High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality
- Background: Cardiac surgery patients represent a high-risk cohort in intensive care units (ICUs). Central venous pressure (CVP) measurement seems to remain an integral part in hemodynamic monitoring, especially in cardio-surgical ICUs. However, its value as a prognostic marker for organ failure is still unclear. Therefore, we analyzed postoperative CVP values after adult cardiac surgery in a large cohort with regard to its prognostic value for morbidity and mortality. Methods: All adult patients admitted to our ICUs between 2006 and 2019 after cardiac surgery were eligible for inclusion in the study (n = 11,198). We calculated the median initial CVP (miCVP) after admission to the ICU, which returned valid values for 9802 patients. An ROC curve analysis for optimal cut-off miCVP to predict ICU mortality was conducted with consecutive patient allocation into a (a) low miCVP (LCVP) group (≤11 mmHg) and (b) high miCVP (HCVP) group (>11 mmHg). We analyzed the impact of high miCVP on morbidity and mortality by propensity score matching (PSM) and logistic regression. Results: ICU mortality was increased in HCVP patients. In addition, patients in the HCVP group required longer mechanical ventilation, had a higher incidence of acute kidney injury, were more frequently treated with renal replacement therapy, and showed a higher risk for postoperative liver dysfunction, parametrized by a postoperative rise of ≥ 10 in MELD Score. Multiple regression analysis confirmed HCVP has an effect on postoperative ICU-mortality and intrahospital mortality, which seems to be independent. Conclusions: A high initial CVP in the early postoperative ICU course after cardiac surgery is associated with worse patient outcome. Whether or not CVP, as a readily and constantly available hemodynamic parameter, should promote clinical efforts regarding diagnostics and/or treatment, warrants further investigations.
Author: | Fridtjof SchiefenhövelORCiD, Ralf Felix TrauzeddelORCiD, Michael SanderORCiD, Matthias HeringlakeORCiD, Heinrich Volker GroesdonkORCiD, Herko GrubitzschORCiD, Jochen Kruppa-ScheetzORCiD, Christian BergerORCiD, Sascha TreskatschORCiD, Felix BalzerORCiD |
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Title (English): | High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality |
URN: | urn:nbn:de:bsz:959-opus-59027 |
DOI: | https://doi.org/10.3390/jcm10173945 |
ISSN: | 2077-0383 |
Parent Title (English): | Journal of Clinical Medicine (JCM) |
Document Type: | Article |
Language: | English |
Year of Completion: | 2021 |
Release Date: | 2024/04/23 |
Tag: | Cardiac surgery; Central venous pressure; Outcome; Venous congestion |
Volume: | 10 |
Issue: | 17 |
Article Number: | 3945 |
Page Number: | 12 |
Faculties: | Fakultät AuL |
DDC classes: | 600 Technik, Medizin, angewandte Wissenschaften / 610 Medizin, Gesundheit |
Review Status: | Veröffentlichte Fassung/Verlagsversion |
Licence (German): | ![]() |