PT  - JOURNAL ARTICLE
AU  - Annette Marie Maznyczka
AU  - Mohamad Fahed Barakat
AU  - Bassey Ussen
AU  - Amit Kaura
AU  - Huda Abu-Own
AU  - Fadi Jouhra
AU  - Hannah Jaumdally
AU  - George Amin-Youssef
AU  - Niki Nicou
AU  - Max Baghai
AU  - Ranjit Deshpande
AU  - Olaf Wendler
AU  - Shyam Kolvekar
AU  - Darlington O Okonko
TI  - Calculated plasma volume status and outcomes in patients undergoing coronary bypass graft surgery
AID  - 10.1136/heartjnl-2018-314246
DP  - 2019 Jul 01
TA  - Heart
PG  - 1020--1026
VI  - 105
IP  - 13
4099  - http://heart.bmj.com/content/105/13/1020.short
4100  - http://heart.bmj.com/content/105/13/1020.full
SO  - Heart2019 Jul 01; 105
AB  - Objectives Congestion is associated with worse outcomes in critically ill surgical patients but can be difficult to quantify noninvasively. We hypothesised that plasma volume status (PVS), estimated preoperatively using a validated formula that enumerates percentage change from ideal plasma volume (PV), would provide incremental prognostic utility after coronary artery bypass graft (CABG) surgery.Methods In this retrospective cohort study, patients who underwent CABG surgery (1999–2010) were identified from a prospectively collected database. Actual ([1-haematocrit] x [a+(b x weight [kg])]) and ideal (c x weight [kg]) PV were obtained from equations where a, b and c are sex-dependent constants. Calculated PVS was then derived (100% x [(actual−ideal)/ideal]).Results In 1887 patients (mean age 67±10 years; 79% male; median European System for Cardiac Operative Risk Evaluation [EuroSCORE] 4), mean PVS was −8.2±9%. While 8% of subjects had clinical evidence of congestion, a relatively increased PV (PVS >0%) was estimated in 17% and correlated with lower serum sodium, higher EuroSCORE and a diagnosis of diabetes mellitus. A PVS≥5.6% was optimally prognostic and associated with greater mortality (HR: 2.31, p=0.009), independently of, and incremental to, EuroSCORE, New York Heart Association class and serum sodium. A PVS≥5.6% also independently predicted longer intensive care (β: 0.65, p=0.007) and hospital (β: 2.01, p=0.006) stays, and greater postoperative renal (OR: 1.61, p=0.008) and arrhythmic (OR: 1.29, p=0.03) complications.Conclusions Higher PVS values, calculated simply from weight and haematocrit, are associated with worse inpatient outcomes after CABG. PVS could help refine risk stratification and further investigations are warranted to evaluate the potential clinical utility of PVS-guided management in patients undergoing CABG.