Skip to main content
Top
Published in: European Journal of Medical Research 1/2021

Open Access 01-12-2021 | Heart Surgery | Research

EuroScore and IL-6 predict the course in ICU after cardiac surgery

Authors: Andreas Bauer, Insa Korten, Gerd Juchem, Isabel Kiesewetter, Erich Kilger, Jens Heyn

Published in: European Journal of Medical Research | Issue 1/2021

Login to get access

Abstract

Background

Despite modern advances in intensive care medicine and surgical techniques, mortality rates in cardiac surgical patients are still about 3%. Considerable efforts were made to predict morbidity and mortality after cardiac surgery. In this study, we analysed the predictive properties of EuroScore and IL-6 for mortality in ICU, prolonged postoperative mechanical ventilation, and prolonged stay in ICU.

Methods

We enrolled 2972 patients undergoing cardiac surgery. The patients either underwent aortic valve surgery (AV), mitral valve surgery (MV), coronary artery bypass grafting (CABG), and combined operations of aortic valve and coronary artery bypass grafting (AV + CABG) or of mitral and tricuspid valve (MV + TV). Different laboratory and clinical parameters were analysed.

Results

EuroScore as well as IL-6 were associated with increased mortality after cardiac surgery. Furthermore, a higher EuroScore and elevated levels of IL-6 were predictors for prolonged mechanical ventilation and a longer stay in ICU. Especially, highly significant elevated IL-6 levels and an increased EuroScore showed a strong association. Statistics suggested superiority when both parameters were combined in a single model.

