Mukaida Hiroshi, Hayashida Masakazu, Matsushita Satoshi, Yamamoto Makiko, Nakamura Atsushi, Amano Atsushi
Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan.
Department of Clinical Engineering, Juntendo University Hospital, Tokyo, Japan.
PLoS One. 2017 Jul 12;12(7):e0181154. doi: 10.1371/journal.pone.0181154. eCollection 2017.
A previous study reported that low baseline cerebral oxygen saturation (ScO2) (≤50%) measured with near-infrared spectroscopy was predictive of poor clinical outcomes after cardiac surgery. However, such findings have not been reconfirmed by others. We conducted the current study to evaluate whether the previous findings would be reproducible, and to explore mechanisms underlying the ScO2-based outcome prediction.
We retrospectively investigated 573 consecutive patients, aged 20 to 91 (mean ± standard deviation, 67.1 ± 12.8) years, who underwent major cardiovascular surgery. Preanesthetic baseline ScO2, lowest intraoperative ScO2, various clinical variables, and hospital mortality were examined.
Bivariate regression analyses revealed that baseline ScO2 correlated significantly with plasma brain natriuretic peptide concentration (BNP), hemoglobin concentration (Hgb), estimated glomerular filtration rate (eGFR), and left ventricular ejection fraction (LVEF) (p < 0.0001 for each). Baseline ScO2 correlated with BNP in an exponential manner, and BNP was the most significant factor influencing ScO2. Logistic regression analyses revealed that baseline and lowest intraoperative ScO2 values, but not relative ScO2 decrements, were significantly associated with hospital mortality (p < 0.05), independent of the EuroSCORE (p < 0.01). Receiver operating curve analysis of ScO2 values and hospital mortality revealed an area under the curve (AUC) of 0.715 (p < 0.01) and a cutoff value of ≤50.5% for the baseline and ScO2, and an AUC of 0.718 (p < 0.05) and a cutoff value of ≤35% for the lowest intraoperative ScO2. Low baseline ScO2 (≤50%) was associated with increases in intubation time, intensive care unit stay, hospital stay, and hospital mortality.
Baseline ScO2 was reflective of severity of systemic comorbidities and was predictive of clinical outcomes after major cardiovascular surgery. ScO2 correlated most significantly with BNP in an exponential manner, suggesting that BNP plays a major role in the ScO2-based outcome prediction.
先前的一项研究报告称，用近红外光谱法测得的低基线脑氧饱和度（ScO2）（≤50%）可预测心脏手术后的不良临床结局。然而，其他研究尚未再次证实这些发现。我们开展本研究以评估先前的发现是否可重现，并探究基于ScO2的结局预测背后的机制。
我们回顾性调查了573例连续接受重大心血管手术的患者，年龄在20至91岁（平均±标准差，67.1±12.8岁）。检查了麻醉前基线ScO2、术中最低ScO2、各种临床变量和医院死亡率。
双变量回归分析显示，基线ScO2与血浆脑钠肽浓度（BNP）、血红蛋白浓度（Hgb）、估算肾小球滤过率（eGFR）和左心室射血分数（LVEF）显著相关（每项p<0.0001）。基线ScO2与BNP呈指数相关，且BNP是影响ScO2的最显著因素。逻辑回归分析显示，基线和术中最低ScO2值与医院死亡率显著相关（p<0.05），而非相对ScO2下降幅度，且独立于欧洲心脏手术风险评估系统（EuroSCORE）（p<0.01）。ScO2值与医院死亡率的受试者工作特征曲线分析显示，基线ScO2的曲线下面积（AUC）为0.715（p<0.01），截断值为≤50.5%；术中最低ScO2的AUC为0.718（p<0.05），截断值为≤35%。低基线ScO2（≤50%）与插管时间延长、重症监护病房停留时间延长、住院时间延长和医院死亡率增加相关。
基线ScO2反映了全身合并症的严重程度，并可预测重大心血管手术后的临床结局。ScO2与BNP最显著地呈指数相关，提示BNP在基于ScO2的结局预测中起主要作用。
