Predictive value of preoperative uric acid on postoperative prolonged mechanical ventilation in patients undergoing mechanical heart valve replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Xin , ZHANG Chengxin , DONG Wenpeng ,  GE Shenglin

Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, P.R.China;

Corresponding author：

GE Shenglin, Email: aydgsl@sina.com

Keywords：

Uric acid; mechanical ventilation; valve replacement; logistic regression; receiver operating characteristic curve

DOI：

10.7507/1007-4848.201806035

Video：

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Objective To investigate the association of preoperative serum uric acid (UA) levels with postoperative prolonged mechanical ventilation (PMV) in patients undergoing mechanical heart valve replacement.Methods Clinical data of 311 patients undergoing mechanical heart valve replacement in The First Affiliated Hospital of Anhui Medical University from January 2017 to December 2017 were retrospectively analyzed. There were 164 males at age of 55.6±11.4 years and 147 females at age of 54.2±9.8 years. The patients were divided into a PMV group (>48 h) and a control group according to whether the duration of PMV was longer than 48 hours. Spearman's rank correlation coefficient and logistic regression analysis were conducted to evaluate the relationship between preoperative UA and postoperative PMV. The predictive value of UA for PMV was undertaken using the receiver operating characteristic (ROC) curve..Results Among 311 patients, 38 (12.2%) developed postoperative PMV. Preoperative serum UA level mean values were 6.11±1.94 mg/dl, while the mean UA concentration in the PMV group was significantly higher than that in the control group (7.48±2.24 mg/dl vs. 5.92±1.82 mg/dl, P<0.001). Rank correlation analysis showed that UA was positively correlated with postoperative PMV (r_s=0.205, P<0.001). Multivariate logistic regression analysis demonstrated that preoperative elevated UA was associated independently with postoperative PMV with odds ratio (OR)=1.44 and confidence interval (CI) 1.15–1.81 (P=0.002). The area under the ROC curve of UA predicting PMV was 0.72, 95% CI0.635–0.806, 6.40 mg/dl was the optimal cut-off value, and the sensitivity and specificity was 76.3% and 63.0% at this time, respectively.Conclusion Preoperative elevated serum UA is an independent risk factor for postoperative PMV in patients undergoing mechanical heart valve replacement and has a good predictive value.

Citation： LI Xin, ZHANG Chengxin, DONG Wenpeng, GE Shenglin. Predictive value of preoperative uric acid on postoperative prolonged mechanical ventilation in patients undergoing mechanical heart valve replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(4): 332-337. doi: 10.7507/1007-4848.201806035 Copy

