Perioperative risk predictors of cardiac outcomes in patients undergoing liver transplantation surgery

Anas Safadi, Mohamed Homsi, Waddah Maskoun, Kathleen A. Lane, Inder Singh, Stephen Sawada, Jo Mahenthiran

Research output: Contribution to journalArticle

99 Citations (Scopus)

Abstract

BACKGROUND-: Cardiac risk assessment for perioperative outcomes of liver transplantation patients is limited. We examined the outcomes of an older intermediate-cardiac-risk group of patients undergoing liver transplantation surgery. METHODS AND RESULTS-: Patients who had liver transplantation surgery between 2001 and 2005 were studied. The 3 outcomes analyzed were nonfatal myocardial infarction, death, and either outcome within the first 30 days after the liver transplantation surgery. Of 403 patients (mean age, 52±9 years; 67% male), 106 (26%) were diabetic, 84 (21%) were hypertensive, and 173 (43%) had a history of smoking. There were 48 total events (12%), 25 myocardial infarctions (7%), and 38 deaths (9%) recorded during the perioperative period. From the final multivariate model, history of coronary artery disease, prior stroke, and postoperative sepsis predicted greater risk (P=0.014; odds ratio [OR], 4.0; 95% confidence interval [CI], 1.3 to 11.8; P=0.025; OR, 6.6; 95% CI, 1.3 to 33.8; and P<0.001; OR, 7.5; 95% CI, 3.3 to 17.1, respectively). Use of perioperative β-blockers was protective (P=0.004; OR, 0.20; 95% CI, 0.1 to 0.6) for combined cardiac outcomes. For the outcome of death on multivariate analysis, postoperative sepsis and increased interventricular septal thickness predicted risk (P<0.001; OR, 8.6; 95% CI, 3.5 to 20.9; and P=0.027; OR, 2.8; 95% CI, 1.1 to 7.2, respectively), whereas the use of perioperative β-blockers was again protective (P=0.012; OR, 0.07; 95% CI, 0.01 to 0.56). CONCLUSIONS-: In our study of cardiac risk assessment for liver transplantation surgery, history of stroke, coronary artery disease, postoperative sepsis, and increased interventricular septal thickness were markers of adverse perioperative cardiac outcomes, whereas use of perioperative β-blockers was significantly protective.

Original languageEnglish
Pages (from-to)1189-1194
Number of pages6
JournalCirculation
Volume120
Issue number13
DOIs
StatePublished - Sep 2009

Fingerprint

Liver Transplantation
Odds Ratio
Confidence Intervals
Sepsis
Coronary Artery Disease
Stroke
Myocardial Infarction
Perioperative Period
Multivariate Analysis
Smoking

Keywords

  • Echocardiography
  • Liver
  • Prognosis
  • Risk factors
  • Surgery
  • Transplantation

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Perioperative risk predictors of cardiac outcomes in patients undergoing liver transplantation surgery. / Safadi, Anas; Homsi, Mohamed; Maskoun, Waddah; Lane, Kathleen A.; Singh, Inder; Sawada, Stephen; Mahenthiran, Jo.

In: Circulation, Vol. 120, No. 13, 09.2009, p. 1189-1194.

Research output: Contribution to journalArticle

Safadi, Anas ; Homsi, Mohamed ; Maskoun, Waddah ; Lane, Kathleen A. ; Singh, Inder ; Sawada, Stephen ; Mahenthiran, Jo. / Perioperative risk predictors of cardiac outcomes in patients undergoing liver transplantation surgery. In: Circulation. 2009 ; Vol. 120, No. 13. pp. 1189-1194.
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abstract = "BACKGROUND-: Cardiac risk assessment for perioperative outcomes of liver transplantation patients is limited. We examined the outcomes of an older intermediate-cardiac-risk group of patients undergoing liver transplantation surgery. METHODS AND RESULTS-: Patients who had liver transplantation surgery between 2001 and 2005 were studied. The 3 outcomes analyzed were nonfatal myocardial infarction, death, and either outcome within the first 30 days after the liver transplantation surgery. Of 403 patients (mean age, 52±9 years; 67{\%} male), 106 (26{\%}) were diabetic, 84 (21{\%}) were hypertensive, and 173 (43{\%}) had a history of smoking. There were 48 total events (12{\%}), 25 myocardial infarctions (7{\%}), and 38 deaths (9{\%}) recorded during the perioperative period. From the final multivariate model, history of coronary artery disease, prior stroke, and postoperative sepsis predicted greater risk (P=0.014; odds ratio [OR], 4.0; 95{\%} confidence interval [CI], 1.3 to 11.8; P=0.025; OR, 6.6; 95{\%} CI, 1.3 to 33.8; and P<0.001; OR, 7.5; 95{\%} CI, 3.3 to 17.1, respectively). Use of perioperative β-blockers was protective (P=0.004; OR, 0.20; 95{\%} CI, 0.1 to 0.6) for combined cardiac outcomes. For the outcome of death on multivariate analysis, postoperative sepsis and increased interventricular septal thickness predicted risk (P<0.001; OR, 8.6; 95{\%} CI, 3.5 to 20.9; and P=0.027; OR, 2.8; 95{\%} CI, 1.1 to 7.2, respectively), whereas the use of perioperative β-blockers was again protective (P=0.012; OR, 0.07; 95{\%} CI, 0.01 to 0.56). CONCLUSIONS-: In our study of cardiac risk assessment for liver transplantation surgery, history of stroke, coronary artery disease, postoperative sepsis, and increased interventricular septal thickness were markers of adverse perioperative cardiac outcomes, whereas use of perioperative β-blockers was significantly protective.",
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T1 - Perioperative risk predictors of cardiac outcomes in patients undergoing liver transplantation surgery

