title: Five-year mortality in cardiac surgery patients with low cardiac output syndrome treated with levosimendan: prognostic evaluation of NT-proBNP and C-reactive protein.
abstract: BACKGROUND
  To determine the clinical risk factors predictive of the 5-year mortality in patients with low cardiac output syndrome (LCOS) after cardiac surgery. In addition, to assess the influence of inflammation and myocardial dysfunction severity, as measured by C-reactive protein (CRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations, on outcome.
  
  
  METHODS
  We studied 30 patients who underwent cardiac surgery and developed postoperative LCOS requiring inotropic support for longer than 48 hours after intensive care unit (ICU) admission. All patients received a 24-hour infusion of levosimendan after study enrolment. We measured the following at baseline, 24 h, 48 h and 7 days: clinical data, serum NT-proBNP and serum CRP levels. Patients were followed-up at 5 years for death by any cause. A risk-adjusted Cox proportional hazards regression model was used for statistical analysis. Hazard ratios and their 95% confidence intervals (CI) are presented.
  
  
  RESULTS
  The 5-year mortality was 36.6% (n.=11). The predictors of 5-year mortality were the presence of dilated cardiomyopathy (HR=36.909; 95% CI: 1.901-716.747; P=0.017), a higher central venous pressure (CVP) at 48 hours (HR=2.686; 95% CI: 1.383-5.214; P=0.004), and lower CRP levels on day 7 (HR=0.963; 95% CI: 0.933-0.994; P=0.021). NT-proBNP levels showed a trend to higher initial levels in survivors without statistical significance, but were not associated with 5-year mortality.
  
  
  CONCLUSIONS
  The presence of dilated cardiomyopathy, elevated CVP at 48 h and reduced CRP levels on day 7 predicted 5-year mortality in patients who developed postoperative LCOS after cardiac surgery. NT-proBNP levels in the first postoperative week were not predictors of long-term outcomes.
authors.affiliation: Department of Intensive Care, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Herminia
authors.initials: H
authors.lastname: Torrado
authors.forename: Juan C
authors.initials: JC
authors.lastname: Lopez-Delgado
authors.forename: Elisabet
authors.initials: E
authors.lastname: Farrero
authors.forename: David
authors.initials: D
authors.lastname: Rodríguez-Castro
authors.forename: María J
authors.initials: MJ
authors.lastname: Castro
authors.forename: Elisabet
authors.initials: E
authors.lastname: Periche
authors.forename: Maria L
authors.initials: ML
authors.lastname: Carriò
authors.forename: Jacobo E
authors.initials: JE
authors.lastname: Toscano
authors.forename: Alain
authors.initials: A
authors.lastname: Pinseau
authors.forename: Casimiro
authors.initials: C
authors.lastname: Javierre
authors.forename: Josep L
authors.initials: JL
authors.lastname: Ventura
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011724:Pyridazines / Q000627:therapeutic use*; D012307:Risk Factors; D000077464:Simendan; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D010446:Peptide Fragments; D011724:Pyridazines; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D000077464:Simendan; D002097:C-Reactive Protein