Limits...
Risk Assessment of Patients Undergoing Transfemoral Aortic Valve Implantation upon Admission for Post-Interventional Intensive Care and Surveillance: Implications on Short- and Midterm Outcomes

View Article: PubMed Central - PubMed

ABSTRACT

Background: Several studies have found that standard risk scores inaccurately reflect risk in TAVI cohorts. The assessment of mortality risk upon post-interventional ICU admission is important to optimizing clinical management. This study sought to determine outcomes and factors affecting mortality in patients admitted to the intensive care unit (ICU) after transcatheter aortic valve implantation (TAVI), and to analyze and compare the predictive values of SAPS II and EuroSCORE.

Methods and findings: 214 consecutive patients treated with transfemoral TAVI (2006–2012) admitted to the ICU in an academic tertiary-care university hospital, were included in this retrospective data analysis. The overall 30-day mortality rate was 7%. Non-survivors at 30-days and survivors showed differences in the rates of catecholamine therapy upon ICU admission (93 vs. 29%; p<0.001), stroke (20 vs. 1%;p<0.001), sepsis (27 vs. 2%;p<0.001), kidney injury (83 vs. 56%; log-rank p<0.001), catecholamine therapy (88 vs. 61%;log-rank p<0.001) and vascular complications (60 vs. 17%; p<0.001). Mean SAPS II score and predicted mortality were higher in non-survivors (38.1±7.0 vs. 29.9±6.2;p<0.001 and 23.1±11.7 vs. 10.5±8.2;p<0.001, retrospectively), whereas the logistic EuroSCORE could not discriminate between the groups (p = 0.555). Among the biochemical parameters, the maximum values of creatinine, procalcitonin, and troponin I during the first 48 h after ICU admission were significantly higher in non-survivors. Multivariate analysis of baseline characteristics and complications associated with two-year mortality showed no significant results.

Conclusions: The SAPS II is a good tool for estimating ICU mortality immediately after performing the TAVI procedure and provides valuable information for other known predictors of mortality.

No MeSH data available.


Related in: MedlinePlus

Survival.Survival rate, as indicated by the rate of peri-procedural acute kidney injury (A) and to the need for catecholamine adminstration (B).
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5120839&req=5

pone.0167072.g001: Survival.Survival rate, as indicated by the rate of peri-procedural acute kidney injury (A) and to the need for catecholamine adminstration (B).

Mentions: For the patients, who were alive at 30 days after TAVI (“survivors”), the two-year survival was 83%. Acute kidney injury (83% vs. 56%; log-rank p < 0.001) as well as catecholamine therapy (88% vs. 61%; log-rank p < 0.001) significantly influenced the two-year survival rate (Fig 1).


Risk Assessment of Patients Undergoing Transfemoral Aortic Valve Implantation upon Admission for Post-Interventional Intensive Care and Surveillance: Implications on Short- and Midterm Outcomes
Survival.Survival rate, as indicated by the rate of peri-procedural acute kidney injury (A) and to the need for catecholamine adminstration (B).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120839&req=5

pone.0167072.g001: Survival.Survival rate, as indicated by the rate of peri-procedural acute kidney injury (A) and to the need for catecholamine adminstration (B).
Mentions: For the patients, who were alive at 30 days after TAVI (“survivors”), the two-year survival was 83%. Acute kidney injury (83% vs. 56%; log-rank p < 0.001) as well as catecholamine therapy (88% vs. 61%; log-rank p < 0.001) significantly influenced the two-year survival rate (Fig 1).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Several studies have found that standard risk scores inaccurately reflect risk in TAVI cohorts. The assessment of mortality risk upon post-interventional ICU admission is important to optimizing clinical management. This study sought to determine outcomes and factors affecting mortality in patients admitted to the intensive care unit (ICU) after transcatheter aortic valve implantation (TAVI), and to analyze and compare the predictive values of SAPS II and EuroSCORE.

Methods and findings: 214 consecutive patients treated with transfemoral TAVI (2006&ndash;2012) admitted to the ICU in an academic tertiary-care university hospital, were included in this retrospective data analysis. The overall 30-day mortality rate was 7%. Non-survivors at 30-days and survivors showed differences in the rates of catecholamine therapy upon ICU admission (93 vs. 29%; p&lt;0.001), stroke (20 vs. 1%;p&lt;0.001), sepsis (27 vs. 2%;p&lt;0.001), kidney injury (83 vs. 56%; log-rank p&lt;0.001), catecholamine therapy (88 vs. 61%;log-rank p&lt;0.001) and vascular complications (60 vs. 17%; p&lt;0.001). Mean SAPS II score and predicted mortality were higher in non-survivors (38.1&plusmn;7.0 vs. 29.9&plusmn;6.2;p&lt;0.001 and 23.1&plusmn;11.7 vs. 10.5&plusmn;8.2;p&lt;0.001, retrospectively), whereas the logistic EuroSCORE could not discriminate between the groups (p = 0.555). Among the biochemical parameters, the maximum values of creatinine, procalcitonin, and troponin I during the first 48 h after ICU admission were significantly higher in non-survivors. Multivariate analysis of baseline characteristics and complications associated with two-year mortality showed no significant results.

Conclusions: The SAPS II is a good tool for estimating ICU mortality immediately after performing the TAVI procedure and provides valuable information for other known predictors of mortality.

No MeSH data available.


Related in: MedlinePlus