Post-Cardiopulmonary Bypass Alterations in Liver Delta Ratio: A Retrospective Clinical Study

Öz

Aim: To investigate the effect of cardiopulmonary bypass on the liver using data obtained from differences in liver-related blood parameters in blood samples taken before and after coronary artery bypass grafting surgery. Methods: This retrospective study included a total of 88 patients who underwent coronary artery bypass graft surgery. A difference analysis was performed for AST, ALT, LDH, CRP, RBC, Hct, albumin, CRP, lactate, K, and bilirubin levels. Kruskal–Wallis and correlation analyses were used to evaluate the relationships between the differences in the data. Results: When preoperative and postoperative values were compared, significant differences were found between AST difference ALT, AST difference LDH, ALT difference LDH, ALT difference CRP, LDH difference CRP, RBC difference Hct, and Albumin difference CRP (p<0.05). GGT, albumin, Hct, RBC, and potassium levels decreased significantly (p<0.05). Conclusıon: Significant increases in AST, ALT, LDH, total and direct bilirubin, and CRP levels were observed in the postoperative period, while significant decreases were observed in albumin, Hct, and RBC counts. The increase in AST levels was found to be related to the total perfusion time, while the increase in LDH was sensitive to the cross-clamp time.

Anahtar Kelimeler

• Liver parameters
• Cardiopulmonary bypass
• Cardiopulmonary bypass and hematological parameters
• De Ritis

Kardiyopulmoner Bypass Sonrası Karaciğer Delta Oranındaki Değişiklikler: Retrospektif Klinik Çalışma

Öz

Amaç: Koroner arter bypass greftleme cerrahisi öncesi ve sonrası alınan kan örneklerinde karaciğerle ilişkili kan parametrelerindeki farklılıklardan elde edilen veriler kullanılarak, kardiyopulmoner bypassın karaciğer üzerindeki etkisini araştırmak. Materyal ve Metot: Bu retrospektif çalışmaya koroner arter bypass greft ameliyatı geçiren toplam 88 hasta dâhil edildi. AST, ALT, LDH, CRP, RBC, Hct, albümin, laktat, potasyum ve bilirubin düzeyleri için fark analizi yapıldı. Verilerdeki farklar arasındaki ilişkileri değerlendirmek amacıyla Kruskal–Wallis ve korelasyon analizleri kullanıldı. Bulgular: Preoperatif ve postoperatif değerler karşılaştırıldığında; AST farkı–ALT, AST farkı–LDH, ALT farkı–LDH, ALT farkı–CRP, LDH farkı–CRP, RBC farkı–Hct ve Albümin farkı–CRP arasında anlamlı farklılıklar bulundu (p<0.05). GGT, albümin, Hct, RBC ve potasyum düzeylerinde anlamlı düşüşler saptandı (p<0.05). Sonuç: Postoperatif dönemde AST, ALT, LDH, total ve direkt bilirubin ile CRP düzeylerinde belirgin artışlar gözlenirken, albümin, Hct ve RBC sayılarında anlamlı düşüşler saptandı. AST düzeylerindeki artışın toplam perfüzyon süresiyle ilişkili olduğu, LDH artışının ise kros-klemp süresine duyarlı olduğu görüldü.

Anahtar Kelimeler

• Karaciğer parametreleri
• Kardiyopulmoner bypass
• Kardiyopulmoner bypass ve hematolojik parametreler
• De Ritis

