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Published on: February 2, 2021
Platelet Counts, Acute Kidney Injury, and Mortality after Coronary Artery Bypass Grafting Surgery
Miklos D Kertai1, Shan Zhou, Jörn A Karhausen
1From the Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology (M.D.K., S.Z., J.A.K., M.C., E.J., W.D.W., S.A., M.V.P., I.J.W., J.H.L., M.S.-S., J.P.M.), Department of Biostatistics and Bioinformatics and Molecular Physiology Institute (Y.-J.L.), Division of Cardiovascular and Thoracic Surgery, Department of Surgery (J.G.), Duke University Medical Center, Durham, North Carolina; and Division of Cardiac Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut (M.L.F.).
Insights
Low platelet counts after coronary artery bypass grafting (CABG) surgery are linked to a higher risk of acute kidney injury (AKI) and short-term mortality. Monitoring platelet levels post-CABG is crucial for predicting patient outcomes.
Area of Science:
- Cardiology
- Nephrology
- Hematology
Background:
- Cardiac surgery involving cardiopulmonary bypass can activate platelets.
- Platelets play a role in ischemia and inflammatory injury.
Purpose of the Study:
- To investigate the association between postoperative nadir platelet counts and acute kidney injury (AKI) and mortality following coronary artery bypass grafting (CABG) surgery.
Main Methods:
- Evaluated 4,217 adult patients undergoing CABG surgery.
- Defined postoperative nadir platelet counts as the lowest in-hospital values.
- Utilized multivariable logistic regression and Cox proportional hazard models to analyze associations.
Main Results:
- A decrease in platelet count by 30 × 10/l correlated with a 14% increased risk of AKI.
- Patients with the lowest 10th percentile of platelet counts had a threefold higher risk of severe AKI and a significantly increased risk of mortality.
- The incidence of postoperative AKI was 54%.
Conclusions:
- Postoperative nadir platelet counts are significantly associated with AKI and short-term mortality after CABG surgery.
Background:
Cardiac surgery requiring cardiopulmonary bypass is associated with platelet activation. Because platelets are increasingly recognized as important effectors of ischemia and end-organ inflammatory injury, the authors explored whether postoperative nadir platelet counts are associated with acute kidney injury (AKI) and mortality after coronary artery bypass grafting (CABG) surgery.
Methods:
The authors evaluated 4,217 adult patients who underwent CABG surgery. Postoperative nadir platelet counts were defined as the lowest in-hospital values and were used as a continuous predictor of postoperative AKI and mortality. Nadir values in the lowest 10th percentile were also used as a categorical predictor. Multivariable logistic regression and Cox proportional hazard models examined the association between postoperative platelet counts, postoperative AKI, and mortality.
Results:
The median postoperative nadir platelet count was 121 × 10/l. The incidence of postoperative AKI was 54%, including 9.5% (215 patients) and 3.4% (76 patients) who experienced stages II and III AKI, respectively. For every 30 × 10/l decrease in platelet counts, the risk for postoperative AKI increased by 14% (adjusted odds ratio, 1.14; 95% CI, 1.09 to 1.20; P < 0.0001). Patients with platelet counts in the lowest 10th percentile were three times more likely to progress to a higher severity of postoperative AKI (adjusted proportional odds ratio, 3.04; 95% CI, 2.26 to 4.07; P < 0.0001) and had associated increased risk for mortality immediately after surgery (adjusted hazard ratio, 5.46; 95% CI, 3.79 to 7.89; P < 0.0001).
Conclusion:
The authors found a significant association between postoperative nadir platelet counts and AKI and short-term mortality after CABG surgery.
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