1.	Fernandez-Zamora MD, Gordillo-Brenes A, Banderas-Bravo E, et al. Prolonged mechanical ventilation as a predictor of mortality after cardiac surgery. Respir Care, 2018, 63(5): 550-557.
2.	He S, Chen B, Li W, et al. Ventilator-associated pneumonia after cardiac surgery: a meta-analysis and systematic review. J Thorac Cardiovasc Surg, 2014, 148(6): 3148-3155.e3141-3145.
3.	Vora CS, Karnik ND, Gupta V, et al. Clinical profile of patients requiring prolonged mechanical ventilation and their outcome in a tertiary care medical ICU. J Assoc Physicians India, 2015, 63(10): 14-19.
4.	Loss SH, de Oliveira RP, Maccari JG, et al. The reality of patients requiring prolonged mechanical ventilation: a multicenter study. Rev Bras Ter Intensiva, 2015, 27(1): 26-35.
5.	Lazzeroni D, Bini M, Camaiora U, et al. Serum uric acid level predicts adverse outcomes after myocardial revascularization or cardiac valve surgery. Eur J Prev Cardiol, 2018, 25(2): 119-126.
6.	Holme I, Aastveit AH, Hammar N, et al. Uric acid and risk of myocardial infarction, stroke and congestive heart failure in 417,734 men and women in the Apolipoprotein MOrtality RISk study (AMORIS). J Intern Med, 2009, 266(6): 558-570.
7.	Anker SD, Doehner W, Rauchhaus M, et al. Uric acid and survival in chronic heart failure: validation and application in metabolic, functional, and hemodynamic staging. Circulation, 2003, 107(15): 1991-1997.
8.	Lapsia V, Johnson RJ, Dass B, et al. Elevated uric acid increases the risk for acute kidney injury. Am J Med, 2012, 125(3): 302.e309-317.
9.	Joung KW, Jo JY, Kim WJ, et al. Association of preoperative uric acid and acute kidney injury following cardiovascular surgery. J Cardiothorac Vasc Anesth, 2014, 28(6): 1440-1447.
10.	Lee EH, Choi JH, Joung KW, et al. Relationship between serum uric acid concentration and acute kidney injury after coronary artery bypass surgery. J Korean Med Sci, 2015, 30(10): 1509-1516.
11.	Oura K, Morisawa T, Kamisaka K, et al. Determinants of prolonged mechanical ventilation after cardiac surgery. Kyobu Geka, 2014, 67(7): 528-532.
12.	Bartz RR, Ferreira RG, Schroder JN, et al. Prolonged pulmonary support after cardiac surgery: incidence, risk factors and outcomes: a retrospective cohort study. J Crit Care, 2015, 30(5): 940-944.
13.	Sharma V, Rao V, Manlhiot C, et al. A derived and validated score to predict prolonged mechanical ventilation in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg, 2017, 153(1): 108-115.
14.	LoCicero J, 3rd, McCann B, Massad M, et al. Prolonged ventilatory support after open-heart surgery. Crit Care Med, 1992, 20(7): 990-992.
15.	Kataoka H, Yang K, Rock KL. The xanthine oxidase inhibitor Febuxostat reduces tissue uric acid content and inhibits injury-induced inflammation in the liver and lung. Eur J Pharmacol, 2015, 746: 174-179.
16.	Jeha S. Tumor lysis syndrome. Semin Hematol, 2001, 38(4 Suppl 10): 4-8.
17.	Martinon F, Petrilli V, Mayor A, et al. Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature, 2006, 440(7081): 237-241.
18.	Amaral FA, Costa VV, Tavares LD, et al. NLRP3 inflammasome-mediated neutrophil recruitment and hypernociception depend on leukotriene B(4) in a murine model of gout. Arthritis Rheum, 2012, 64(2): 474-484.
19.	Li Y, Li H, Liu S, et al. Pirfenidone ameliorates lipopolysaccharide-induced pulmonary inflammation and fibrosis by blocking NLRP3 inflammasome activation. Mol Immunol, 2018, 99: 134-144.
20.	Ruggiero C, Cherubini A, Miller E, 3rd, et al. Usefulness of uric acid to predict changes in C-reactive protein and interleukin-6 in 3-year period in Italians aged 21 to 98 years. Am J Cardiol, 2007, 100(1): 115-121.
21.	Aida Y, Shibata Y, Osaka D, et al. The relationship between serum uric acid and spirometric values in participants in a health check: the Takahata study. Int J Med Sci, 2011, 8(6): 470-478.

