Preoperative creatinine clearance as a predictor of short-term outcomes after cardiac surgery: a cohort study for the comparison between the Cockroft-Gault and modification of diet in renal disease formulae

Abstract

Background: Preoperative renal function is an important risk factor in cardiac surgery for long-term and short-term outcomes. Renal function is best assessed by measuring or calculating the glomerular filtration rate (GFR). Several algorithms using the endogenous marker serum creatinine have been developed to estimate renal function. These include the Cockcroft and Gault and the modification of diet in renal disease (MDRD) formulae. The aim of this study was to compare the predictive power of the two formulae towards short-term outcomes after cardiac surgery, such as the length of intensive care unit (ICU) stay, the length of mechanical ventilation time, and the length of in-hospital stay.

Methods: One hundred and fifty patients undergoing cardiac surgery and not affected by renal failure were followed up until hospital discharge. We collected data before, during and after surgery. Before surgery data consisted of date of birth, sex, height, weight, plasma creatinine level; during surgery data consisted of type of intervention (including number of bypasses, if any), cardiopulmonary bypass time and aortic cross-clamp time; after surgery data consisted of length of ICU stay, mechanical ventilation time, length of in-hospital stay after intensive-care discharge (ward stay), incidence of acute renal failure (expressed as the need for dialysis) and mortality. The dataset was analyzed using Cox regression.

Results: The average mechanical ventilation time, ICU stay and ward stay were 11 h, 49 h and 10 days, respectively. After having adjusted for chronic obstructive pulmonary disease, diabetes and postsurgical dialysis, the GFR calculated with the Cockcroft and Gault formula appeared to be a predictor of ICU stay and mechanical ventilation time with very strong evidence (P = 0.002 and <0.001, respectively) and a predictor of ward stay with some evidence (P = 0.062). After an identical case-mix adjustment, the GFR calculated with the MDRD formula appeared to be a predictor of ICU stay with strong evidence (P = 0.007), a predictor of mechanical ventilation time with some evidence (P = 0.075) and it has shown no evidence of predicting ward stay (P = 0.197).

Conclusion: There is an indication that the Cockcroft and Gault formula could be more powerful than the MDRD formula for the preoperative prediction of early postoperative clinical outcomes in cardiac surgery, in patients not affected by renal failure. Further research is needed to confirm this result.