GKD Anest Yoð Bak Dern Derg. 2018; 24(3): 111-117 | DOI: 10.5222/GKDAD.2018.06978

Kardiyak cerrahi sonrasý mortalite; BNP, EuroSCORE ve SOFA Skoru kýyaslanmasý

Ferda Fatma Kartufan, Kamil Karaoðlu
Ýstanbul Üniversitesi Kardiyoloji Enstitüsü, Anesteziyoloji ve Reanimasyon Ana Bilim Dalý, Ýstanbul

GÝRÝÞ ve AMAÇ: Kardiyak cerrahi sonrasý mortalite %2.94-%30.7 arasýndadýr. Elektif izole koroner arter bypass greft (CABG) operasyonu geçirmiþ hastalarýn preoperatif beyin natriüretik peptid (preBNP) düzeyleri ile 3 günlük Sequential Organ Failure Assessment (SOFA) ve maksimum SOFA skorlarýnýn uzun dönem mortalite tahminindeki anlamlýlýk ve ayrým güçlerini European System for Cardiac Operative Risk Evaluation (EuroSCORE) ile kýyaslamayý amaçladýk.
YÖNTEM ve GEREÇLER: Etik komite onaylý retrospektif çalýþmamýzda 2007-2009 yýllarýnda CABG olmuþ hastalarýn verileri tarandý. Kayýtlarda veya kan testlerinde eksik olan, acil, ek cerrahi veya farklý cerrahi teknik (off pump) uygulanan, düþük mobilizasyonlu, sol ventrikül fonksiyonu <30%, pulmoner hipertansiyonu olan, ameliyat sýrasý ve sonrasý ilk 60 günde kaybedilen hastalar çalýþmamýzdan dýþlanarak; 45-80 yaþ arasý, 173 hastadan 40 adedi çalýþmamýza alýndý. BNP ölçümleri preoperatif alýnmýþtý. EuroSCORE preoperatif verilerden bilgisayar ortamýnda hesaplandý. SOFA skorlarý postoperatif cerrahi ilk 24st (SOFA0), 24-48st (SOFA1) ve 48-72st (SOFA2) ve 3 günün maksimum SOFA deðeri (maxSOFA) hastalarýn yoðun bakým verilerinden hesaplandý.
SPSS 15.0 kullanýldý. Sonuçlar %95 güven aralýðýnda, anlamlýlýk p<0.05 olarak kabul edildi.

BULGULAR: SOFA1 kaybedilen olgularda yaþayanlara göre EuroSCORE’dan daha anlamlýdýr (sýrasýyla p<0.05, p=0.06). PreBNP ile SOFA1 (p<0.05), SOFA2 (p<0.01) ve EuroSCORE (p<0.01) arasýnda pozitif korelasyon vardýr.
SOFA1, ROC analizinde eðri altýnda kalan alana göre (EAA) mortalite tahmininde çok iyi (EAA: 0.764, p=0.02); EuroSCORE ise iyi (EAA: 0.727, p=0.05) olarak deðerlendirilmiþtir.
TARTIÞMA ve SONUÇ: Mortalite deðerlendirmesinde SOFA skoru ve preBNP kýyaslanmasý bildiðimiz kadarýyla literatürde yoktur. Yüksek SOFA skorlarý ve preBNP deðerleri CABG hastalarýnda mortaliteyle iliþkilidir.
Çalýþmamýzda CABG sonrasý uzun dönem mortalite deðerlendirmesinde SOFA1 diðer deðerlendirme yöntemlerine göre daha anlamlý bulunmuþtur.

Anahtar Kelimeler: Koroner Arter ByPass Grefti (CABG), mortalite, BNP, SOFA Skoru, EuroSCORE

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Mortality after cardiac surgery; a comparison of BNP, EuroSCORE and SOFA Score

Ferda Fatma Kartufan, Kamil Karaoðlu
Department of Anesthesiology and Reanimation, Istanbul University Institude of Cardiology, Istanbul, Turkey

INTRODUCTION: Mortality after cardiac surgery is between 2.94% and 30.7%. In our study, we aimed to compare the significance and the discrimination power of estimated long term mortality in patients who underwent elective isolated coronary artery bypass graft (CABG) operation with BNP; SOFA scores and EuroSCORE.

METHODS: Ethical committee approved our retrospective study. We searched 173 patients who underwent CABG between 2007 and 2009.
Lack of blood test results or patients records; emergent, additive surgery or different surgical technique( off-pump); weak mobilization; left ventricular function below 30%; pulmonary hipertension and mortality in operation theatre or within 60 days after surgery were discriminated.
40 patients were included. BNP blood tests were taken preoperatively. SOFA scores were measured from recorded datas of the patient’s in ICU(0-24hr SOFA0, 24-48hr SOFA1, 48-72hr SOFA2, maximum score of 3 days maxSOFA).
SPSS 15.0 was used. Obtained results were sustained within 95% confidence interval and the significance of p<0.05.
RESULTS: SOFA1 is more significant from EuroSCORE considering mortality of the patients ( SOFA1 p<0.05, EuroSCORE p=0.06). There is a positive correlation between preBNP and SOFA1 score (p<0.05), SOFA2 score (p<0.01) and EuroSCORE (p<0.01).
In mortality prediction, SOFA1 has evaluated as “better” and EuroSCORE as “good” according to ROC curve analysis (AUC: 0.764, p=0.02 and AUC: 0.727, p=0.05 respectively).
DISCUSSION AND CONCLUSION: In our study, we found that SOFA1 is more significant than the other mortality prediction methods in long term mortality of the patients who underwent isolated CABG.

Keywords: Coronary artery bypass graft (CABG), mortality, BNP, SOFA Score, EuroSCORE

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