AU - Safadi, Anas

AU - Homsi, Mohamed

AU - Maskoun, Waddah

AU - Lane, Kathleen A.

AU - Singh, Inder

AU - Sawada, Stephen

AU - Mahenthiran, Jo

PY - 2009/9

Y1 - 2009/9

N2 - BACKGROUND-: Cardiac risk assessment for perioperative outcomes of liver transplantation patients is limited. We examined the outcomes of an older intermediate-cardiac-risk group of patients undergoing liver transplantation surgery. METHODS AND RESULTS-: Patients who had liver transplantation surgery between 2001 and 2005 were studied. The 3 outcomes analyzed were nonfatal myocardial infarction, death, and either outcome within the first 30 days after the liver transplantation surgery. Of 403 patients (mean age, 52±9 years; 67% male), 106 (26%) were diabetic, 84 (21%) were hypertensive, and 173 (43%) had a history of smoking. There were 48 total events (12%), 25 myocardial infarctions (7%), and 38 deaths (9%) recorded during the perioperative period. From the final multivariate model, history of coronary artery disease, prior stroke, and postoperative sepsis predicted greater risk (P=0.014; odds ratio [OR], 4.0; 95% confidence interval [CI], 1.3 to 11.8; P=0.025; OR, 6.6; 95% CI, 1.3 to 33.8; and P<0.001; OR, 7.5; 95% CI, 3.3 to 17.1, respectively). Use of perioperative β-blockers was protective (P=0.004; OR, 0.20; 95% CI, 0.1 to 0.6) for combined cardiac outcomes. For the outcome of death on multivariate analysis, postoperative sepsis and increased interventricular septal thickness predicted risk (P<0.001; OR, 8.6; 95% CI, 3.5 to 20.9; and P=0.027; OR, 2.8; 95% CI, 1.1 to 7.2, respectively), whereas the use of perioperative β-blockers was again protective (P=0.012; OR, 0.07; 95% CI, 0.01 to 0.56). CONCLUSIONS-: In our study of cardiac risk assessment for liver transplantation surgery, history of stroke, coronary artery disease, postoperative sepsis, and increased interventricular septal thickness were markers of adverse perioperative cardiac outcomes, whereas use of perioperative β-blockers was significantly protective.

AB - BACKGROUND-: Cardiac risk assessment for perioperative outcomes of liver transplantation patients is limited. We examined the outcomes of an older intermediate-cardiac-risk group of patients undergoing liver transplantation surgery. METHODS AND RESULTS-: Patients who had liver transplantation surgery between 2001 and 2005 were studied. The 3 outcomes analyzed were nonfatal myocardial infarction, death, and either outcome within the first 30 days after the liver transplantation surgery. Of 403 patients (mean age, 52±9 years; 67% male), 106 (26%) were diabetic, 84 (21%) were hypertensive, and 173 (43%) had a history of smoking. There were 48 total events (12%), 25 myocardial infarctions (7%), and 38 deaths (9%) recorded during the perioperative period. From the final multivariate model, history of coronary artery disease, prior stroke, and postoperative sepsis predicted greater risk (P=0.014; odds ratio [OR], 4.0; 95% confidence interval [CI], 1.3 to 11.8; P=0.025; OR, 6.6; 95% CI, 1.3 to 33.8; and P<0.001; OR, 7.5; 95% CI, 3.3 to 17.1, respectively). Use of perioperative β-blockers was protective (P=0.004; OR, 0.20; 95% CI, 0.1 to 0.6) for combined cardiac outcomes. For the outcome of death on multivariate analysis, postoperative sepsis and increased interventricular septal thickness predicted risk (P<0.001; OR, 8.6; 95% CI, 3.5 to 20.9; and P=0.027; OR, 2.8; 95% CI, 1.1 to 7.2, respectively), whereas the use of perioperative β-blockers was again protective (P=0.012; OR, 0.07; 95% CI, 0.01 to 0.56). CONCLUSIONS-: In our study of cardiac risk assessment for liver transplantation surgery, history of stroke, coronary artery disease, postoperative sepsis, and increased interventricular septal thickness were markers of adverse perioperative cardiac outcomes, whereas use of perioperative β-blockers was significantly protective.

KW - Echocardiography

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KW - Prognosis

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