Department of Cardiovascular Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
Department of Anesthesiology and Reanimation, University of Health Sciences Kartal Dr. Lütfi Kirdar Training and Research Hospital, Istanbul, Turkey.
Ann Card Anaesth. 2023 Apr-Jun;26(2):190-196. doi: 10.4103/aca.aca_55_22.
Previous studies have shown that hepatic fibrosis indices and rates can be used to predict cardiovascular mortality and morbidity. Our aim with this study was to investigate the effect of aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio and fibrosis-4 (FIB-4) index calculated with ALT, AST, and platelet biomarkers, which are simple, fast, and relatively inexpensive and were used in previous studies to predict cardiovascular disease prognosis, on the prediction of postoperative morbidity and early mortality after mitral valve replacement (MVR) surgery.
By scanning the hospital electronic health record system, 116 patients who underwent isolated MVR or MVR + tricuspid valve intervention were identified from 178 patients who underwent MVR with the standard sternotomy procedure between 2011 and 2021. The study was completed with 81 of these patients. Patients were divided into AST/ALT <2 (Group 1) and >2 (Group 2). In addition, the same patients were divided into FIB-4 index <3.25 (Group 3) and >3.25 (Group 4), and a total of four groups were formed.
The mean age of Group 2 was significantly higher than Group 1 (P = 0.049). In addition, the mean age of Group 4 was significantly higher than Group 3 (P = 0.003). Postoperative complications did not differ between Groups 1 and 2 (P > 0.05). While noninvasive mechanincal ventilation (NIMV) requirements did not differ between Groups 3 and 4 (P > 0.05), MV duration and intensive care unit stay were significantly longer in Group 4 (P < 0.05).
The AST/ALT ratio, which has been shown to be a predictor of cardiovascular mortality in various studies, was not useful in predicting mortality and morbidity in our study. However, a high FIB-4 index, another hepatic fibrosis index, was found to be associated with increased perioperative bleeding, duration of mechanical ventilation, and cardiac intensive care unit stay, which are important criteria in the prediction of morbidity in cardiovascular surgery.
先前的研究表明，肝纤维化指数和速率可用于预测心血管死亡率和发病率。本研究旨在探讨天门冬氨酸氨基转移酶/丙氨酸氨基转移酶（AST/ALT）比值和纤维化-4（FIB-4）指数的效果，这些指数使用 ALT、AST 和血小板生物标志物计算，这些标志物简单、快速且相对便宜，并且在先前的研究中用于预测心血管疾病预后，以预测二尖瓣置换（MVR）手术后的术后发病率和早期死亡率。
通过扫描医院电子健康记录系统，从 2011 年至 2021 年期间接受标准胸骨切开术的 178 名接受 MVR 的患者中确定了 116 名接受单纯 MVR 或 MVR+三尖瓣介入治疗的患者。本研究完成了其中 81 名患者。患者分为 AST/ALT<2（第 1 组）和>2（第 2 组）。此外，对相同的患者进行分组，FIB-4 指数<3.25（第 3 组）和>3.25（第 4 组），共分为四组。
第 2 组的平均年龄明显高于第 1 组（P=0.049）。此外，第 4 组的平均年龄明显高于第 3 组（P=0.003）。第 1 组和第 2 组之间的术后并发症无差异（P>0.05）。虽然第 3 组和第 4 组之间的无创机械通气（NIMV）需求无差异（P>0.05），但第 4 组的 MV 持续时间和重症监护病房停留时间明显更长（P<0.05）。
AST/ALT 比值在各种研究中被证明是心血管死亡率的预测因子，但在本研究中对死亡率和发病率的预测没有帮助。然而，另一个肝纤维化指数高 FIB-4 指数与围手术期出血、机械通气时间和心脏重症监护病房停留时间增加相关，这是心血管手术发病率预测的重要标准。
