title: Preoperative cerebral oxygen saturation and clinical outcomes in cardiac surgery.
abstract: BACKGROUND
  The current study was designed to determine the relation between preoperative cerebral oxygen saturation (Sco2), variables of cardiopulmonary function, mortality, and morbidity in a heterogeneous cohort of cardiac surgery patients.
  
  
  METHODS
  In this study, 1,178 consecutive patients scheduled for on-pump surgery were prospectively studied. Preoperative Sco2, demographics, N-terminal pro-B-type natriuretic peptide, high-sensitive troponin T, clinical outcomes, and 30-day and 1-yr mortality were recorded.
  
  
  RESULTS
  Median additive EuroSCORE was 5 (range: 0-19). Thirty-day and 1-yr mortality and major morbidity (at least two major complications and/or a high-dependency unit stay of at least 10 days) were 3.5%, 7.7%, and 13.3%, respectively. Median minimal preoperative oxygen supplemented Sco2 (Sco2min-ox) was 64% (range: 15-92%). Sco2min-ox was correlated (all: P value <0.0001) with N-terminal pro-B-type natriuretic peptide (ρ: -0.35), high-sensitive troponin T (ρ: -0.28), hematocrit (ρ: 0.34), glomerular filtration rate (ρ: 0.19), EuroSCORE (τ: 0.20), and left ventricular ejection fraction class (τ: 0.12). Thirty-day nonsurvivors had a lower Sco2min-ox than survivors (median 58% [95% CI, 50.7-62%] vs. 64% [95% CI, 64-65%]; P < 0.0001). Receiver-operating curve analysis of Sco2min-ox and 30-day mortality revealed an area-under-the-curve of 0.71 (95% CI, 0.68-0.73%; P < 0.0001) in the total cohort and an area-under-the-curve of 0.77 (95% CI, 0.69-0.86%; P < 0.0001) in patients with a EuroSCORE more than 10. Logistic regression based on different EuroSCORE categories (0-2; 3-5, 6-10, >10), Sco2min-ox, and duration of cardiopulmonary bypass showed that a Sco2min-ox equal or less than 50% is an independent risk factor for 30-day and 1-yr mortality.
  
  
  CONCLUSIONS
  Preoperative Sco2 levels are reflective of the severity of cardiopulmonary dysfunction, associated with short- and long-term mortality and morbidity, and may add to preoperative risk stratification in patients undergoing cardiac surgery.
authors.affiliation: Cardiac Anesthesia Unit, Department of Anesthesiology, University of Lübeck, Lübeck, Germany. heringlake@t-online.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Heringlake
authors.forename: Christof
authors.initials: C
authors.lastname: Garbers
authors.forename: Jan-Hendrik
authors.initials: JH
authors.lastname: Käbler
authors.forename: Ingrid
authors.initials: I
authors.lastname: Anderson
authors.forename: Hermann
authors.initials: H
authors.lastname: Heinze
authors.forename: Julika
authors.initials: J
authors.lastname: Schön
authors.forename: Klaus-Ulrich
authors.initials: KU
authors.lastname: Berger
authors.forename: Leif
authors.initials: L
authors.lastname: Dibbelt
authors.forename: Hans-Hinrich
authors.initials: HH
authors.lastname: Sievers
authors.forename: Thorsten
authors.initials: T
authors.lastname: Hanke
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001921:Brain / Q000378:metabolism*; D001923:Brain Chemistry; D006348:Cardiac Surgical Procedures; D002560:Cerebrovascular Circulation; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006400:Hematocrit; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010092:Oximetry / Q000379:methods; D010100:Oxygen / Q000378:metabolism*; D010446:Peptide Fragments / Q000097:blood; D011183:Postoperative Complications / Q000378:metabolism*; D057234:Preoperative Period; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D019265:Spectroscopy, Near-Infrared; D016019:Survival Analysis; D020107:Troponin T / Q000097:blood
chemical_list: D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D010100:Oxygen