Conclusion

Our results suggest that EuroScore and IL-6 are helpful in predicting the course in ICU after cardiac surgery, and therefore, the use of intensive care resources. Especially, the combination of highly elevated levels of IL-6 and EuroScore may prove to be excellent predictors for an unfortunate postoperative course in ICU.
Appendix
Available only for authorised users
Literature
2.
go back to reference Ranucci M, Baryshnikova E, Crapelli GB, Rahe-Meyer N, Menicanti L, Frigiola A, et al. Randomized, double-blinded, placebo-controlled trial of fibrinogen concentrate supplementation after complex cardiac surgery. J Am Heart Assoc. 2015;4:e002066.CrossRef Ranucci M, Baryshnikova E, Crapelli GB, Rahe-Meyer N, Menicanti L, Frigiola A, et al. Randomized, double-blinded, placebo-controlled trial of fibrinogen concentrate supplementation after complex cardiac surgery. J Am Heart Assoc. 2015;4:e002066.CrossRef
3.
go back to reference Mazzeffi M, Zivot J, Buchman T, Halkos M. In-hospital mortality after cardiac surgery: patient characteristics, timing, and association with postoperative length of intensive care unit and hospital stay. Ann Thorac Surg. 2014;97:1220–5.CrossRef Mazzeffi M, Zivot J, Buchman T, Halkos M. In-hospital mortality after cardiac surgery: patient characteristics, timing, and association with postoperative length of intensive care unit and hospital stay. Ann Thorac Surg. 2014;97:1220–5.CrossRef
4.
go back to reference Siregar S, Groenwold RH, de Mol BA, Takkenberg JJ, Bots ML, van der Graaf Y, et al. Evaluation of cardiac surgery mortality rates: 30-day mortality or longer follow-up? Eur J Cardiothorac Surg. 2013;44:875–83.CrossRef Siregar S, Groenwold RH, de Mol BA, Takkenberg JJ, Bots ML, van der Graaf Y, et al. Evaluation of cardiac surgery mortality rates: 30-day mortality or longer follow-up? Eur J Cardiothorac Surg. 2013;44:875–83.CrossRef
5.
go back to reference Pitkanen O, Niskanen M, Rehnberg S, Hippelainen M, Hynynen M. Intra-institutional prediction of outcome after cardiac surgery: comparison between a locally derived model and the EuroSCORE. Eur J Cardiothorac Surg. 2000;18:703–10.CrossRef Pitkanen O, Niskanen M, Rehnberg S, Hippelainen M, Hynynen M. Intra-institutional prediction of outcome after cardiac surgery: comparison between a locally derived model and the EuroSCORE. Eur J Cardiothorac Surg. 2000;18:703–10.CrossRef
6.
go back to reference O’Connor GT, Plume SK, Olmstead EM, Coffin LH, Morton JR, Maloney CT, et al. Multivariate prediction of in-hospital mortality associated with coronary artery bypass graft surgery Northern New England Cardiovascular Disease Study Group. Circulation. 1992;85(6):2110–8.CrossRef O’Connor GT, Plume SK, Olmstead EM, Coffin LH, Morton JR, Maloney CT, et al. Multivariate prediction of in-hospital mortality associated with coronary artery bypass graft surgery Northern New England Cardiovascular Disease Study Group. Circulation. 1992;85(6):2110–8.CrossRef
7.
go back to reference Bridgewater B, Neve H, Moat N, Hooper T, Jones M. Predicting operative risk for coronary artery surgery in the United Kingdom: a comparison of various risk prediction algorithms. Heart. 1998;79:350–5.CrossRef Bridgewater B, Neve H, Moat N, Hooper T, Jones M. Predicting operative risk for coronary artery surgery in the United Kingdom: a comparison of various risk prediction algorithms. Heart. 1998;79:350–5.CrossRef
8.
go back to reference Tu JV, Jaglal SB, Naylor CD. Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery Steering Committee of the Provincial Adult Cardiac Care Network of Ontario. Circulation. 1995;91:677–84.CrossRef Tu JV, Jaglal SB, Naylor CD. Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery Steering Committee of the Provincial Adult Cardiac Care Network of Ontario. Circulation. 1995;91:677–84.CrossRef
9.
go back to reference Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999;16:9–13.CrossRef Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999;16:9–13.CrossRef
10.
