• Aarne Jyrala, Robert E Weiss, Robin A Jeffries, and Gregory L Kay.
• Heart Institute at Good Samaritan Hospital, Department of Cardiothoracic Surgery, Los Angeles, USA. lathoracic@hotmail.com
• Interact Cardiovasc Thorac Surg. 2010 May 1;10(5):777-82.

ObjectivesThe objective of this study is to evaluate differences in patient presentation and short- and long-term outcomes between patients dichotomized by the level of preoperative s-creatinine (s-crea) without renal failure and to use EuroSCORE (ES) risk stratification for validating differences and for predictive purposes.MethodsA thousand consecutive cardiac surgery patients from January 1999 through May 2000 were analyzed. Patients with off-pump surgery or s-crea >200 micromol/l (>2.2 mg/dl) were excluded leaving 885 patients for analysis. Group 1 (n=703) had s-crea 0.5-1.2 mg/dl and Group 2 (n=182) had elevated s-crea 1.3-2.2 mg/dl but no renal insufficiency.ResultsGroup 2 patients were older (P<0.0001), had a higher percentage of males (P=0.008), had lower left ventricular ejection fraction (LVEF) (P=0.001), had higher New York Heart Association (NYHA) classification (P<0.0001), had more diabetics (P=0.001) and had more patients with a history of congestive heart failure (CHF) (P<0.0001). Both additive ES (AES) and logistic ES (LES) variables were higher in Group 2 patients, AES 8.45+/-4.28% vs. 6.05+/-3.80% (P<0.0001) and LES 17.7+/-19.1% vs. 9.57+/-13.3% (P<0.0001). Proportions of emergency operations and use of intra-aortic balloon pulsation (IABP) support did not differ. There were more coronary artery bypass grafting (CABG) with or without concomitant procedures in Group 1 but otherwise the procedures performed were similar. Cardiopulmonary bypass (CPB) times did not differ (P=0.1). Operative mortality was similar (P=0.06) but hospital mortality was higher in Group 2: 19/10.4% vs. 25/3.6% (P<0.0001), odds ratio (OR) 3.16. Total length of stay (LOS) and length of stay in the postoperative intensive care unit (ICU) did not differ. Postoperative renal failure (PORF) (s-crea increase to >2.25 mg/dl or >200 micromol/l) developed in 38/4.5% patients in Group 1 and in 41/22.5% patients in Group 2 (P<0.0001), OR=5.08. Follow-up all-cause mortality was higher in Group 2: 68/37.4% vs. 167/23.8% (P<0.0001), OR=1.91. Both ES definitions predicted hospital mortality, LOS, ICU, PORF and long-term mortality well, while increased s-crea predicted PORF and long-term mortality in both groups.ConclusionsMild increase in s-crea is a marker for patients with increased cardiac risk factors and the risk for poor outcomes. Both ES definitions are highly predictive of the outcomes.2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

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