Effect of standardized fluid management on cardiac function after CRS + HIPEC in patients with PMP: a single-center case-control study

Figures & data

Figure 1. Total parenteral nutrition (TPN) configuration tool.

Figure 2. Statistical tool for assessing postoperative input and output.

Table 1. Major clinicopathological characteristics, preoperative cardiac and renal function parameters of PMP patients in this study.

Variables	Control group (n = 42)	Study group (n = 62)	p value
Gender, n (%)			0.695
Male	26 (61.9)	36 (58.1)
Female	16 (38.1)	26 (41.9)
Age (years), median (range)	57 (33–76)	56 (31–76)	0.666
Intravenous chemotherapy, n (%)			0.206
No	32 (76.2)	40 (64.5)
Yes	10 (23.8)	22 (35.5)
KPS, median (range)	90 (70–100)	90 (60–100)	0.067
Pathological diagnosis, n (%)			0.997
Low grade	21 (50.0)	31 (50.0)
High grade	14 (33.3)	21 (33.9)
High grade with signet ring cells	7 (16.7)	10 (16.1)
Vascular invasion, n (%)			0.628
No	41 (97.6)	58 (93.5)
Yes	1 (2.4)	4 (6.5)
Lymphatic metastasis, n (%)			1.000
No	38 (90.5)	55 (88.7)
Yes	4 (9.5)	7 (11.3)
Preoperative NT-proBNP > ULN, n (%)			0.715
NO	39 (92.9)	55 (88.7)
Yes	3 (7.1)	7 (11.3)
Preoperative CK-MB > ULN, n (%)			NA
No	42 (100.0)	62 (100.0)
Yes	0 (0.0)	0 (0.0)
Preoperative CTNI > ULN, n (%)			NA
No	42 (100.0)	62 (100.0)
Yes	0 (0.0)	0 (0.0)
Preoperative SCr > ULN, n (%)			NA
No	42 (100.0)	62 (100.0)
Yes	0 (0.0)	0 (0.0)
Preoperative BUN > ULN, n (%)			0.314
No	40 (95.2)	62 (100.0)
Yes	2 (4.8)	0 (0.0)

KPS: Karnofsky performance status score; ULN: upper limit of normal; SCr: serum creatinine; BUN: blood urea nitrogen; NA: not applicable.

Table 2. Major CRS + HIPEC characteristics of PMP patients between control and study groups.

Variables	Control group (n = 42)	Study group (n = 62)	p value
Operative duration (min), mean ± SD	598.9 ± 186.16	627.1 ± 136.74	0.378
Resected organs, median (range)	4 (0–8)	4 (0–9)	0.134
Anastomosis, n (%)			0.796
No	9 (21.4)	12 (19.4)
Yes	33 (78.6)	50 (80.6)
PCI, median (range)	29.5 (3.0–39.0)	30.0 (1.0–39.0)	0.774
CC, n (%)			0.517
0–1	21 (50.0)	35 (56.5)
2–3	21 (50.0)	27 (43.5)
Blood loss volume (mL), median (range)	600 (100–5,000)	600 (50–2,400)	0.619
Fluid transfusion volume (mL), mean ± SD	7,564.8 ± 2,643.00	7,176.0 ± 2,679.85	0.469
Urine volume (mL), median (range)	1,650 (600–4,500)	1,800 (600–8,000)	0.503
RBC transfusion volume (U), median (range)	2 (0–20)	4 (0–10)	0.288
Plasma transfusion volume (mL), median (range)	800 (0–1,500)	800 (0–1,200)	0.216
Ascites volume (mL), median (range)	800 (0–20,000)	600 (0–10,000)	0.398

PCI: peritoneal cancer index; CC: completeness of cytoreduction; RBC: red blood cells.

Figure 3. Comparison of fluid volumes in control vs. study groups by postoperative day (POD). (A) Comparison in median fluid volume on POD1 (**p = 0.002); (B) Comparison in median fluid volume on POD2 (***p < 0.001); (C) Comparison in median fluid volume on POD3 (***p < 0.001).

Table 3. The degree and duration of postoperative elevation in cardiac and renal function parameters between control and study groups.