Kaynakça

1. Di Tomasso N, Monaco F, Landoni G. Hepatic and renal effects of cardiopulmonary bypass. Best Pract Res Clin Anaesthesiol. 2015;29(2):151-161. Crossref
2. Chacon MM, Schulte TE. Liver dysfunction in cardiac surgery-what causes it and is there anything we can do? J Cardiothorac Vasc Anesth. 2018;32(4):1719-1721. Crossref
3. Gao M, Cheng Y, Zheng Y, Zhang W, Wang L, Qin L. Association of serum transaminases with short- and long-term outcomes in patients with st-elevation myocardial infarction undergoing primary percutaneous coronary intervention. BMC Cardiovasc Disord. 2017;17(1):43. Crossref
4. Kapoor MC. N-acetyl Cysteine to Mitigate Liver Damage in Patients with Deranged Liver Function Undergoing Surgery on Cardiopulmonary Bypass. Ann Card Anaesth. 2024;27(4):299-300. Crossref
5. Steininger M, Winter MP, Reiberger T, Koller L, El-Hamid F, Forster S, et al. De Ritis Ratio Improves LongTerm Risk Prediction after Acute Myocardial Infarction. J Clin Med. 2018;7(12):474. Crossref
6. Amaç B, Bağış MZ, Padak M. Comparison of De Ritis Rate for Del Nido Versus Blood Cardioplegia in Patients Who Underwent Coronary Artery Bypass Graft Under Cardiopulmonary Bypass. J Cukurova Anesth Surg. 2024;7(3):144-148. Crossref
7. Feng X, Wen Y, Peng FF, Wang N, Zhan X, Wu X. Association between aminotransferase/alanine aminotransferase ratio and cardiovascular disease mortality in patients on peritoneal dialysis: a multi-center retrospective study. BMC Nephrol. 2020;21(1):209. Crossref
8. Van Deursen VM, Damman K, Hillege HL, van Beek AP, van Veldhuisen DJ, Voors AA. Abnormal liver function in relation to hemodynamic profile in heart failure patients. J Card Fail. 2010;16(1):84-90. Crossref

9. Furat C, İlhan G, Bayar E, Bozok Ş, Güvener M, Yılmaz M. L-carnitine on myocardial function after coronary artery bypass grafting. Turk Gogus Kalp Dama. 2018;26(1):22-29. Crossref
10. Heo RH, Wang MK, Meyre PB, Birchenough L, Park L, Vuong K, et al. Associations of Inflammatory Biomarkers With the Risk of Morbidity and Mortality After Cardiac Surgery: A Systematic Review and Meta-analysis. Can J Cardiol. 2023;39(11):1686-1694. Crossref
11. Santonocito C, Sanfilippo F, De Locker I, Chiarenza F, Giacomo C, Njimi H, et al. C-Reactive protein kinetics after cardiac surgery: A retrospective multicenter study. Ann Card Anaesth. 2022;25(4):498-504. Crossref
12. Amaç B, Bağış MZ. Kardiyopulmoner Bypass Eşliğinde Kalp Kapak Cerrahisi Uygulanan Hastalarda Perfüzyon Süresinin Postoperatif Sonuçlar Üzerine Etkisi. BÜSAD. 2023;4(2):252-262. Crossref
13. Amaç B, Koçarslan A, Aydın MS, Kankılıç N, Padak M, Dikme R. Kardiyopulmoner Bypass'ın Hemogram Parametreleri Üzerine Etkisi. Online Turk J Health Sci Life. 2021;6(1):102-111. Crossref
14. Bayanmelek AB, Kutluk E. Kardiyopulmoner Bypass Uygulanan Hastalarda Hipotermi ve Normoterminin pH, Serum Laktat Üzerine Etkisi. Turk J Clin Cardiov Perfusion. 2024;2(1):15-20. Crossref
15. Levitt DG, Levitt MD. Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements. Int J Gen Med. 2016;9:229-255. Crossref
16. Huang T, An Z, Huang Z, Gao W, Hao B, Xu J. Serum albumin and cardiovascular disease: a Mendelian randomization study. BMC Cardiovasc Disord. 2024;24:196. Crossref
17. Zakeri S, Vafaey H, Banihashem N, Alijanpour A, Gholinia H, Behzad C. Evaluation of liver function tests after coronary artery bypass surgery (CABG). Caspian J Intern Med. 2021;12(1):45-52. Crossref