Does preoperative hyponatremia potentiate the effects of left ventricular dysfunction on mortality after cardiac surgery?

Juan A. Crestanello, Gary Phillips, Michael S. Firstenberg, Chittoor Sai Sudhakar, John Sirak, Robert Higgins, William T. Abraham

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: Left ventricular dysfunction and preoperative hyponatremia are associated with adverse outcomes after cardiac surgery. However, the interactions between them are unknown. Thus, we evaluated the interaction of low left ventricular ejection fraction (<40%) and preoperative hyponatremia (Na <135 mEq/L) with morbidity and mortality after cardiac surgery. Methods: The interaction of hyponatremia and ejection fraction with hospital complications, length of stay, and mortality was analyzed using logistic and Cox regression analysis in 2247 patients who underwent cardiac surgery between 2005 and 2008 at The Ohio State University Wexner Medical Center. Results: Of the patients, 68.5% had normal ejection fraction. Hyponatremia was present in 18% of patients with normal ejection fraction and 35% of patients with low ejection fraction. Hyponatremic patients had higher rates of New York Heart Association class III and IV, more comorbidities, and higher Society of Thoracic Surgeons score and European System for Cardiac Operative Risk Evaluation irrespectively of their ejection fraction. The correlation between preoperative sodium and ejection fraction was weak (r2 = 0.04). Hyponatremia increased the rate of postoperative complications and hospital stay, and decreased 1- and 3-year survivals in patients with both normal and low ejection fraction. Hyponatremia was independently associated with longer hospital stay for normal ejection fraction (multiplier, 1.18; confidence interval, 1.09-1.27; P < .001) and low ejection fraction (multiplier, 1.10; confidence interval, 1.0-1.21; P = .05), increased need for dialysis for normal ejection fraction (odds ratio, 2.16; confidence interval, 1.08-4.32; P = .03), and increased risk of mortality for normal ejection fraction (hazard ratio, 1.56; confidence interval, 1.20-2.05; P = .001), but not for patients with low ejection fraction (hazard ratio, 1.21; confidence interval, 0.89-1.65; P = .21). Conclusions: Hyponatremia is more common in patients with low ejection fraction. Although preoperative hyponatremia is independently associated with adverse outcomes in patients with normal ejection fraction, an association with adverse outcomes in patients with low ejection fraction was not demonstrated.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
Volume145
Issue number6
DOIs
StatePublished - Jan 1 2013

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Hyponatremia
Left Ventricular Dysfunction
Thoracic Surgery
Mortality
Confidence Intervals
Length of Stay
Stroke Volume
Comorbidity
Dialysis
Logistic Models
Sodium
Odds Ratio
Regression Analysis
Morbidity
Survival

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Does preoperative hyponatremia potentiate the effects of left ventricular dysfunction on mortality after cardiac surgery? / Crestanello, Juan A.; Phillips, Gary; Firstenberg, Michael S.; Sai Sudhakar, Chittoor; Sirak, John; Higgins, Robert; Abraham, William T.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 145, No. 6, 01.01.2013.

Research output: Contribution to journalArticle

Crestanello, Juan A. ; Phillips, Gary ; Firstenberg, Michael S. ; Sai Sudhakar, Chittoor ; Sirak, John ; Higgins, Robert ; Abraham, William T. / Does preoperative hyponatremia potentiate the effects of left ventricular dysfunction on mortality after cardiac surgery?. In: Journal of Thoracic and Cardiovascular Surgery. 2013 ; Vol. 145, No. 6.
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abstract = "Objective: Left ventricular dysfunction and preoperative hyponatremia are associated with adverse outcomes after cardiac surgery. However, the interactions between them are unknown. Thus, we evaluated the interaction of low left ventricular ejection fraction (<40{\%}) and preoperative hyponatremia (Na <135 mEq/L) with morbidity and mortality after cardiac surgery. Methods: The interaction of hyponatremia and ejection fraction with hospital complications, length of stay, and mortality was analyzed using logistic and Cox regression analysis in 2247 patients who underwent cardiac surgery between 2005 and 2008 at The Ohio State University Wexner Medical Center. Results: Of the patients, 68.5{\%} had normal ejection fraction. Hyponatremia was present in 18{\%} of patients with normal ejection fraction and 35{\%} of patients with low ejection fraction. Hyponatremic patients had higher rates of New York Heart Association class III and IV, more comorbidities, and higher Society of Thoracic Surgeons score and European System for Cardiac Operative Risk Evaluation irrespectively of their ejection fraction. The correlation between preoperative sodium and ejection fraction was weak (r2 = 0.04). Hyponatremia increased the rate of postoperative complications and hospital stay, and decreased 1- and 3-year survivals in patients with both normal and low ejection fraction. Hyponatremia was independently associated with longer hospital stay for normal ejection fraction (multiplier, 1.18; confidence interval, 1.09-1.27; P < .001) and low ejection fraction (multiplier, 1.10; confidence interval, 1.0-1.21; P = .05), increased need for dialysis for normal ejection fraction (odds ratio, 2.16; confidence interval, 1.08-4.32; P = .03), and increased risk of mortality for normal ejection fraction (hazard ratio, 1.56; confidence interval, 1.20-2.05; P = .001), but not for patients with low ejection fraction (hazard ratio, 1.21; confidence interval, 0.89-1.65; P = .21). Conclusions: Hyponatremia is more common in patients with low ejection fraction. Although preoperative hyponatremia is independently associated with adverse outcomes in patients with normal ejection fraction, an association with adverse outcomes in patients with low ejection fraction was not demonstrated.",
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T1 - Does preoperative hyponatremia potentiate the effects of left ventricular dysfunction on mortality after cardiac surgery?

