Increased preoperative serum vitamin B-12 level as a predictor of postoperative mortality in patients undergoing cardiac surgery

초록

BACKGROUND: Serum vitamin B-12 level is a useful prognostic marker for various conditions. The present study examined whether preoperative serum vitamin B-12 level can predict mortality after cardiac surgery. METHODS: The present observational study comprised adult patients who underwent cardiac surgery at our institute between 2012 and 2019. The performance of preoperative vitamin B-12 level in discriminating postoperative in-hospital mortality, the primary outcome of this study, was assessed by receiver operating characteristic (ROC) curve analysis. After dichotomizing vitamin B-12 level using Youden's J Index, weighted logistic regression analysis was performed. Cumulative all-cause mortality, the secondary outcome, was also compared using the Kaplan-Meier estimator and Cox regression analysis. RESULTS : A total of 973 patients were analyzed. The area under the ROC curve of vitamin B-12 level for predicting in-hospital mortality was 0.76 (95% confidence interval [CI]: 0.73-0.78). Weighted logistic regression analysis revealed that the high vitamin B-12 group (>726 pg/mL) had a significantly increased risk of in-hospital mortality compared to the low vitamin B-12 group (adjusted odds ratio, 12.01; 95% CI: 7.73-18.67). The risk of mortality was higher in the high vitamin B-12 group than the low vitamin B-12 group (log-rank test, P<0.001; adjusted hazard ratio, 2.41; 95% CI: 1.70-2.39). In addition, the high vitamin B-12 group had significantly poorer survival than the low vitamin B-12 group, even within the same EuroSCORE II stratum (< or >= 4%; log-rank test, P<0.001 and P=0.001, respectively). CONCLUSIONS: Preoperative measurement of serum vitamin B12 level may be an alternative for predicting the prognosis of patients undergoing cardiac surgery.

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