Variables	Control group (n = 42)	Study group (n = 62)	p value
NT-proBNP > ULN, n (%)			0.840
No	4 (9.5)	4 (6.5)
Yes	38 (90.5)	58 (93.5)
Duration of NT-proBNP > ULN, mean ± SD (day)	3.4 ± 2.90	4.3 ± 3.09	0.053
CTNI > ULN, n (%)			0.008
NO	22 (52.4)	48 (77.4)
Yes	20 (47.6)	14 (22.6)
CTNI > 2 × ULN, n (%)			0.023
No	28 (66.7)	53 (85.5)
Yes	14 (33.3)	9 (14.5)
CTNI > 3 × ULN, n (%)			0.012
No	30 (71.4)	56 (90.3)
Yes	12 (28.6)	6 (9.7)
Duration of CTNI > ULN, mean ± SD (day)	1.7 ± 2.59	0.9 ± 2.25	0.009
CK-MB > ULN, n (%)			0.285
No	22 (52.4)	39 (58.7)
Yes	20 (47.6)	23 (41.3)
Duration of CK-MB > ULN, mean ± SD (day)	0.9 ± 1.32	0.4 ± 0.56	0.088
SCr > ULN, n (%)			0.005
No	31 (73.8)	58 (93.5)
Yes	11 (26.2)	4 (6.5)
Duration of SCr > ULN, mean ± SD (day)	0.7 ± 1.81	0.2 ± 1.08	0.005
BUN > ULN, n (%)			0.001
No	9 (21.4)	34 (54.8)
Yes	33 (78.6)	28 (45.2)
Duration of BUN > ULN, mean ± SD (day)	3.6 ± 3.01	2.0 ± 3.01	0.001

ULN: upper limit of normal; NT-proBNP: N-terminal pro-hormone brain natriuretic peptide; CTNI: cardiac troponin I; CK-MB: creatine kinase MB; SCr: serum creatinine; BUN: blood urea nitrogen.

Table 4. SAEs between control and study groups.

Variable	Control group (n = 42)	Study group (n = 62)	p value
Total SAEs, n (%)			0.112
No	32 (76.2)	38 (61.3)
Yes	10 (23.8)	24 (38.7)
Cardiovascular SAEs, n (%)			0.356
No	38 (90.5)	60 (96.8)
Yes	4 (9.5)	2 (3.2)

SAEs: serious adverse events.

Table 5. Correlation analysis of postoperative NT-proBNP and myocardial injury markers with cardiovascular SAEs after CRS + HIPEC in PMP patients.

Variables	No cardiovascular SAEs (n = 98)	Cardiovascular SAEs (n = 6)	p value
NT-proBNP > ULN, n (%)			1.000
No	8 (8.2)	0 (0)
Yes	90 (91.8)	6 (100.0)
NT-proBNP > 3 × ULN, n (%)			0.028
No	54 (55.1)	0 (0)
Yes	44 (44.9)	6 (100.0)
CTNI > ULN, n (%)			0.002
No	70 (71.4)	0 (0)
Yes	28 (28.6)	6 (100.0)
CTNI > 2 × ULN, n (%)			0.028
No	79 (80.6)	2 (33.3)
Yes	19 (19.4)	4 (66.7)
CTNI > 3 × ULN, n (%)			0.104
No	83 (84.7)	3 (50.0)
Yes	15 (15.3)	3 (50.0)
CK-MB > ULN, n (%)			0.085
No	60 (61.2)	1 (16.7)
Yes	38 (38.8)	5 (83.3)
CK-MB > 2 × ULN, n (%)			0.127
No	82 (83.7)	3 (50.0)
Yes	16 (16.3)	3 (50.0)

ULN: upper limit of normal; NT-proBNP: N-terminal pro-hormone brain natriuretic peptide; CTNI: cardiac troponin I; CK-MB: creatine kinase MB; SAEs: serious adverse events.

Figure 4. Survival analysis. (A) Overall survival analysis of all patients; (B) Survival curve analysis of control group and study group.

Figure 5. Univariate analysis of survival. (A) Pathological grading; (B) CC score; (C) CTNI > ULN.

Table 6. Multivariate survival analysis of PMP patients after CRS + HIPEC.

Variables	Wald	OR	95%CI	p
CC
2–3 vs. 0–1	6.439	3.287	1.311–8.242	0.011
Pathological grading
High grade with signet ring cells vs. Low grade	7.584	4.004	1.492–10.747	0.006
Postoperative CTNI > ULN
Yes vs. No	11.671	3.999	1.805–8.856	0.001

OR: odds ratio; CI: confidence interval; CC: completeness of cytoreduction; ULN: upper limit of normal; CTNI: cardiac troponin I.