Key result
Multiorgan failure occurred in 10.4% of patients following pericardiectomy and was significantly associated with risk factors including elevated blood lactate (OR 9.273), preoperative central venous pressure, and fluid overload.
Why the study?
The study aimed to investigate the risk factors associated with multiorgan failure following pericardiectomy for constrictive pericarditis.
What are the risk factors for multiorgan failure following pericardiectomy for constrictive pericarditis?
Cohort (n=826)
Yes
What are the risk factors for multiorgan failure following pericardiectomy for constrictive pericarditis?
Incomplete pericardial dissection, fluid overload, and delayed diagnosis are associated with a higher risk of multiorgan failure and mortality following pericardiectomy for constrictive pericarditis.
These associations support heightened lactate and fluid monitoring post-pericardiectomy; hypothesis-generating for targeted prevention trials.
BACKGROUND: We aimed to investigate risk factors of multiorgan failure following pericardiectomy. METHODS: This was a retrospective study of patients undergoing pericardiectomy between January 1994 and May 2021 at three hospitals. RESULTS: 826 patients were included in the study and divided into two groups: group with multiorgan failure (n = 86) and group without multiorgan failure (n = 740). There were 86 patients with multiorgan failure (86/826, 10.4%). There were 66 operative deaths (66/826, 8.0%). The causes of operative deaths were multiorgan failure, including cardiogenic shock + AKI + ventricular fibrillation (13/66), cardiogenic shock + AKI (35/66), cardiogenic shock + AKI + hepatic failure + septicemia (8/66), cardiogenic shock + AKI + respiratory failure (10/66). Univariate and multivariate analyses showed the factors associated with multiorgan failure, including male (P = 0.006), time between symptoms and surgery (P < 0.001), thickness of pericardium (P < 0.001), intubation time (P < 0.001), ICU retention time (P < 0.001), hospitalized time postoperative (P < 0.001), preoperative central venous pressure (P < 0.001), postoperative central venous pressure (P < 0.001), D0 fluid balance (P < 0.001), D2 fluid balance (P < 0.001), postoperative chest drainage (P < 0.001), preoperative LVEDD(P < 0.001), postoperative LVEDD (P < 0.001), surgical duration (P < 0.001), bleeding during operation (P < 0.001), serum creatinine 24 h after surgery (P = 0.042), serum creatinine 48 h after surgery (P < 0.001), fresh-frozen plasma (P < 0.001), packed red cells (P < 0.001), blood lactate (P < 0.001). CONCLUSION: In our study, incomplete pericardial dissection, fluid overload, delayed diagnosis and treatment are associated with multiorgan failure following pericardiectomy.
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Huang et al. (2022) conducted a cohort in Constrictive pericarditis (n=826). Risk factors (e.g., elevated blood lactate, fluid overload, delayed diagnosis) vs. Absence of risk factors was evaluated on Multiorgan failure after pericardiectomy (OR 9.273, 95% CI 3.784-22.72, p=<0.001). Multiorgan failure occurred in 10.4% of patients following pericardiectomy and was significantly associated with risk factors including elevated blood lactate (OR 9.273), preoperative central venous pressure, and fluid overload.
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