1. Fernandez-Zamora MD, Gordillo-Brenes A, Banderas-Bravo E, et al. Prolonged mechanical ventilation as a predictor of mortality after cardiac surgery. Respir Care, 2018, 63(5): 550-557.
2. He S, Chen B, Li W, et al. Ventilator-associated pneumonia after cardiac surgery: a meta-analysis and systematic review. J Thorac Cardiovasc Surg, 2014, 148(6): 3148-3155.e3141-3145.
3. Vora CS, Karnik ND, Gupta V, et al. Clinical profile of patients requiring prolonged mechanical ventilation and their outcome in a tertiary care medical ICU. J Assoc Physicians India, 2015, 63(10): 14-19.
4. Loss SH, de Oliveira RP, Maccari JG, et al. The reality of patients requiring prolonged mechanical ventilation: a multicenter study. Rev Bras Ter Intensiva, 2015, 27(1): 26-35.
5. Lazzeroni D, Bini M, Camaiora U, et al. Serum uric acid level predicts adverse outcomes after myocardial revascularization or cardiac valve surgery. Eur J Prev Cardiol, 2018, 25(2): 119-126.
6. Holme I, Aastveit AH, Hammar N, et al. Uric acid and risk of myocardial infarction, stroke and congestive heart failure in 417,734 men and women in the Apolipoprotein MOrtality RISk study (AMORIS). J Intern Med, 2009, 266(6): 558-570.
7. Anker SD, Doehner W, Rauchhaus M, et al. Uric acid and survival in chronic heart failure: validation and application in metabolic, functional, and hemodynamic staging. Circulation, 2003, 107(15): 1991-1997.
8. Lapsia V, Johnson RJ, Dass B, et al. Elevated uric acid increases the risk for acute kidney injury. Am J Med, 2012, 125(3): 302.e309-317.
9. Joung KW, Jo JY, Kim WJ, et al. Association of preoperative uric acid and acute kidney injury following cardiovascular surgery. J Cardiothorac Vasc Anesth, 2014, 28(6): 1440-1447.
10. Lee EH, Choi JH, Joung KW, et al. Relationship between serum uric acid concentration and acute kidney injury after coronary artery bypass surgery. J Korean Med Sci, 2015, 30(10): 1509-1516.
11. Oura K, Morisawa T, Kamisaka K, et al. Determinants of prolonged mechanical ventilation after cardiac surgery. Kyobu Geka, 2014, 67(7): 528-532.
12. Bartz RR, Ferreira RG, Schroder JN, et al. Prolonged pulmonary support after cardiac surgery: incidence, risk factors and outcomes: a retrospective cohort study. J Crit Care, 2015, 30(5): 940-944.
13. Sharma V, Rao V, Manlhiot C, et al. A derived and validated score to predict prolonged mechanical ventilation in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg, 2017, 153(1): 108-115.
14. LoCicero J, 3rd, McCann B, Massad M, et al. Prolonged ventilatory support after open-heart surgery. Crit Care Med, 1992, 20(7): 990-992.
15. Kataoka H, Yang K, Rock KL. The xanthine oxidase inhibitor Febuxostat reduces tissue uric acid content and inhibits injury-induced inflammation in the liver and lung. Eur J Pharmacol, 2015, 746: 174-179.
16. Jeha S. Tumor lysis syndrome. Semin Hematol, 2001, 38(4 Suppl 10): 4-8.
17. Martinon F, Petrilli V, Mayor A, et al. Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature, 2006, 440(7081): 237-241.
18. Amaral FA, Costa VV, Tavares LD, et al. NLRP3 inflammasome-mediated neutrophil recruitment and hypernociception depend on leukotriene B(4) in a murine model of gout. Arthritis Rheum, 2012, 64(2): 474-484.
19. Li Y, Li H, Liu S, et al. Pirfenidone ameliorates lipopolysaccharide-induced pulmonary inflammation and fibrosis by blocking NLRP3 inflammasome activation. Mol Immunol, 2018, 99: 134-144.
20. Ruggiero C, Cherubini A, Miller E, 3rd, et al. Usefulness of uric acid to predict changes in C-reactive protein and interleukin-6 in 3-year period in Italians aged 21 to 98 years. Am J Cardiol, 2007, 100(1): 115-121.
21. Aida Y, Shibata Y, Osaka D, et al. The relationship between serum uric acid and spirometric values in participants in a health check: the Takahata study. Int J Med Sci, 2011, 8(6): 470-478.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Predictive value of preoperative uric acid on postoperative prolonged mechanical ventilation in patients undergoing mechanical heart valve replacement

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