go back to reference Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E, et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg. 1999;15:816–22 (discussion 22-3).CrossRef Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E, et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg. 1999;15:816–22 (discussion 22-3).CrossRef
11.
go back to reference Meadows K, Gibbens R, Gerrard C, Vuylsteke A. Prediction of patient length of stay on the intensive care unit following cardiac surgery: a logistic regression analysis based on the cardiac operative mortality risk calculator EuroSCORE. J Cardiothorac Vasc Anesth. 2018;32:2676–82.CrossRef Meadows K, Gibbens R, Gerrard C, Vuylsteke A. Prediction of patient length of stay on the intensive care unit following cardiac surgery: a logistic regression analysis based on the cardiac operative mortality risk calculator EuroSCORE. J Cardiothorac Vasc Anesth. 2018;32:2676–82.CrossRef
12.
go back to reference Lindman BR, Goldstein JS, Nassif ME, Zajarias A, Novak E, Tibrewala A, et al. Systemic inflammatory response syndrome after transcatheter or surgical aortic valve replacement. Heart. 2015;101:537–45.CrossRef Lindman BR, Goldstein JS, Nassif ME, Zajarias A, Novak E, Tibrewala A, et al. Systemic inflammatory response syndrome after transcatheter or surgical aortic valve replacement. Heart. 2015;101:537–45.CrossRef
13.
go back to reference Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther. 2015;154:13–20.CrossRef Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther. 2015;154:13–20.CrossRef
14.
go back to reference Franke A, Lante W, Fackeldey V, Becker HP, Kurig E, Zöller LG, et al. Pro-inflammatory cytokines after different kinds of cardio-thoracic surgical procedures: is what we see what we know? Eur J Cardiothorac Surg. 2005;28:569–75.CrossRef Franke A, Lante W, Fackeldey V, Becker HP, Kurig E, Zöller LG, et al. Pro-inflammatory cytokines after different kinds of cardio-thoracic surgical procedures: is what we see what we know? Eur J Cardiothorac Surg. 2005;28:569–75.CrossRef
15.
go back to reference Plummer AR, du Bois JL, Flynn JM, Roesner J, Lee SM, Magee P, et al. A simple method to estimate flow restriction for dual ventilation of dissimilar patients: The BathRC model. PLoS ONE. 2020;15:e0242123.CrossRef Plummer AR, du Bois JL, Flynn JM, Roesner J, Lee SM, Magee P, et al. A simple method to estimate flow restriction for dual ventilation of dissimilar patients: The BathRC model. PLoS ONE. 2020;15:e0242123.CrossRef
16.
go back to reference Khan SS, Nessim S, Gray R, Czer SL, Chaux A, Matloff J. Increased mortality of women in coronary artery bypass surgery: evidence for referral bias. Ann Intern Med. 1990;112:561–7.CrossRef Khan SS, Nessim S, Gray R, Czer SL, Chaux A, Matloff J. Increased mortality of women in coronary artery bypass surgery: evidence for referral bias. Ann Intern Med. 1990;112:561–7.CrossRef
17.
go back to reference Edwards FH, Carey JS, Grover FL, Bero JW, Hartz RW. Impact of gender on coronary by pass operative mortality. Ann Thorac Surg. 1998;66:125–31.CrossRef Edwards FH, Carey JS, Grover FL, Bero JW, Hartz RW. Impact of gender on coronary by pass operative mortality. Ann Thorac Surg. 1998;66:125–31.CrossRef
18.
go back to reference Hogue CW Jr, Barzilai B, Pieper KS, Coombs LP, DeLong ER, Kouchoukos NT, et al. Sex differences in neurological outcomes and mortality after cardiac surgery: a society of thoracic surgery national database report. Circulation. 2001;103(2133):7. Hogue CW Jr, Barzilai B, Pieper KS, Coombs LP, DeLong ER, Kouchoukos NT, et al. Sex differences in neurological outcomes and mortality after cardiac surgery: a society of thoracic surgery national database report. Circulation. 2001;103(2133):7.
19.
go back to reference Totonchi Z, Baazm F, Chitsazan M, Seifi S, Chitsazan M. Predictors of prolonged mechanical ventilation after open heart surgery. J Cardiovasc Thorac Res. 2014;6:211–6.CrossRef Totonchi Z, Baazm F, Chitsazan M, Seifi S, Chitsazan M. Predictors of prolonged mechanical ventilation after open heart surgery. J Cardiovasc Thorac Res. 2014;6:211–6.CrossRef
20.
