Prognostic value of postoperative proteinuria in cardiac surgery

A pilot study

Keyvan Karkouti*, Shahriar Shayan, Duminda N. Wijeysundera, Stuart A. McCluskey, Mohammed Ghannam, W. Scott Beattie

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Proteinuria is a non-specific marker of inflammation that may reflect the glomerular component of systemic capillary leak. The objective of this pilot study was to determine if postoperative proteinuria is associated with adverse outcomes following cardiac surgery with cardiopulmonary bypass. Methods: Eligible patients were in dividuals undergoing cardiac surgery with cardiopulmonary bypass who did not have severe pre-existing renal dysfunction. Urine was collected after induction of anesthesia (baseline) and two to four hours after arrival to the intensive care unit (ICU). Proteinuria was measured as random protein creatinine ratio in g·mol-1. Adverse events were defined a priori as prolonged ICU stay (≥ 90th percentile) and organ dysfunction. The relationship between proteinuria and adverse events was assessed by bivariate (Chi-square or Fisher's exact tests) and multivariable (multiple logistic regression) analyses. Results: The study included 197 (of 243 eligible) patients. Postoperative proteinuria (protein creatinine ratio ≥ 30 g·mol-1) was associated with prolonged (≥ four days) ICU stay [odds ratio (OR) 7.0; 95% confidence interval (CI) 2.8-17.1] and organ dysfunction (OR 3.9; CI 1.9-8.1). After adjustment for confounders, proteinuria was associated with a 3.2-fold increase in the odds of both prolonged ICU stay (CI 1.1-9.7) and organ dysfunction (CI 1.4-7.0). Conclusions: Proteinuria two to four hours after cardiac surgery with cardiopulmonary bypass may be a useful marker for systemic capillary leak and adverse postoperative events. Large prospective studies are needed to confirm these findings.

Original languageEnglish (US)
Pages (from-to)500-506
Number of pages7
JournalCanadian Journal of Anesthesia
Volume53
Issue number5
DOIs
StatePublished - May 1 2006

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Proteinuria
Thoracic Surgery
Intensive Care Units
Cardiopulmonary Bypass
Confidence Intervals
Creatinine
Odds Ratio
Proteins
Anesthesia
Logistic Models
Regression Analysis
Urine
Prospective Studies
Inflammation
Kidney

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Karkouti, K., Shayan, S., Wijeysundera, D. N., McCluskey, S. A., Ghannam, M., & Beattie, W. S. (2006). Prognostic value of postoperative proteinuria in cardiac surgery: A pilot study. Canadian Journal of Anesthesia, 53(5), 500-506. https://doi.org/10.1007/BF03022624
Karkouti, Keyvan ; Shayan, Shahriar ; Wijeysundera, Duminda N. ; McCluskey, Stuart A. ; Ghannam, Mohammed ; Beattie, W. Scott. / Prognostic value of postoperative proteinuria in cardiac surgery : A pilot study. In: Canadian Journal of Anesthesia. 2006 ; Vol. 53, No. 5. pp. 500-506.
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abstract = "Background: Proteinuria is a non-specific marker of inflammation that may reflect the glomerular component of systemic capillary leak. The objective of this pilot study was to determine if postoperative proteinuria is associated with adverse outcomes following cardiac surgery with cardiopulmonary bypass. Methods: Eligible patients were in dividuals undergoing cardiac surgery with cardiopulmonary bypass who did not have severe pre-existing renal dysfunction. Urine was collected after induction of anesthesia (baseline) and two to four hours after arrival to the intensive care unit (ICU). Proteinuria was measured as random protein creatinine ratio in g·mol-1. Adverse events were defined a priori as prolonged ICU stay (≥ 90th percentile) and organ dysfunction. The relationship between proteinuria and adverse events was assessed by bivariate (Chi-square or Fisher's exact tests) and multivariable (multiple logistic regression) analyses. Results: The study included 197 (of 243 eligible) patients. Postoperative proteinuria (protein creatinine ratio ≥ 30 g·mol-1) was associated with prolonged (≥ four days) ICU stay [odds ratio (OR) 7.0; 95{\%} confidence interval (CI) 2.8-17.1] and organ dysfunction (OR 3.9; CI 1.9-8.1). After adjustment for confounders, proteinuria was associated with a 3.2-fold increase in the odds of both prolonged ICU stay (CI 1.1-9.7) and organ dysfunction (CI 1.4-7.0). Conclusions: Proteinuria two to four hours after cardiac surgery with cardiopulmonary bypass may be a useful marker for systemic capillary leak and adverse postoperative events. Large prospective studies are needed to confirm these findings.",
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Karkouti, K, Shayan, S, Wijeysundera, DN, McCluskey, SA, Ghannam, M & Beattie, WS 2006, 'Prognostic value of postoperative proteinuria in cardiac surgery: A pilot study', Canadian Journal of Anesthesia, vol. 53, no. 5, pp. 500-506. https://doi.org/10.1007/BF03022624

Prognostic value of postoperative proteinuria in cardiac surgery : A pilot study. / Karkouti, Keyvan; Shayan, Shahriar; Wijeysundera, Duminda N.; McCluskey, Stuart A.; Ghannam, Mohammed; Beattie, W. Scott.

In: Canadian Journal of Anesthesia, Vol. 53, No. 5, 01.05.2006, p. 500-506.

Research output: Contribution to journalArticle

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T2 - A pilot study

AU - Karkouti, Keyvan

AU - Shayan, Shahriar

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AU - Ghannam, Mohammed

AU - Beattie, W. Scott

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N2 - Background: Proteinuria is a non-specific marker of inflammation that may reflect the glomerular component of systemic capillary leak. The objective of this pilot study was to determine if postoperative proteinuria is associated with adverse outcomes following cardiac surgery with cardiopulmonary bypass. Methods: Eligible patients were in dividuals undergoing cardiac surgery with cardiopulmonary bypass who did not have severe pre-existing renal dysfunction. Urine was collected after induction of anesthesia (baseline) and two to four hours after arrival to the intensive care unit (ICU). Proteinuria was measured as random protein creatinine ratio in g·mol-1. Adverse events were defined a priori as prolonged ICU stay (≥ 90th percentile) and organ dysfunction. The relationship between proteinuria and adverse events was assessed by bivariate (Chi-square or Fisher's exact tests) and multivariable (multiple logistic regression) analyses. Results: The study included 197 (of 243 eligible) patients. Postoperative proteinuria (protein creatinine ratio ≥ 30 g·mol-1) was associated with prolonged (≥ four days) ICU stay [odds ratio (OR) 7.0; 95% confidence interval (CI) 2.8-17.1] and organ dysfunction (OR 3.9; CI 1.9-8.1). After adjustment for confounders, proteinuria was associated with a 3.2-fold increase in the odds of both prolonged ICU stay (CI 1.1-9.7) and organ dysfunction (CI 1.4-7.0). Conclusions: Proteinuria two to four hours after cardiac surgery with cardiopulmonary bypass may be a useful marker for systemic capillary leak and adverse postoperative events. Large prospective studies are needed to confirm these findings.

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