Shimon Furusato, Keita Sato, Yasuyuki Nii, Reo Tanoshima, Masami Uechi
In cohort A, preoperative Tbil showed a linear positive association with 2-year all-cause mortality even within reference interval (ie, adjusted hazard ratio [0.3 vs. 0.1 mg/dL]: 1.33; 95% CI, 1.04-1.70). This association disappeared in dogs surviving beyond 30 days. Furthermore, higher preoperative Tbil levels were associated with an increased incidence of cardiac-related 30-day deaths in cohort A, and with right-sided cardiac overload at discharge in cohort B, which resolved by one month postoperatively. Hepatic congestion was associated with right-sided overload but not Tbil levels.
BACKGROUND: While serum total bilirubin concentration (Tbil) has emerged as a potential prognostic marker in dogs with myxomatous mitral valve disease (MMVD) after mitral valve repair (MVR), its dose-response relationship and underlying pathophysiological mechanisms remain unclear.
HYPOTHESIS/OBJECTIVES: To characterize the dose-response relationships between preoperative Tbil and 2-year all-cause mortality after MVR and explore the role of right-sided cardiac compromise.
ANIMALS: Two thousand sixty-three (cohort A) and 301 (cohort B) dogs with MMVD undergoing MVR at a single center.
METHODS: This retrospective cohort study used multivariable Cox regression to assess the association between Tbil and 2-year mortality in cohort A. Cohort B evaluated relationships among Tbil, hepatic congestion, and right-sided overload.
RESULTS: In cohort A, preoperative Tbil showed a linear positive association with 2-year all-cause mortality even within reference interval (ie, adjusted hazard ratio [0.3 vs. 0.1 mg/dL]: 1.33; 95% CI, 1.04-1.70). This association disappeared in dogs surviving beyond 30 days. Furthermore, higher preoperative Tbil levels were associated with an increased incidence of cardiac-related 30-day deaths in cohort A, and with right-sided cardiac overload at discharge in cohort B, which resolved by one month postoperatively. Hepatic congestion was associated with right-sided overload but not Tbil levels.
CONCLUSIONS AND CLINICAL IMPORTANCE: Subtle preoperative Tbil elevations were associated with short-term all-cause mortality and transient right-sided overload, warranting careful interpretation even within reference intervals. However, the pathophysiological mechanism linking Tbil to postoperative prognosis remains to be elucidated.
ABSTRACT TRANSLATED TO JAPANESE: ビリルビン (Tbil) は、 (MVR) の (MMVD) のにおけるのがされているが、そのおよびはとしてである。 Tbil と MVR 2とのをらかにし、とのをすること。で MVR をけた MMVD の、コホートA 2,063 およびコホートB 301 。とろきコホートでは、コホートA において Tbil と 2 とのを Cox モデルによりした。コホート B では、 Tbil とうっおよびのをした。コホートA において、 Tbil はであっても2とのをした (ハザード [0.3 0.1 mg/dL]: 1.33、95% 1.04-1.70)。このは 30をえてしたではした。さらに、 Tbil は、コホートA における 30 のの、およびコホートB におけるののとし、このは 1 かまでにした。うっはとしたが、 Tbil とはしなかった。とのわずかな Tbil は、およびのとしており、のであってもになをつがある。ただし、 Tbil とをびつけるはとしてらかではない。.