AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/JHV-2021/006
*Corresponding Author: James Elliott, Department of Vascular Surgery, Princess Alexandra Hospital, Queensland, Australia.
Citation: Elliott J., Tom Cavaye, Peden S. and Webb L., (2021) Pre-operative pH is a predictor of 30-day mortality in patients undergoing open repair of ruptured abdominal aortic aneurysm J, Heart and Vasculature 1(2); DOI: 10.31579/JHV-2021/006
Copyright: © 2021, James Elliott, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 04 March 2021 | Accepted: 10 March 2021 | Published: 08 April 2021
Keywords: abdominal; aneurysm; aorta; rupture; mortality
There are multiple patient characteristics that are associated with mortality following ruptured and abdominal aortic aneurysm (AAA) repair. The use of available objective tests, such as pH, within validated assessment tools to predict mortality in patients with ruptured AAA pre-operatively remains unutilised. This study aims to examine whether pH is an appropriate pre-operative marker of mortality in patients presenting with ruptured AAA and undergoing open repair. 77 patients with ruptured AAA were included over a 9 year period and their lowest pre-operative serum pH reading recorded. There was a significant relationship between lowest measured pH and 30-day mortality. For each 0.01 decrease in lowest pH, the odds of a 30-day mortality increase by 5%. Consideration should be given to including pre-operative serum pH in future studies attempting to more accurately design scoring systems for mortality and morbidity risk in patients with ruptured abdominal aortic aneurysm.
Mortality from a ruptured abdominal aortic aneurysm (AAA) has been slowly decreasing over the last 4 decades. However, it still remains close to 80% [1]. Up to 50% of ruptured AAA die before hospital and of those who make it to hospital, a difficult decision of who to offer surgical intervention to remains. Judicious treatment relies on a rapid assessment of a critically unwell patient with varied levels of background medical history.
Initial management strategies prior to surgery are well-described, as are intraoperative approaches and considerations [2]. A ruptured AAA commonly presents with hypotension and this can quickly progress to hypovolemic shock. Total body hypoperfusion seen in shock associated with ruptured AAA causes an anaerobic state and a change in the acid-base status of the body. With the increasing prevalence of point of care testing of blood in peripheral centres in Australia [3], most critically ill patients, including those with ruptured AAA, undergo an assessment of acid-base status.
Previous studies have shown both positive and negative associations of pH in critically ill patients with mortality. This has included trauma [4], vascular injury [5], and out-of-hospital cardiac arrests [6]. A retrospective study in AAA repair has shown that lactate and base deficit tested post-operatively are good predictors of survival following ruptured AAA repair [7]. One study [8] from the USA in 2018 recorded pre-operative pH measurements of less than 7.2 in patients with ruptured AAA but this included patients treated with Endovascular Aneurysm Repair (EVAR) and did not analyse the range of pH scores and how they may stratify mortality risk. Pre-operative pH measurement has not been thoroughly analysed in patients who undergo open repair of ruptured AAA (regardless of survival perioperatively).
There are multiple patient characteristics that are associated with mortality following ruptured and elective AAA repair. These have been collated into validated assessment tools used pre-operatively worldwide such as the Glasgow Aneurysm Score [9]. However, the use of available objective tests, such as pH, within these tools pre-operatively remains unutilised. This study aims to examine whether pH is an appropriate pre-operative marker of mortality in patients presenting with ruptured AAA and undergoing open repair. Often the pH reading is included in the assessment to determine suitability for surgery by clinicians, but its association with mortality has not been objectively tested in this cohort of patients.
This study protocol conforms to the ethical guidelines of the 1975 Declaration of Helskinki and prior approval by the institutions human research committee has been obtained.
Using the Operating Room Management Information System (ORMIS) database at this institution, a search for patients who underwent emergency surgical repair between January 1st 2011 and December 31st 2019 (9 years) for ruptured abdominal aortic aneurysms captured all potential patients for inclusion in this retrospective cohort study. Further scrutiny of these individual cases identified those who underwent open repair of a ruptured native, non-infected, abdominal aortic aneurysm. Patients with symptomatic AAAs, infected/mycotic AAAs, and those who had previously undergone abdominal aortic surgery were excluded. Patients who underwent Endovascular Abdominal Aortic Aneurysm Repair (EVAR) were also excluded. A simple review of the Auslab Pathology software system was undertaken, with the lowest serum pH reading (arterial or venous blood) recorded.
Cohort characteristics (age at rupture and gender) were reported overall (n%) and mean (SD)) and compared between the 30-Day mortality groups using a χ2 tests of independence and a two-sample t-test respectively. The lowest pH was reported overall and between the two groups using median (IQR) as the data was skewed, and was compared between the 30-day mortality groups using a Mann-Whitney U test. To further investigate the effect of lowest pH value on the 30-day outcome, logistic regression was performed with an odds ratio (OR) calculated for 30-day mortality for each 0.01 increase in lowest pH. Statistical significance was set at p<0.05. All analyses were performed in Stata version 15 (StataCorp, College Station, TX, U.S.A.).
Following the exclusion process, a total of 77 patients were included in the study, with the vast majority (89.6%) being male. The average age of patients undergoing surgery was 72.0 and the average pre-operative serum pH level was 7.24. Table 1 presents the descriptive statistics and comparisons for the cohort characteristics (gender and age) and the lowest pre-operative serum pH. There was no significant difference in age or gender between the 30-day mortality groups. Patients with a 30-day mortality had a significantly lower “lowest pH” (p=0.011).
The outcome of the logistic regression is given in Table 2. For each 0.01 increase in “lowest pH”, the odds of having a 30-day mortality reduces 0.95 (95% CI: 0.92-0.99). This can also be interpreted as; for each 0.01 decrease in lowest pH, the odds of 30-day mortality increases by 5%.
There is a significant relationship between lowest measured pH and 30-day mortality. For each 0.01 decrease in lowest pH, the odds of a 30-day mortality increase by 5%. The utility of measuring pre-operative pH in critically unwell patients with ruptured abdominal aortic aneurysm has merit. Whilst it may be primarily used by intensivists, anaesthetists and emergency physicians in the pre-operative and intraoperative care phase for these patients, it certainly provides objective information about mortality risk for the decision-making surgeon. Consideration should be given to including pre-operative serum pH in future studies attempting to more accurately design scoring systems for mortality and morbidity risk in patients with ruptured abdominal aortic aneurysm.
This study demonstrates the utility of pre-operative serum pH measurement as a part of the decision-making assessment process in this critically unwell patient cohort. Scoring systems to predict mortality and morbidity are becoming increasingly detailed and accurate, and so the utilisation of this parameter in future assessment tools should be paramount.
Thanks must go to Michelle McGrath who assisted with the identification of the subjects for this study through the methods outlined above.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
