Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2018; 15 (2): 65-144 ➤ Диагностическое значение общей амилазы и факторы риска развития послеоперационного панкреатита в кардиохирургии

Diagnostic importance of amylase activity and risk factors of pancreatic after cardiac surgery

Authors: D.Sh. Samuilova 1, M.G. Plyushch 1, O.V. Samuilova 2, A.A. Kupryashov 1, L.A. Bockeria 1

Company:
1Bakoulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
2Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, ul. Trubetskaya, 8, stroenie 2, Moscow, 119991, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2018-15-2-126-133

UDC: 616.37-002:616.12-089.168-06:577.15-07

Link: Clinical Physiology of Blood Circulaiton. 2018; 15 (2): 126-133

Quote as:

Objective. This study aimed to identify the risk factors for postoperative pancreatitis after open heart surgery and usefulness of amylase activity as a diagnosis marker of pancreatitis.
Material and methods. We retrospectively analyzed 133 patients who underwent cardiac surgery with cardiopulmonary bypass. The analysis endpoints included development of postoperative pancreatitis or death during hospitalization. Duration of cardiopulmonary bypass, aortic clamping time, Nadir hematocrit during cardiopulmonary bypass and pre- and postoperative values of amylase, ALT, creatinine, bilirubin and lactate were used as predictors for acute pancreatitis development.
Results. Acute pancreatitis is associated with significant mortality after open heart surgery with cardiopulmonary bypass (OR = 72.25 (95%CI [14,844; 351,668], p < 0.0001). In multivariant model, risk factors of acute pancreatitis are duration of cardiopulmonary bypass, lactate concentration and amylase activity.
Conclusion. Acute pancreatitis screening tests are necessary in patients with preoperative amylase activity higher than 48 U/l, lactate concentration higher than 10 mmol/l during first 6 h after operation and duration of cardiopulmonary bypass longer than 118 min. Amylase activities higher than 371 U/l represented a biochemical marker of acute postoperative pancreatitis.

Keywords:  amylase pancreatitis lactate multiorgan failure

Received / Accepted:  02.02.2018/07.02.2018

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Abstract

Objective – to assess the ability of the complex echocardiography in the diagnosis of the diastolic left ventricular dys- function in the early postoperative period in patients with acquired valvular heart disease.
Material and methods. In our study, 38 patients with acquired valvular heart disease were analyzed by tissue Doppler imaging in the early postoperative period. All of them had the normal pumping function, but were complicated with low left ventricular volumes.
Results. 7 patients had restrictive diastolic dysfunction. In the course of the treatment diastolic function was improved in 5 patients, who, where, transferred from the intensive care unit.
Conclusion. These data suggest that advanced technology of echocardiography can help performed the differential diag- nosis in early postoperative period. Early detection and echocardiographic follow-up of myocardial function allows the adequate management of diastolic heart failure and decreased the mortality and morbidity.