go back to reference Messaoudi N, De Cocker J, Stockman BA, Bossaert LL, Rodrigus IE. Is EuroSCORE useful in the prediction of extended intensive care unit stay after cardiac surgery? Eur J Cardiothorac Surg. 2009;36:35–9.CrossRef Messaoudi N, De Cocker J, Stockman BA, Bossaert LL, Rodrigus IE. Is EuroSCORE useful in the prediction of extended intensive care unit stay after cardiac surgery? Eur J Cardiothorac Surg. 2009;36:35–9.CrossRef
21.
go back to reference Michel P, Roques F, Nashef SA, Euro SPG. Logistic or additive EuroSCORE for high-risk patients? Eur J Cardiothorac Surg. 2003;23:684–7 (discussion 7).CrossRef Michel P, Roques F, Nashef SA, Euro SPG. Logistic or additive EuroSCORE for high-risk patients? Eur J Cardiothorac Surg. 2003;23:684–7 (discussion 7).CrossRef
22.
go back to reference Mestres CA, Castro MA, Bernabeu E, Josa M, Cartaná R, Pomar JL, et al. Preoperative risk stratification in infective endocarditis. Does the EuroSCORE model work? Preliminary results. Eur J CardiothoracSurg. 2007;32:281–5.CrossRef Mestres CA, Castro MA, Bernabeu E, Josa M, Cartaná R, Pomar JL, et al. Preoperative risk stratification in infective endocarditis. Does the EuroSCORE model work? Preliminary results. Eur J CardiothoracSurg. 2007;32:281–5.CrossRef
23.
go back to reference Zingone B, Pappalardo A, Dreas L. Logistic versus additive EuroSCORE. A comparative assessment of the two models in an independent population sample. Eur J Cardiothorac Surg. 2004;26:1134–40.CrossRef Zingone B, Pappalardo A, Dreas L. Logistic versus additive EuroSCORE. A comparative assessment of the two models in an independent population sample. Eur J Cardiothorac Surg. 2004;26:1134–40.CrossRef
24.
go back to reference Pinna Pintor P, Bobbio M, Colangelo S, Veglia F, Marras R, Diena M. Can EuroSCORE predict direct costs of cardiac surgery? Eur J Cardiothorac Surg. 2003;23:595–8.CrossRef Pinna Pintor P, Bobbio M, Colangelo S, Veglia F, Marras R, Diena M. Can EuroSCORE predict direct costs of cardiac surgery? Eur J Cardiothorac Surg. 2003;23:595–8.CrossRef
25.
go back to reference Gurler S, Gebhard A, Godehardt E, Boeken U, Feindt P, Gams E. EuroSCORE as a predictor for complications and outcome. Thorac Cardiovasc Surg. 2003;51:73–7.CrossRef Gurler S, Gebhard A, Godehardt E, Boeken U, Feindt P, Gams E. EuroSCORE as a predictor for complications and outcome. Thorac Cardiovasc Surg. 2003;51:73–7.CrossRef
26.
go back to reference Kurki TS, Jarvinen O, Kataja MJ, Laurikka J, Tarkka M. Performance of three preoperative risk indices; CABDEAL, EuroSCORE and Cleveland models in a prospective coronary bypass database. Eur J Cardiothorac Surg. 2002;21:406–10.CrossRef Kurki TS, Jarvinen O, Kataja MJ, Laurikka J, Tarkka M. Performance of three preoperative risk indices; CABDEAL, EuroSCORE and Cleveland models in a prospective coronary bypass database. Eur J Cardiothorac Surg. 2002;21:406–10.CrossRef
27.
go back to reference Ercan A, Karal IH, Gurbuz O, Kumtepe G, Onder T, Saba D. A comparison of off-pump and on-pump coronary bypass surgery in patients with low EuroSCORE. J Cardiothorac Surg. 2014;9:105.CrossRef Ercan A, Karal IH, Gurbuz O, Kumtepe G, Onder T, Saba D. A comparison of off-pump and on-pump coronary bypass surgery in patients with low EuroSCORE. J Cardiothorac Surg. 2014;9:105.CrossRef
28.
go back to reference Hazama S, Eishi K, Yamachika S, Noguchi M, Ariyoshi T, Takai H, et al. Inflammatory response after coronary revascularization: off-pump versus on-pump (heparin-coated circuits and poly2methoxyethylacrylate-coated circuits). Ann Thorac Cardiovasc Surg. 2004;10:90–6.PubMed Hazama S, Eishi K, Yamachika S, Noguchi M, Ariyoshi T, Takai H, et al. Inflammatory response after coronary revascularization: off-pump versus on-pump (heparin-coated circuits and poly2methoxyethylacrylate-coated circuits). Ann Thorac Cardiovasc Surg. 2004;10:90–6.PubMed
29.
go back to reference Holcomb HB, Stammers AH, Gao C, Nutter B, Ellis T, Ahlgren RL, et al. Perfusion treatment algorithm: methods of improving the quality of perfusion. J Extra Corpor Technol. 2003;35:290–6.PubMed Holcomb HB, Stammers AH, Gao C, Nutter B, Ellis T, Ahlgren RL, et al. Perfusion treatment algorithm: methods of improving the quality of perfusion. J Extra Corpor Technol. 2003;35:290–6.PubMed
