The relationship between inotrope exposure, six-hour postoperative physiological variables, hospital mortality and renal dysfunction in patients undergoing cardiac surgery

Jason Shahin, Benoit DeVarennes, Chun Wing Tse, Dan-Alexandru Amarica, Sandra Dial, Jason Shahin, Benoit DeVarennes, Chun Wing Tse, Dan-Alexandru Amarica, Sandra Dial

Abstract

Introduction: Acute haemodynamic complications are common after cardiac surgery and optimal perioperative use of inotropic agents, typically guided by haemodynamic variables, remains controversial. The aim of this study was to examine the relationship of inotrope use to hospital mortality and renal dysfunction.

Material and methods: A retrospective cohort study of 1,326 cardiac surgery patients was carried out at two university-affiliated ICUs. Multivariable logistic regression analysis and propensity matching were performed to evaluate whether inotrope exposure was independently associated with mortality and renal dysfunction.

Results: Patients exposed to inotropes had a higher mortality rate than those not exposed. After adjusting for differences in Parsonnet score, left ventricular ejection fraction, perioperative intraaortic balloon pump use, bypass time, reoperation and cardiac index, inotrope exposure appeared to be independently associated with increased hospital mortality (adjusted odds ratio (OR) 2.3, 95% confidence interval (95% CI) 1.2 to 4.5) and renal dysfunction (adjusted OR 2.7, 95% CI 1.5 to 4.6). A propensity score-matched analysis similarly demonstrated that death and renal dysfunction were significantly more likely to occur in patients exposed to inotropes (P = 0.01).

Conclusions: Postoperative inotrope exposure was independently associated with worse outcomes in this cohort study. Further research is needed to better elucidate the appropriate use of inotropes in cardiac surgery.

Figures

Figure 1
Figure 1
Hospital mortality by Parsonnet score in a cohort of 1,326 cardiac surgery patients. Error bars indicate 95% confidence intervals (95% CIs).
Figure 2
Figure 2
Hospital mortality stratified by (A) oxygen delivery, (B) cardiac index, (C) serum lactate and (D) mixed venous oxygen saturation. Two groups of patients are represented (inotrope-exposed and inotrope-unexposed). The adjusted odds ratios for the association between inotrope exposure and mortality were 8.5 (95% CI 4.8 to 15.0) after adjusting for oxygen delivery and 7.7 (95% CI 4.4 to 13.7) after adjusting for cardiac index. The adjusted odds ratios for the association between inotropes exposure and mortality were 5.7 (95% CI 2.4 to 13.5) after adjusting for serum lactate and 5.3 (95% CI 2.4 to 11.4) after adjusting for mixed venous oxygen saturation. Error bars indicate 95% CI. Data from only one hospital were used for analyses of serum lactate and mixed venous oxygen saturation, resulting in wider 95% CIs.
Figure 3
Figure 3
Renal dysfunction stratified by (A) oxygen delivery, (B) cardiac index, (C) serum lactate and (D) mixed venous oxygen saturation. Two groups of patients are represented (inotrope-exposed and inotrope-unexposed). The adjusted odds ratios for the association between inotrope exposure and renal dysfunction were 6.0 (95% CI 3.8 to 9.5) after adjusting for oxygen delivery and 5.9 (95% CI 3.7 to 9.6) after adjusting for cardiac index. The adjusted odds ratios for the association between inotrope exposure and mortality were 5.6 (95% CI 2.8 to 11.2) after adjusting for serum lactate and 5.3 (95% CI 2.5 to 10.9) after adjusting for mixed venous oxygen saturation. Error bars indicate 95% CI. Data from only one hospital were used for analyses of serum lactate and mixed venous oxygen saturation, resulting in wider 95% CIs.

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