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References

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  2. Chung J.W., Ryu S.H., Jo J.H., Park J.Y., Lee S., Park S.W. et al. Clinical implications and risk factors of acute pancreatitis after cardiac valve surgery. Yonsei Med. J. 2013; 54 (1): 154–9. DOI: 10.3349/ymj.2013.54.1.154
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  9. Madole M.B., Iyer C.M., Madivalar M.T., Wadde S.K., Howale D.S. Evaluation of biochemical markers serum amylase and serum lipase for the assessment of pancre- atic exocrine function in diabetes mellitus. J. Clin. Diagn. Res. 2016; 10 (11): BC01–4. DOI: 10.7860/ JCDR/2016/23787.8900
  10. Nakajima K. Low serum amylase and obesity, diabetes and metabolic syndrome: a novel interpretation. World. J. Diabetes. 2016; 7 (6): 112–21. DOI: 10.4239/ wjd.v7.i6.112
  11. Dong G., Liu C., Xu B., Jing H., Li D., Wu H. Postoperative abdominal complications after cardiopul- monary bypass. J. Cardiothorac. Surg. 2012; 7: 108. DOI: 10.1186/1749-8090-7-108
  12. De Jong P.R., González-Navajas J.M., Jansen N.J. The digestive tract as the origin of systemic inflammation. Crit. Care. 2016; 20 (1): 279. DOI: 10.1186/s13054- 016-1458-3
  13. Malinoski D.J., Hadjizacharia P., Salim A., Kim H., Dolich M.O., Cinat M. et al. Elevated serum pancreat- ic enzyme levels after hemorrhagic shock predict organ failure and death. J. Trauma. 2009; 67 (3): 445–9. DOI: 10.1097/TA.0b013e3181b5dc11
  14. Ihaya A., Muraoka R., Chiba Y., Kimura T., Uesaka T., Morioka K. et al. Hyperamylasemia and subclinical pancreatitis after cardiac surgery. World J. Surg. 2001; 25 (7): 862–4.
  15. Rattner D.W., Gu Z.Y., Vlahakes G.J., Warshaw A.L.Hyperamylasemia after cardiac surgery. Incidence, sig- nificance, and management. Ann. Surg. 1989; 209 (3): 279–83. DOI: 10.1097/00000658/19893000-00005
  16. Rodriges R., Robich M.P., Plate J.F., Trooskin S.Z., Sellke F.W. Gastrointestinal complications following cardiac surgery: a comprehensive review. J. Card. Surg. 2010; 25 (2): 188–97. DOI: 10.1111/j.1540-8191. 2009.00985.x
  17. Shah A.M., Eddi R., Kothari S.T., Maksoud C., DiGiacomo W.S., Baddour W. Acute pancreatitis with normal serum lipase: a case series. JOP. 2010; 11: 369–72.
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  19. Naik R., George G., Karuppiah S., Philip M.A. Hyperlactatemia in patients undergoing adult cardiac surgery under cardiopulmonary bypass: causative fac- tors and its effect on surgical outcome. Ann. Card. Anaesth. 2016; 19 (4): 668–75. DOI: 10.4103/0971- 9784.191579
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  23. Sanisoglu I., Guden M., Bayramoglu Z., Sagbas E., Dibekoglu C., Sanisoglu S.Y., Akpinar B. Does off- pump CABG reduce gastrointestinal complications? Ann. Thorac. Surg. 2004; 77 (2): 619–25. DOI: 10.1016/j.athoracsur.2003:08.006
  24. Ranucci M., Carboni G., Cotza M., Bianchi P., Di Dedda U., Aloisio T.; Surgical and Clinical Outcome Research (SCORE) Group. Hemodilution on cardiopulmonary bypass as a determinant of early postoperative hyperlactatemia. PLoS One. 2015; 10 (5): e0126939. DOI: 10.1371/journal.pone.0126939. eCollection 2015
  25. Krejci V., Hiltebrand L.B., Sigurdsson G.H. Effects of epinephrine, norepinephrine, and phenylephrine on microcirculatory blood flow in the gastrointestinal tract in sepsis. Crit. Care Med. 2006; 34: 1456–63. DOI: 10.1097/01.CCM.000215834.48023.57

About Authors

Samuilova Daniya Shavketovna, Dr. Biol. Sc., Head of Laboratory of Rapid Diagnosis; orcid.org/0000-0003-0048-4116
Plyushch Marina Grigor’evna, Cand. Biol. Sc., Head of Laboratory of Biochemistry; orcid.org/0000-0002-0359-0195
Samuilova Ol’ga Vital’evna, Cand. Biol. Sc., Associate Professor of Biochemistry Chair
Kupryashov Aleksey Anatol’evich, Dr. Med. Sc., Head of Blood Transfusion Department; orcid.org/0000-0001-7673-4762
Bockeria Leo Antonovich, Dr. Med. Sc., Professor, Academician of RAS and RAMS, Director; orcid.org/0000-0002-6180-2619

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