30.
go back to reference Allan CK, Newburger JW, McGrath E, Elder J, Psoinos C, Laussen PC, et al. The relationship between inflammatory activation and clinical outcome after infant cardiopulmonary bypass. Anesth Analg. 2010;111:1244–51.CrossRef Allan CK, Newburger JW, McGrath E, Elder J, Psoinos C, Laussen PC, et al. The relationship between inflammatory activation and clinical outcome after infant cardiopulmonary bypass. Anesth Analg. 2010;111:1244–51.CrossRef
31.
go back to reference Heyn J, Beiras-Fernandez A, Luchting B, Briegel J, Weis F. Inflammatory reactions and hydrocortisone in the setting of cardiac surgery: an overview. Cardiovasc Hematol Agents Med Chem. 2011;9:56–61.CrossRef Heyn J, Beiras-Fernandez A, Luchting B, Briegel J, Weis F. Inflammatory reactions and hydrocortisone in the setting of cardiac surgery: an overview. Cardiovasc Hematol Agents Med Chem. 2011;9:56–61.CrossRef
32.
go back to reference Day JR, Taylor KM. The systemic inflammatory response syndrome and cardiopulmonary bypass. Int J Surg. 2005;3:129–40.CrossRef Day JR, Taylor KM. The systemic inflammatory response syndrome and cardiopulmonary bypass. Int J Surg. 2005;3:129–40.CrossRef
33.
go back to reference Nechemia-Arbely Y, Barkan D, Pizov G, Shriki A, Rose-John S, Galun E, et al. IL-6/IL-6R axis plays a critical role in acute kidney injury. J Am Soc Nephrol. 2008;19:1106–15.CrossRef Nechemia-Arbely Y, Barkan D, Pizov G, Shriki A, Rose-John S, Galun E, et al. IL-6/IL-6R axis plays a critical role in acute kidney injury. J Am Soc Nephrol. 2008;19:1106–15.CrossRef
34.
go back to reference Jones SA, Fraser DJ, Fielding CA, Jones GW. Interleukin-6 in renal disease and therapy. Nephrol Dial Transplant. 2015;30:564–74.CrossRef Jones SA, Fraser DJ, Fielding CA, Jones GW. Interleukin-6 in renal disease and therapy. Nephrol Dial Transplant. 2015;30:564–74.CrossRef
35.
go back to reference Kanda T, Takahashi T. Interleukin-6 and cardiovascular diseases. Jpn Heart J. 2004;45:183–93.CrossRef Kanda T, Takahashi T. Interleukin-6 and cardiovascular diseases. Jpn Heart J. 2004;45:183–93.CrossRef
36.
go back to reference Kavsak PA, Ko DT, Newman AM, Palomaki GE, Lustig V, MacRae AR, et al. Risk stratification for heart failure and death in an acute coronary syndrome population using inflammatory cytokines and N-terminal pro-brain natriuretic peptide. Clin Chem. 2007;53:2112–8.CrossRef Kavsak PA, Ko DT, Newman AM, Palomaki GE, Lustig V, MacRae AR, et al. Risk stratification for heart failure and death in an acute coronary syndrome population using inflammatory cytokines and N-terminal pro-brain natriuretic peptide. Clin Chem. 2007;53:2112–8.CrossRef
37.
go back to reference Biancari F, Kangasniemi OP, Luukkonen J, Vuorisalo S, Satta J, Pokela R, et al. EuroSCORE predicts immediate and late outcome after coronary artery bypass surgery. Ann Thorac Surg. 2006;82:57–61.CrossRef Biancari F, Kangasniemi OP, Luukkonen J, Vuorisalo S, Satta J, Pokela R, et al. EuroSCORE predicts immediate and late outcome after coronary artery bypass surgery. Ann Thorac Surg. 2006;82:57–61.CrossRef
38.
go back to reference Elíasdóttir SB, Klemenzson G, Torfason B, Valsson F. Brain natriuretic peptide is a good predictor for outcome in cardiac surgery. Acta Anaesthesiol Scand. 2008;52(2):182–7.CrossRef Elíasdóttir SB, Klemenzson G, Torfason B, Valsson F. Brain natriuretic peptide is a good predictor for outcome in cardiac surgery. Acta Anaesthesiol Scand. 2008;52(2):182–7.CrossRef
Metadata
Title
EuroScore and IL-6 predict the course in ICU after cardiac surgery
Authors
Andreas Bauer
Insa Korten
Gerd Juchem
Isabel Kiesewetter
Erich Kilger
Jens Heyn
Publication date
01-12-2021
Publisher
BioMed Central
Published in
European Journal of Medical Research / Issue 1/2021
Electronic ISSN: 2047-783X
DOI
https://doi.org/10.1186/s40001-021-00501-1

Other articles of this Issue 1/2021

European Journal of Medical Research 1/2021 Go to the issue