Clinically-defined preoperative serum phosphorus abnormalities and outcomes of coronary artery bypass grafting: Retrospective analysis using inverse probability weighting adjustment
Autoři:
Jungchan Park aff001; Kwan Young Hong aff001; Jeong Jin Min aff001; Eunjin Kwon aff001; Young Tak Lee aff002; Wook Sung Kim aff002; Hye Seung Kim aff003; Kyunga Kim aff003; Jong-Hwan Lee aff001
Působiště autorů:
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sung Kyunkwan University School of Medicine, Seoul, Korea
aff001; Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
aff002; Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
aff003; Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
aff004
Vyšlo v časopise:
PLoS ONE 14(12)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0225720
Souhrn
Background
Serum phosphorus is a well-known marker of vascular calcification, but the effects of serum phosphorus abnormalities defined by clinical criteria on the outcomes of coronary artery bypass grafting (CABG) remain unclear. We aimed to evaluate whether preoperative serum phosphorus abnormalities defined based on clinical criteria are associated with outcomes of CABG using a relatively new statistical technique, inverse probability weighting (IPW) adjustment.
Methods
From January 2001 to December 2014, 4,989 consecutive patients who underwent CABG were stratified into normal (2.5–4.5 mg/dl; n = 4,544), hypophosphatemia (<2.5 mg/dl; n = 238), or hyperphophatemia (>4.5 mg/dl; n = 207) groups depending on preoperative serum phosphorus level.
Results
The primary outcome was all-cause death during a median follow-up of 48 months. Secondary outcomes were cardiovascular death, graft failure, myocardial infarction, repeat revascularization, and stroke. In multivariate Cox analysis, preoperative hypophosphatemia was significantly associated with all-cause death (hazard ratio [HR] 1.76; 95% confidence interval [CI] 1.13–2.76; P = 0.01). However, this association varied depending on chronic kidney disease and emergent operation (p for interaction = 0.05 and 0.03, respectively). In addition, analysis after IPW adjustment demonstrated that preoperative serum phosphorus abnormalities were not significantly associated with all-cause death (P = 0.08) or any secondary outcomes except graft failure. Graft failure was significantly associated with preoperative hypophosphatemia (HR 2.51; 95% CI 1.37–4.61; P = 0.003).
Conclusion
Our study showed that preoperative serum phosphorus abnormalities in clinical criteria were not associated with outcomes after CABG except for graft failure. And, the association of hypophosphatemia with graft failure remains to be evaluated.
Klíčová slova:
Coronary heart disease – Chronic kidney disease – Arteries – Coronary arteries – Myocardial infarction – Ejection fraction – Calcification – Coronary artery bypass grafting
Zdroje
1. Komaba H, Fukagawa M. Phosphate-a poison for humans? Kidney Int. 2016; 90:753–63. doi: 10.1016/j.kint.2016.03.039 27282935
2. Podd D. Hyperphosphatemia: understanding the role of phosphate metabolism. JAAPA. 2010; 23:32–7. doi: 10.1097/01720610-201007000-00008 20690439
3. O'Neill WC. Pyrophosphate, alkaline phosphatase, and vascular calcification. Circ Res. 2006; 99:e2. doi: 10.1161/01.RES.0000234909.24367.a9 16857967
4. Tonelli M, Sacks F, Pfeffer M, Gao Z, Curhan G, Cholesterol, et al. Relation between serum phosphate level and cardiovascular event rate in people with coronary disease. Circulation. 2005; 112:2627–33. doi: 10.1161/CIRCULATIONAHA.105.553198 16246962
5. Tonelli M, Curhan G, Pfeffer M, Sacks F, Thadhani R, Melamed ML, et al. Relation between alkaline phosphatase, serum phosphate, and all-cause or cardiovascular mortality. Circulation. 2009; 120:1784–92. doi: 10.1161/CIRCULATIONAHA.109.851873 19841303
6. Adeney KL, Siscovick DS, Ix JH, Seliger SL, Shlipak MG, Jenny NS, et al. Association of serum phosphate with vascular and valvular calcification in moderate CKD. J Am Soc Nephrol. 2009; 20:381–7. doi: 10.1681/ASN.2008040349 19073826
7. Kestenbaum B, Sampson JN, Rudser KD, Patterson DJ, Seliger SL, Young B, et al. Serum phosphate levels and mortality risk among people with chronic kidney disease. J Am Soc Nephrol. 2005; 16:520–8. doi: 10.1681/ASN.2004070602 15615819
8. Cohen J, Kogan A, Sahar G, Lev S, Vidne B, Singer P. Hypophosphatemia following open heart surgery: incidence and consequences. Eur J Cardiothorac Surg. 2004; 26:306–10. doi: 10.1016/j.ejcts.2004.03.004 15296888
9. Andersen PT, Nielsen LK, Moller-Petersen J, Henneberg EW, Egeblad K. Severe hypophosphatemia following elective abdominal aortic bypass grafting. Acta Chir Scand. 1987; 153:641–6. 3434107
