McKhann et al identified risk factors for development of encephalopathy or stroke in patients undergoing coronary artery bypass graft (CABG) surgery. This can help identify patients who should be considered for alternative therapy or who may benefit from more aggressive therapy and monitoring. The authors are from Johns Hopkins University and the Eastern Virginia Medical School.
Risk factors for encephalopathy:
(1) history of past stroke
(2) carotid bruit
(3) hypertension
(4) diabetes mellitus
(5) age in years
|
Past Stroke |
Carotid Bruit |
Hyper-tension |
Diabetes Mellitus |
Age |
Probability |
|---|---|---|---|---|---|
|
N |
N |
N |
N |
< 65 |
0.03 |
|
N |
N |
N |
N |
65 - 75 |
0.04 |
|
N |
N |
N |
N |
> 75 |
0.08 |
|
N |
N |
N |
Y |
< 65 |
0.04 |
|
N |
N |
N |
Y |
65 - 75 |
0.06 |
|
N |
N |
N |
Y |
> 75 |
0.11 |
|
N |
N |
Y |
N |
< 65 |
0.04 |
|
N |
N |
Y |
N |
65 - 75 |
0.06 |
|
N |
N |
Y |
N |
> 75 |
0.11 |
|
N |
N |
Y |
Y |
< 65 |
0.06 |
|
N |
N |
Y |
Y |
65 - 75 |
0.09 |
|
N |
N |
Y |
Y |
> 75 |
0.15 |
|
N |
Y |
N |
N |
< 65 |
0.04 |
|
N |
Y |
N |
N |
65 - 75 |
0.06 |
|
N |
Y |
N |
N |
> 75 |
0.11 |
|
N |
Y |
N |
Y |
< 65 |
0.06 |
|
N |
Y |
N |
Y |
65 - 75 |
0.09 |
|
N |
Y |
N |
Y |
> 75 |
0.16 |
|
N |
Y |
Y |
N |
< 65 |
0.06 |
|
N |
Y |
Y |
N |
65 - 75 |
0.09 |
|
N |
Y |
Y |
N |
> 75 |
0.16 |
|
N |
Y |
Y |
Y |
< 65 |
0.09 |
|
N |
Y |
Y |
Y |
65 - 75 |
0.13 |
|
N |
Y |
Y |
Y |
> 75 |
0.22 |
|
Y |
N |
N |
N |
< 65 |
0.06 |
|
Y |
N |
N |
N |
65 - 75 |
0.09 |
|
Y |
N |
N |
N |
> 75 |
0.15 |
|
Y |
N |
N |
Y |
< 65 |
0.08 |
|
Y |
N |
N |
Y |
65 - 75 |
0.12 |
|
Y |
N |
N |
Y |
> 75 |
0.21 |
|
Y |
N |
Y |
N |
< 65 |
0.08 |
|
Y |
N |
Y |
N |
65 - 75 |
0.12 |
|
Y |
N |
Y |
N |
> 75 |
0.21 |
|
Y |
N |
Y |
Y |
< 65 |
0.12 |
|
Y |
N |
Y |
Y |
65 - 75 |
0.17 |
|
Y |
N |
Y |
Y |
> 75 |
0.21 |
|
Y |
Y |
N |
N |
< 65 |
0.09 |
|
Y |
Y |
N |
N |
65 - 75 |
0.13 |
|
Y |
Y |
N |
N |
> 75 |
0.29 |
|
Y |
Y |
N |
Y |
< 65 |
0.13 |
|
Y |
Y |
N |
Y |
65 - 75 |
0.18 |
|
Y |
Y |
N |
Y |
> 75 |
0.28 |
|
Y |
Y |
Y |
N |
< 65 |
0.13 |
|
Y |
Y |
Y |
N |
65 - 75 |
0.18 |
|
Y |
Y |
Y |
N |
> 75 |
0.29 |
|
Y |
Y |
Y |
Y |
< 65 |
0.18 |
|
Y |
Y |
Y |
Y |
65 - 75 |
0.24 |
|
Y |
Y |
Y |
Y |
> 75 |
0.38 |
from Figure 1 page 1424
Risk factors for stroke:
(1) history of past stroke
(2) hypertension
(3) age in years
|
Past Stroke |
Hypertension |
Age |
Probability |
|---|---|---|---|
|
N |
N |
< 65 |
0.01 |
|
N |
N |
65 - 75 |
0.02 |
|
N |
N |
> 75 |
0.04 |
|
N |
Y |
< 65 |
0.01 |
|
N |
Y |
65 - 75 |
0.03 |
|
N |
Y |
> 75 |
0.07 |
|
Y |
N |
< 65 |
0.02 |
|
Y |
N |
