Dissertação
Uso de um escore derivado do hemograma na predição de risco de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea
Fecha
2015-04-29Registro en:
RÖDEL, Ana Paula Porto. USEFULNESS OF COMPLETE BLOOD COUNT-DERIVED SCORE IN PATIENTS UNDERGOING CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS. 2015. 85 f. Dissertação (Mestrado em Farmacologia) - Universidade Federal de Santa Maria, Santa Maria, 2015.
Autor
Rödel, Ana Paula Porto
Institución
Resumen
Some CBC parameters have been implicated in individual susceptibility to
death, both in heart disease and cardiac surgery populations. The cellular elements
of blood are widely affected during cardiopulmonary bypass (CPB), technique used in
cardiac surgery. A Complete Blood Count called Risk Score (CBC-RS) was
calculated from the average of the deviations of the various elements of the CBC and
has been previously validated and published. The CBC-RS showed as excellent
predictor of death from all causes in large healthy and cardiovascular risk
populations. Despite the effect of CPB on the blood cells, there is no
acknowledgement from the prior assessment of this score in the surgical setting. The
aim of this study was to evaluate the role of CBC-RS in the surgical risk prediction
(mortality and morbidity) in patients undergoing cardiac surgery with CPB. For this, it
was evaluated a historical cohort of 428 patients undergoing cardiac surgery with
CPB. The individual CBC-RS was calculated using the collected blood count of
patients preoperatively. Logistic regression and statistical C analyzed the predictive
accuracy of this score. The primary endpoint was in-hospital mortality (all-cause) and
secondary outcomes included the majors and bleeding complications. In our study,
CBC-RS was a predictor of hospital mortality (OR = 1.28 for each score increments,
95% CI = 1123-1458, p <0.001) and secondary outcomes (OR = 1.208, 95% CI =
1.103 to 1.323, p <0.001). The areas under the curve (AUC) was 0.697 (p <0.001)
and 0.636 (p <0.001) for both the primary and secondary endpoints, respectively. In
multivariate analysis, after adjustment for other risk predictors (EuroSCORE II and
CPB time), the CBC-RS remained significant and was the strongest predictor of
mortality. Therefore, the CBC-RS proved to be an independent predictor of mortality
and surgical complications during hospitalization. It may be a useful tool in risk
assessment of patients undergoing cardiac surgery.