Microalbuminuria and short-term prognosis in patients undergoing cardiac surgery.
OBJECTIVE
To examine if preoperative microalbuminuria (MA) is associated with in increased risk of adverse outcomes in patients undergoing elective cardiothoracic surgery, and if adding information on MA could improve the accuracy of the additive EuroSCORE.


METHODS
In a follow-up study we included 962 patients undergoing elective cardiothoracic surgery from 1 April 2005 to 30 September 2007 at our department. MA (urine albumin/creatinine ratio between 2.5-25 mg/mmol) was assessed in a morning spot-urine sample. We used population-based medical registries for 30-day follow-up and compared the length of stay and adverse outcomes including (i) all-cause death, myocardial infarction, stroke, or atrial fibrillation, (ii) surgical reintervention, renal insufficiency, sternal wound infection, or septicaemia among patients with and without MA.


RESULTS
MA was found in 180 (18.7%) patients. The risk of both combined outcomes (adjusted odds ratios (ORs): 1.00 (95% confidence interval (CI): 0.77-1.30) and 1.18 (95% CI: 0.79-1.75), respectively) and most individual outcomes did not differ between the micro- and normoalbuminuric patients. The patients with MA and an additive EuroSCORE of 5 had a significantly prolonged median length of intensive care unit (ICU) stay (0.15 days [95% CI: 0.04-0.26]) and total hospital stay (0.5 days [95% CI: 0.04-0.96]). Patients with MA had a higher risk of postoperative septicaemia (OR: 12.1 [95% CI: 3.2-45.9]). Area under receiver operating characteristics curves of the EuroSCORE with regard to 30-day mortality was 0.86 both with and without MA.


CONCLUSIONS
Preoperative MA in patients undergoing elective cardiothoracic surgery was not associated with most early adverse outcomes. However, risk of septicaemia was higher and patients with MA also had a marginally longer length of ICU and hospital stay. Information on preoperative MA did not improve the accuracy of the additive EuroSCORE.
Mikkelsen
Martin Majlund
MM
Department of Cardiothoracic and Vascular Surgery T, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. majlund@ki.au.dk
Andersen
Niels Holmark
NH
Christensen
Thomas Decker
TD
Hansen
Troels Krarup
TK
Eiskjaer
Hans
H
Mogensen
Carl Erik
CE
Hjortdal
Vibeke Elisabeth
VE
Johnsen
Søren Paaske
SP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000378:metabolism; D000419:Albuminuria / Q000150:complications* / Q000401:mortality / Q000652:urine; D001281:Atrial Fibrillation / Q000209:etiology; D015415:Biomarkers / Q000652:urine; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D003401:Creatine / Q000652:urine; D003422:Critical Care; D003718:Denmark / Q000453:epidemiology; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D011446:Prospective Studies; D012042:Registries; D051437:Renal Insufficiency / Q000209:etiology; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology; D020521:Stroke / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000418:Albumins; D015415:Biomarkers; D003401:Creatine