Açýk Kalp Cerrahisinde Diyabetik Hastalarda Preoperatif Albümin Deðerinin Renal Fonksiyon Üzerine Etkisi

GÝRÝÞ ve AMAÇ: Açýk kalp cerrahisinde albümin düþüklüðü postoperatif dönemde mortalite ve morbiditeyi arttýran önemli bir risk faktörüdür. Diyabet proetinüri ile albümin kaybýna neden olarak bu klinik durumu etkileyebilir. Bu çalýþmada preoperatif albümin deðerlerinin ve diyabet mellitus (DM) varlýðýnýn postoperatif renal yetmezlik üzerine etkileri araþtýrýldý.
YÖNTEM ve GEREÇLER: Kliniðimizde 01.01.2015-31.12.2019 tarihleri arasýnda kardiyopulmoner baypas eþliðinde koroner arter baypas cerrahisi yapýlan hastalar retrospektif olarak incelendi. Preoperatif dönemde diyaliz tedavisi alan, ejeksiyon fraksiyonu %50’nin altýnda olan ve acil cerrahi yapýlan hastalar çalýþma dýþýnda býrakýldý. Hastalar ameliyat öncesi serum albümin seviyelerine göre 3 gruba ayrýldý. Serum albümin düzeyi ≥3,5 mgr/dl olan hastalar Grup 1; 2,5-3,5 mgr/dl arasýnda olanlar Grup 2; ≤ 2,5 olan hastalar Grup 3 olarak adlandýrýldý. Daha sonra bu 3 grup DM varlýðýna göre 2 alt gruba ayrýldý.
BULGULAR: Çalýþma periyodunda koroner arter baypas cerrahisi uygulanan 308 hasta çalýþmaya dahil edildi. Hastalarýn demografik özellikleri, peroperatif verileri ve operatif verileri benzerdi. Postoperatif dönemde renal replasman tedavisi gereksinimi ise Grup 2 ve Grup 3’de Grup1’e oranla daha yüksek idi.
TARTIÞMA ve SONUÇ: Preoperatif serum albümin düþüklüðü postoperatif dönemde akut bmbrek yetmezliði geliþimi için bir risk aktörü olup, DM varlýðý bu durumu olumsuz etkiler. Postoperatif dönemde bu hastalarýn yakýn takibi mortalite ve morbiditeyi azaltmaya olumlu katký saðlar.

The Effect Of Preoperative Albumin Level on Renal Function In Diabetic Patients in Cardiac Surgery

INTRODUCTION: In cardiac surgery, low serum albumin level is an important risk factor that increases mortality and morbidity in the postoperative period. Diabetes mellitus may affect this clinical condition by causing albumin loss with proetinuria. In this study, the effects of preoperative albumin values and the presence of diabetes mellitus (DM) on postoperative renal failure were investigated.
METHODS: Patients who underwent coronary artery bypass grafting between 01.01.2015-31.12.2019 in our clinic were retrospectively analyzed. Patients who received dialysis treatment in the preoperative period, whose ejection fraction was below 50%, and who underwent emergency surgery were excluded from the study. The patients were divided into 3 groups according to the serum albumin levels before surgery. Patients with serum albumin level ≥3.5 mgr / dl Group 1; those between 2.5-3.5 mg / dl Group 2; patients with ≤ 2.5 were named as Group 3. Later, these 3 groups were divided into 2 subgroups according to the presence of DM.
RESULTS: 308 patients who underwent coronary artery bypass surgery were included in the study. The demographic characteristics, peroperative data and operative data of the patients were similar. The need for renal replacement therapy was higher in Group 2 and Group 3 than in Group 1 in the postoperative period.
DISCUSSION AND CONCLUSION: Preoperative low serum albumin is a risk factor for the development of acute renal failure in the postoperative period, and the presence of DM adversely affects this condition. Close follow-up of these patients positively contributes to reducing mortality and morbidity.