AU - Crestanello, Juan A.

AU - Phillips, Gary

AU - Firstenberg, Michael S.

AU - Sai Sudhakar, Chittoor

AU - Sirak, John

AU - Higgins, Robert

AU - Abraham, William T.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Objective: Left ventricular dysfunction and preoperative hyponatremia are associated with adverse outcomes after cardiac surgery. However, the interactions between them are unknown. Thus, we evaluated the interaction of low left ventricular ejection fraction (<40%) and preoperative hyponatremia (Na <135 mEq/L) with morbidity and mortality after cardiac surgery. Methods: The interaction of hyponatremia and ejection fraction with hospital complications, length of stay, and mortality was analyzed using logistic and Cox regression analysis in 2247 patients who underwent cardiac surgery between 2005 and 2008 at The Ohio State University Wexner Medical Center. Results: Of the patients, 68.5% had normal ejection fraction. Hyponatremia was present in 18% of patients with normal ejection fraction and 35% of patients with low ejection fraction. Hyponatremic patients had higher rates of New York Heart Association class III and IV, more comorbidities, and higher Society of Thoracic Surgeons score and European System for Cardiac Operative Risk Evaluation irrespectively of their ejection fraction. The correlation between preoperative sodium and ejection fraction was weak (r2 = 0.04). Hyponatremia increased the rate of postoperative complications and hospital stay, and decreased 1- and 3-year survivals in patients with both normal and low ejection fraction. Hyponatremia was independently associated with longer hospital stay for normal ejection fraction (multiplier, 1.18; confidence interval, 1.09-1.27; P < .001) and low ejection fraction (multiplier, 1.10; confidence interval, 1.0-1.21; P = .05), increased need for dialysis for normal ejection fraction (odds ratio, 2.16; confidence interval, 1.08-4.32; P = .03), and increased risk of mortality for normal ejection fraction (hazard ratio, 1.56; confidence interval, 1.20-2.05; P = .001), but not for patients with low ejection fraction (hazard ratio, 1.21; confidence interval, 0.89-1.65; P = .21). Conclusions: Hyponatremia is more common in patients with low ejection fraction. Although preoperative hyponatremia is independently associated with adverse outcomes in patients with normal ejection fraction, an association with adverse outcomes in patients with low ejection fraction was not demonstrated.

AB - Objective: Left ventricular dysfunction and preoperative hyponatremia are associated with adverse outcomes after cardiac surgery. However, the interactions between them are unknown. Thus, we evaluated the interaction of low left ventricular ejection fraction (<40%) and preoperative hyponatremia (Na <135 mEq/L) with morbidity and mortality after cardiac surgery. Methods: The interaction of hyponatremia and ejection fraction with hospital complications, length of stay, and mortality was analyzed using logistic and Cox regression analysis in 2247 patients who underwent cardiac surgery between 2005 and 2008 at The Ohio State University Wexner Medical Center. Results: Of the patients, 68.5% had normal ejection fraction. Hyponatremia was present in 18% of patients with normal ejection fraction and 35% of patients with low ejection fraction. Hyponatremic patients had higher rates of New York Heart Association class III and IV, more comorbidities, and higher Society of Thoracic Surgeons score and European System for Cardiac Operative Risk Evaluation irrespectively of their ejection fraction. The correlation between preoperative sodium and ejection fraction was weak (r2 = 0.04). Hyponatremia increased the rate of postoperative complications and hospital stay, and decreased 1- and 3-year survivals in patients with both normal and low ejection fraction. Hyponatremia was independently associated with longer hospital stay for normal ejection fraction (multiplier, 1.18; confidence interval, 1.09-1.27; P < .001) and low ejection fraction (multiplier, 1.10; confidence interval, 1.0-1.21; P = .05), increased need for dialysis for normal ejection fraction (odds ratio, 2.16; confidence interval, 1.08-4.32; P = .03), and increased risk of mortality for normal ejection fraction (hazard ratio, 1.56; confidence interval, 1.20-2.05; P = .001), but not for patients with low ejection fraction (hazard ratio, 1.21; confidence interval, 0.89-1.65; P = .21). Conclusions: Hyponatremia is more common in patients with low ejection fraction. Although preoperative hyponatremia is independently associated with adverse outcomes in patients with normal ejection fraction, an association with adverse outcomes in patients with low ejection fraction was not demonstrated.

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