GKD Anest Yoð Bak Dern Derg. 2022; 28(1): 1-6 | DOI: 10.14744/GKDAD.2022.34735

Kardiak Cerrahi Sonrasý FIB-4 Ýndeks Deðerinin Morbidite ve Erken Mortalite ile Ýliþkisi: Retrospektif Çalýþma

Hülya Yýlmaz Ak¹, Yasemin Özþahin², Mehmet Ali Yeþiltaþ³, Kerem Erkalp², Ziya Salihoðlu², Barýþ Sandal^4
1Kartal Dr. Lütfi Kýrdar Eðitim ve Araþtýrma Hastanesi, Anestezi ve Reanimasyon Ana Bilimdalý, Ýstanbul, Türkiye
²Ýstanbul Üniversitesi-Cerrahpasa, Kardiyoloji Enstitüsü, Anestezi ve Reanimasyon Ana Bilimdalý, Istanbul, Türkiye
³Bakýrköy Dr. Sadi Konuk Eðitim ve Araþtýrma Hastanesi, Kalp ve Damar Cerrahisi Kliniði, Ýstanbul, Türkiye
⁴Istanbul Üniversitesi-Cerrahpasa, Bioistatistk Ana Bilimdalý, Ýstanbul, Türkiye

Amaç: Kardiyopulmoner baypas yapýlan hastalarýn %10'unda bir miktar karaciðer hasarý görülmektedir. Fibrozis-4 (FIB-4) indeksi, karaciðer yet-mezliðini ve karaciðer fibrozunu saptamak için noninvaziv bir puanlama yöntemidir. Bu çalýþmada, kalp cerrahisi hastalarýnda ameliyat sonrasý er-ken dönemde ölçülen FIB-4 indeks deðeri deðiþikliklerinin morbidite ve erken mortalite üzerine etkisinin incelenmesi amaçlandý.
Yöntem: Son iki yýlda (2020-2021) standart sternotomi ile elektif koroner arter baypas greft cerrahisi geçiren 80 yaþýn altýndaki hastalar çalýþmaya alýndý. Çalýþmada ameliyat öncesi ve ameliyat sonrasý dönemde ölçülen FIB-4 indeksinin ameliyat öncesi ve ameliyat sonrasý dönemdeki deðiþi-mi deðerlendirildi. Hastalarýn demografik deðerleri, perioperatif kompli-kasyonlar, kanama miktarý, verilen toplam sývý miktarý ve kardiyovasküler baypas sýrasýndaki kan gazý deðerleri kaydedildi.
Bulgular: Hastalar, FIB-4 indeksi 3,25'in altýnda (Grup 1) ve üstünde (Grup 2) olanlar olarak iki gruba ayrýldý. Grup 1 41 (%27,2) hastadan, grup 2 ise 110 (%72,8) hastadan oluþuyordu. Ortalama entübasyon süresi grup 2'de daha yüksek olmasýna raðmen gruplar arasýnda anlamlý fark bulunmadý. Yoðun bakýmda kalýþ süresi grup 2'de anlamlý olarak daha yüksekti (p=0,033). Otuz günlük mortalite karþýlaþtýrýldýðýnda gruplar ara-sýnda fark bulunmadý (p=0,684).
Sonuç: Kalp cerrahisi için önemli bir morbidite kriteri olan FIB-4 indeksi yüksek olan hastalarýn yoðun bakýmda kalýþ süresinin daha uzun olduðu görüldü. Kalp cerrahisi hastalarýnda morbiditeyi tahmin etmede posto-peratif dönem FIB-4 indeksinin etkili olabileceðini düþünüyoruz.

Anahtar Kelimeler: Fibrozis, fibrozis 4 indeksi, hepatik yetmezlik, kardi-yopulmoner bypass, karaciðer enzimleri

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The Relationship of Post-Operative FIB-4 Index Value with Morbidity and Early Mortality in Cardiac Surgery: A Retrospective Study

Hülya Yýlmaz Ak¹, Yasemin Özþahin², Mehmet Ali Yeþiltaþ³, Kerem Erkalp², Ziya Salihoðlu², Barýþ Sandal^4
1Department of Anesthesiology and Reanimation, Kartal Dr. Lütfi Kirdar Training and Research Hospital, Istanbul, Turkey
²Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpasa, Institute of Cardiology, Istanbul, Turkey
³Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
⁴Department of Biostatistics, Istanbul University-Cerrahpasa, Istanbul, Turkey

Objectives: Hepatic injury is seen in 10% of patients who underwent cardiopulmonary bypass (CPB). The fibrosis-4 (FIB-4) index is a non-in-vasive scoring method for detecting liver failure and liver fibrosis. We aimed to examine the effect of FIB-4 index value changes, which is mea-sured in the early post-operative period, on morbidity and early mortal-ity in cardiac surgery patients.
Methods: All patients had undergone elective coronary artery bypass graft surgery with standard sternotomy in the 2 years and were included in the study. In our study, the change in the pre- and post-operative period of the FIB-4 index, which was calculated in the pre-operative and post-op-erative period, was examined. Patients’ demographic values, perioperative complications, amount of bleeding, total amount of fluid administered, and blood gas during cardiovascular bypass values were recorded.
Results: Patients were divided into two groups as those with FIB-4 index below 3.25 (Group 1) and above (Group 2). Group 1 consisted of 41 (27.2%) patients and Group 2 consisted of 110 (72.8%) patients. Although the mean time to intubate was higher in Group 2, no significant difference was found between the groups. The length of stay in the intensive care unit was significantly higher in Group 2 (p=0.033). When the 30-day mortality was compared, no difference was found between the groups (p=0.684).
Conclusion: It was observed that patients with high FIB-4 index have longer intensive care unit stay, which is an important morbidity criterion for cardiac surgery. We think that the post-operative period FIB-4 index may be effective in estimating morbidity in cardiac surgery patients.

Keywords: Cardiopulmonary bypass, FIB-4, fibrosis, hepatic failure, liver enzymes

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