10. van Kuijk JP, Flu WJ, Chonchol M, Valentijn TM, Verhagen HJ, Bax JJ, et al. Elevated preoperative phosphorus levels are an independent risk factor for cardiovascular mortality. Am J Nephrol. 2010; 32:163–8. doi: 10.1159/000315856 20606420
11. Oh PC, Lee K, Kim TH, Moon J, Park HW, Jang HJ, et al. Prognostic impact of alkaline phosphatase measured at time of presentation in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. PLoS One. 2017; 12:e0171914. doi: 10.1371/journal.pone.0171914 28182682
12. Park JB, Kang DY, Yang HM, Cho HJ, Park KW, Lee HY, et al. Serum alkaline phosphatase is a predictor of mortality, myocardial infarction, or stent thrombosis after implantation of coronary drug-eluting stent. Eur Heart J. 2013; 34:920–31. doi: 10.1093/eurheartj/ehs419 23242189
13. Kim TK, Hong DM, Choi YH, Koo CH, Cho YJ, Park JB, et al. Preoperative Serum Alkaline Phosphatase and Clinical Outcome of Off-Pump Coronary Artery Bypass Surgery. Circ J. 2017; 81:799–805. doi: 10.1253/circj.CJ-16-1288 28250357
14. Hicks KA, Tcheng JE, Bozkurt B, Chaitman BR, Cutlip DE, Farb A, et al. 2014 ACC/AHA Key Data Elements and Definitions for Cardiovascular Endpoint Events in Clinical Trials: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Cardiovascular Endpoints Data Standards). Circulation. 2015; 132:302–61. doi: 10.1161/CIR.0000000000000156 25547519
15. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018; 72:2231–64. doi: 10.1016/j.jacc.2018.08.1038 30153967
16. Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med. 2015; 34:3661–79. doi: 10.1002/sim.6607 26238958
17. Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis. 1998; 31:607–17. doi: 10.1053/ajkd.1998.v31.pm9531176 9531176
18. Bellasi A, Mandreoli M, Baldrati L, Corradini M, Di Nicolo P, Malmusi G, et al. Chronic kidney disease progression and outcome according to serum phosphorus in mild-to-moderate kidney dysfunction. Clin J Am Soc Nephrol. 2011; 6:883–91. doi: 10.2215/CJN.07810910 21393493
19. Uribarri J. Phosphorus homeostasis in normal health and in chronic kidney disease patients with special emphasis on dietary phosphorus intake. Semin Dial. 2007; 20:295–301. doi: 10.1111/j.1525-139X.2007.00309.x 17635818
20. Austin PC. An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Multivariate Behav Res. 2011; 46:399–424. doi: 10.1080/00273171.2011.568786 21818162
21. Austin PC, Stuart EA. The performance of inverse probability of treatment weighting and full matching on the propensity score in the presence of model misspecification when estimating the effect of treatment on survival outcomes. Stat Methods Med Res. 2017; 26:1654–70. doi: 10.1177/0962280215584401 25934643
22. McCaffrey DF, Ridgeway G, Morral AR. Propensity score estimation with boosted regression for evaluating causal effects in observational studies. Psychol Methods. 2004; 9:403–25. doi: 10.1037/1082-989X.9.4.403 15598095
23. Peng A, Wu T, Zeng C, Rakheja D, Zhu J, Ye T, et al. Adverse effects of simulated hyper- and hypo-phosphatemia on endothelial cell function and viability. PLoS One. 2011; 6:e23268. doi: 10.1371/journal.pone.0023268 21858050
24. Dimmeler S, Fleming I, Fisslthaler B, Hermann C, Busse R, Zeiher AM. Activation of nitric oxide synthase in endothelial cells by Akt-dependent phosphorylation. Nature. 1999; 399:601–5. doi: 10.1038/21224 10376603
25. Heames RM, Cope RA. Hypophosphataemia causing profound cardiac failure after cardiac surgery. Anaesthesia. 2006; 61:1211–3. doi: 10.1111/j.1365-2044.2006.04839.x 17090245
26. Rasmussen C, Thiis JJ, Clemmensen P, Efsen F, Arendrup HC, Saunamaki K, et al. Significance and management of early graft failure after coronary artery bypass grafting: feasibility and results of acute angiography and re-re-vascularization. Eur J Cardiothorac Surg. 1997; 12:847–52. doi: 10.1016/s1010-7940(97)00268-6 9489868
Článok vyšiel v časopise
PLOS One
2019 Číslo 12
- Metamizol jako analgetikum první volby: kdy, pro koho, jak a proč?
- Nejasný stín na plicích – kazuistika
- Masturbační chování žen v ČR − dotazníková studie
- Těžké menstruační krvácení může značit poruchu krevní srážlivosti. Jaký management vyšetření a léčby je v takovém případě vhodný?
- Fixní kombinace paracetamol/kodein nabízí synergické analgetické účinky
Najčítanejšie v tomto čísle
- Methylsulfonylmethane increases osteogenesis and regulates the mineralization of the matrix by transglutaminase 2 in SHED cells
- Oregano powder reduces Streptococcus and increases SCFA concentration in a mixed bacterial culture assay
- The characteristic of patulous eustachian tube patients diagnosed by the JOS diagnostic criteria
- Parametric CAD modeling for open source scientific hardware: Comparing OpenSCAD and FreeCAD Python scripts