Preoperative hyperamylasemia relates to renal dysfunction and hyperamylasemia in cardiac surgery: an observational study.

Abstract

The role of preoperative hyperamylasemia in the perioperative enzyme levels in patients undergoing cardiac surgery is unclear. The primary outcome of this observational clinical study was to determine whether patients with preoperative hyperamylasemia undergoing on-pump cardiac surgery document an increase in serum amylase levels perioperatively compared with patients with normal serum amylase levels preoperatively. This prospective study evaluated serum total, pancreatic, and salivary amylase levels, estimated glomerular filtration rate (eGFR), and serum creatinine before the operation at postoperative days (POD) 1, 2, 3, and 7. We also followed up on any perioperative symptoms, including abdominal pain and lower ear or jaw swelling. We preoperatively had 157 patients with normal amylase levels (Normal group) and 45 with hyperamylasemia (Hyperamylasemia group). The Hyperamylasemia group demonstrated continuously lower eGFR and higher creatinine values at the preoperative time, postoperative days 1, 2, 3, and 7, compared with the Normal group. The Hyperamylasemia group showed higher serum total, pancreatic, and salivary amylase levels at preoperative (total 70 [55-90] [Normal] vs. 142 [107 to 162] [Hyperamylasemia] IU/L, median [25-75th percentile], P < 0.001) and postoperative periods compared with the Normal group. The relationship between renal dysfunction and serum amylase levels in all patients was significant in the preoperative, but not postoperative, periods. We noted no patients demonstrating clinical symptoms. Preoperative hyperamylasemia in patients undergoing on-pump cardiac surgery was associated with renal dysfunction without needing hemodialysis. However, whether the relation affects postoperative serum amylase levels is inconclusive.