65 - 75 |
0.04 |
|
Y |
N |
> 75 |
0.07 |
|
Y |
Y |
< 65 |
0.03 |
|
Y |
Y |
65 - 75 |
0.07 |
|
Y |
Y |
> 75 |
0.13 |
from Figure 2 page 1425
Risk factors for encephalopathy or stroke:
(1) history of past stroke
(2) carotid bruit
(3) hypertension
(4) diabetes mellitus
(5) age in years
|
Past Stroke |
Carotid Bruit |
Hyper-tension |
Diabetes Mellitus |
Age |
Probability |
|---|---|---|---|---|---|
|
N |
N |
N |
N |
< 65 |
0.03 |
|
N |
N |
N |
N |
65 - 75 |
0.08 |
|
N |
N |
N |
N |
> 75 |
0.11 |
|
N |
N |
N |
Y |
< 65 |
0.05 |
|
N |
N |
N |
Y |
65 - 75 |
0.08 |
|
N |
N |
N |
Y |
> 75 |
0.15 |
|
N |
N |
Y |
N |
< 65 |
0.05 |
|
N |
N |
Y |
N |
65 - 75 |
0.09 |
|
N |
N |
Y |
N |
> 75 |
0.17 |
|
N |
N |
Y |
Y |
< 65 |
0.07 |
|
N |
N |
Y |
Y |
65 - 75 |
0.12 |
|
N |
N |
Y |
Y |
> 75 |
0.22 |
|
N |
Y |
N |
N |
< 65 |
0.05 |
|
N |
Y |
N |
N |
65 - 75 |
0.09 |
|
N |
Y |
N |
N |
> 75 |
0.16 |
|
N |
Y |
N |
Y |
< 65 |
0.07 |
|
N |
Y |
N |
Y |
65 - 75 |
0.11 |
|
N |
Y |
N |
Y |
> 75 |
0.22 |
|
N |
Y |
Y |
N |
< 65 |
0.08 |
|
N |
Y |
Y |
N |
65 - 75 |
0.13 |
|
N |
Y |
Y |
N |
> 75 |
0.24 |
|
N |
Y |
Y |
Y |
< 65 |
0.11 |
|
N |
Y |
Y |
Y |
65 - 75 |
0.18 |
|
N |
Y |
Y |
Y |
> 75 |
0.31 |
|
Y |
N |
N |
N |
< 65 |
0.07 |
|
Y |
N |
N |
N |
65 - 75 |
0.12 |
|
Y |
N |
N |
N |
> 75 |
0.22 |
|
Y |
N |
N |
Y |
< 65 |
0.10 |
|
Y |
N |
N |
Y |
65 - 75 |
0.16 |
|
Y |
N |
N |
Y |
> 75 |
0.28 |
|
Y |
N |
Y |
N |
< 65 |
0.11 |
|
Y |
N |
Y |
N |
65 - 75 |
0.18 |
|
Y |
N |
Y |
N |
> 75 |
0.32 |
|
Y |
N |
Y |
Y |
< 65 |
0.15 |
|
Y |
N |
Y |
Y |
65 - 75 |
0.23 |
|
Y |
N |
Y |
Y |
> 75 |
0.39 |
|
Y |
Y |
N |
N |
< 65 |
0.11 |
|
Y |
Y |
N |
N |
65 - 75 |
0.17 |
|
Y |
Y |
N |
N |
> 75 |
0.42 |
|
Y |
Y |
N |
Y |
< 65 |
0.15 |
|
Y |
Y |
N |
Y |
65 - 75 |
0.23 |
|
Y |
Y |
N |
Y |
> 75 |
0.39 |
|
Y |
Y |
Y |
N |
< 65 |
0.17 |
|
Y |
Y |
Y |
N |
65 - 75 |
0.25 |
|
Y |
Y |
Y |
N |
> 75 |
0.42 |
|
Y |
Y |
Y |
Y |
< 65 |
0.22 |
|
Y |
Y |
Y |
Y |
65 - 75 |
0.33 |
|
Y |
Y |
Y |
Y |
> 75 |
0.51 |
from Figure 3, page 1427
The risk of encephalopathy is associated with the time on cardiopulmonary bypass.
Risk groups:
(1) low: younger age and no cardiovascular risk factors
(2) high: older age with multiple cardiovascular risk factors
|
Risk |
Time on Bypass |
Probability |
|---|---|---|
|
low |
60 minutes |
0.02 |
|
low |
120 minutes |
0.05 |
|
high |
60 minutes |
0.31 |
|
high |
120 minutes |
0.50 |
from Table 5, page 1426
Thus one way to reduce risk is to perform surgery with the minimum cardiopulmonary bypass time possible.
Specialty: Anesthesiology, Neurology, Surgery, orthopedic
