename: Bernd
authors.initials: B
authors.lastname: Osten
authors.forename: Rolf-Edgar
authors.initials: RE
authors.lastname: Silber
authors.forename: Hans-Stefan
authors.initials: HS
authors.lastname: Hofmann
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006351:Heart Valves / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007674:Kidney Diseases / Q000503:physiopathology*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors