Akmal M A Badreldin

University of Bonn, Bonn, North Rhine-Westphalia, Germany

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Publications (19)29.25 Total impact

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    ABSTRACT: Objectives The Glasgow Coma Scale (GCS) is used commonly for assessing patients’ neurologic condition and outcome in intensive care units (ICUs); however, its reliability in cardiac surgical patients has been questioned. It has been claimed that active sedation is the cause of its unsuitability for these patients. This study aimed to compare the accuracy of GCS in cardiac surgical patients with and without active sedation to find out if the inapplicability of GCS in surgical patients is related to active sedation. Design This was an observational cohort study. Setting The study was conducted in a cardiac surgical intensive care unit between January 1, 2007 and December 31, 2009. Participants All consecutive adult cardiac surgical patients were included in this study. Interventions All types of cardiac surgical procedures performed during the study period were included without any exceptions. The study population was divided into 2 groups: sedated and non-sedated. Measurements and Main Results GCS was calculated daily for the first 7 postoperative days. The authors developed a new 4-point neurologic descriptor (ND): (1) neurologically free, (2) ICU psychosis, (3) actively sedated, and (4) documented focal neurologic deficits. The accuracy of both scales (GCS and ND) at predicting ICU mortality was compared by replacing the GCS in the Sequential Organ Failure Assessment (SOFA) score with the new ND, producing a modified SOFA. GCS was not an accurate outcome predictor in non-sedated or sedated patients. The ND was superior to GCS. Correspondingly, the modified SOFA showed a significantly higher accuracy of ICU-mortality prediction than the original SOFA. Conclusions Regardless of active sedation, GCS is not accurate at outcome prediction for cardiac surgical patients. The suggested ND is a simple and more accurate risk stratification variable in cardiac surgical ICUs.
    Journal of Cardiothoracic and Vascular Anesthesia 10/2014; 28(5):1257–1263. DOI:10.1053/j.jvca.2014.04.003 · 1.48 Impact Factor
  • The Thoracic and Cardiovascular Surgeon 04/2014; 62(3):273-4. DOI:10.1055/s-0034-1372419 · 1.08 Impact Factor
  • Fabian Doerr · Akmal M A Badreldin · Ferzen Can · Ole Bayer · Thorsten Wahlers · Khosro Hekmat
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    ABSTRACT: Objectives. Cardiac surgery patients are excluded from SAPS2 but included in SAPS3. Neither score is evaluated for this exclusive population; however, they are used daily. We hypothesized that SAPS3 may be superior to SAPS2 in outcome prediction in cardiac surgery patients. Design. All consecutive patients undergoing cardiac surgery between January 2007 and December 2010 were included in our prospective study. Both models were tested with calibration and discrimination statistics. We compared the AUC of the ROC curves by DeLong's method and calculated OCC values. Results. A total of 5207 patients with mean age of 67.2 ± 10.9 years were admitted to the ICU. The mean length of ICU stay was 4.6 ± 7.0 days and the ICU mortality was 5.9%. The two tested models had acceptable discriminatory power (AUC: SAPS2: 0.777-0.875; SAPS3: 0.757-893). SAPS3 had a low AUC and poor calibration on admission day. SAPS2 had poor calibration on Days 1-6 and 8. Conclusions. Despite including cardiac surgery patients, SAPS3 was not superior to SAPS2 in our analysis. In this large cohort of ICU cardiac surgery patients, performance of both SAPS models was generally poor. In this subset of patients, neither scoring system is recommended.
    Scandinavian cardiovascular journal: SCJ 03/2014; 48(2). DOI:10.3109/14017431.2014.890248 · 1.10 Impact Factor
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    ABSTRACT: OBJECTIVES: The purpose of this study was to develop a new scoring system for the prompt recognition of clinical deterioration and early treatment in postoperative cardiac surgical patients. METHODS: All consecutive adult patients undergoing cardiac surgery between 1st January 2007 and 31st December 2010 were included. The new score was calculated daily until intensive care unit (ICU) discharge. The score consists of 11 variables representing six different organ systems. Performance was assessed using receiver-operating characteristic (ROC) curves and calibration tests. RESULTS: A total of 5207 patients with a mean age of 67.2 ± 10.9 years were admitted to the ICU after cardiac surgery. The operations performed covered the whole spectrum of cardiac surgery. ICU mortality was 5.9%. The mean length of ICU stay was 4.6 ± 7.0 days. The new score had an excellent discrimination with areas under the ROC curves between 0.91 and 0.96. Calibration was also excellent reflected by observed/expected mortality ratios ranging between 1.0 and 1.26. CONCLUSIONS: The new score is a simple and reliable scoring system to assess organ dysfunction in cardiac intensive care patients. It is designed especially for personal digital assistants to simplify and accelerate the process of risk stratification in cardiac surgical ICUs.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 06/2013; 44(6). DOI:10.1093/ejcts/ezt232 · 2.81 Impact Factor
  • The Thoracic and Cardiovascular Surgeon 04/2013; DOI:10.1055/s-0033-1343387 · 1.08 Impact Factor
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    ABSTRACT: Background Blood lactate is accepted as a mortality risk marker in intensive care units (ICUs), especially after cardiac surgery. Unfortunately, most of the commonly used ICU risk stratification scoring systems did not include blood lactate as a variable. We hypothesized that blood lactate alone can predict the risk of mortality after cardiac surgery with an accuracy that is comparable to those of other complex models. We therefore evaluated its accuracy at mortality prediction and compared it with that of other widely used complex scoring models statistically. Methods We prospectively collected data of all consecutive adult patients who underwent cardiac surgery between January 1, 2007, and December 31, 2009. By using (2) statistics, a blood lactate-based scale (LacScale) with only four cutoff points was constructed in a developmental set of patients (January 1, 2007, and May 31, 2008). LacScale included five categories: 0 ( 1.7 mmol/L); 1 (1.8-5.9 mmol/L), 2 (6.0-9.3 mmol/L), 3 (9.4-13.3 mmol/L), and 4 ( 13.4 mmol/L). Its accuracy at predicting ICU mortality was evaluated in another independent subset of patients (validation set, June 1, 2008, and December 31, 2009) on both study-population level (calibration analysis, overall correct classification) and individual-patient-risk level (discrimination analysis, ROC statistics). The results were then compared with those obtained from other widely used postoperative models in cardiac surgical ICUs (Sequential Organ Failure Assessment [SOFA] score, Simplified Acute Physiology Score II [SAPS II], and Acute Physiology and Chronic Health Evaluation II [APACHE II] score). ResultsICU mortality was 5.8% in 4,054 patients. LacScale had a reliable calibration in the validation set (2,087 patients). It was highly accurate in predicting ICU mortality with an area under the ROC curve (area under curve [AUC]; discrimination) of 0.88. This AUC was significantly larger than that of all the other models (SOFA 0.83, SAPS II: 0.79 and APACHE II: 0.76) according to DeLong's comparison. Integrating the LacScale in those scores further improved their accuracy by increasing their AUCs (0.88, 0.81, and 0.80, respectively). This improvement was also highly significant. Conclusion Blood lactate accurately predicts mortality at both individual patient risk and patient cohort levels. Its precision is higher than that of other commonly used complex scoring models. The proposed LacScale is a simple and highly reliable model. It can be used (at bedside without electronic calculation) as such or integrated in other models to increase their accuracy.
    The Thoracic and Cardiovascular Surgeon 03/2013; 61(8). DOI:10.1055/s-0032-1324796 · 1.08 Impact Factor
  • Akmal M A Badreldin · Rolf Dieter Bader · Khosro Hekmat
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    ABSTRACT: There is no universally accepted single line treatment for residual space empyema. Recently, the vacuum-assisted instillation therapy was applied for wounds in different anatomical positions. However, it has not yet been applied as an intrathoracic management. Herein, we describe the first experience of intrathoracic vacuum-assisted instillation therapy for residual space empyema after extended thoracic surgery. It appears to be an attractive treatment option for patients with large contaminated pleural cavities in preparation for reconstructive surgery.
    The Thoracic and Cardiovascular Surgeon 01/2013; 61(7). DOI:10.1055/s-0032-1330226 · 1.08 Impact Factor
  • F Doerr · A M A Badreldin · E M Bender · M B Heldwein · T Lehmann · O Bayer · B B Brehm · M Ferrari · K Hekmat
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    ABSTRACT: In the process of risk stratification, a logistic calculation of mortality risk in percentage is easier to interpret. Unfortunately, there is no reliable logistic model available for postoperative intensive care patients. The aim of this study was to present the first logistic model for postoperative mortality risk stratification in cardiac surgical intensive care units. This logistic version is based on our previously presented and established additive model (CASUS) that proved a very high reliability. In this prospective study, data from all adult patients admitted to our ICU after cardiac surgery over a period of three years (2007-2009) were collected. The Log-CASUS was developed by weighting the 10 variables of the additive CASUS and adding the number of postoperative day to the model. Risk of mortality is predicted with a logistic regression equation. Statistical performance of the two scores was assessed using calibration (observed/expected mortality ratio), discrimination (area under the receiver operating characteristic curve), and overall correct classification analyses. The outcome measure was ICU mortality. A total of 4054 adult cardiac surgical patients was admitted to the ICU after cardiac surgery during the study period. The ICU mortality rate was 5.8%. The discriminatory power was very high for both additive (0.865-0.966) and logistic (0.874-0.963) models. The logistic model calibrated well from the first until the 13th postoperative day (0.997-1.002), but the additive model over- or underestimated mortality risk (0.626-1.193). The logistic model shows statistical superiority. Because of the precise weighing the individual risk factors, it offers a reliable risk prediction. It is easier to interpret and to facilitate the integration of mortality risk stratification into the daily management more than the additive one.
    Minerva anestesiologica 04/2012; 78(8):879-86. · 2.27 Impact Factor
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    ABSTRACT: The original Logistic Organ Dysfunction Sore (LODS) excluded cardiac surgery patients from its target population, and the suitability of this score in cardiac surgery patients has never been tested. We evaluated the accuracy of the LODS and the usefulness of its daily measurement in cardiac surgery patients. The LODS is not a true logistic scoring system, since it does not use β-coefficients. This prospective study included all consecutive adult patients who were admitted to the intensive care unit (ICU) after cardiac surgery between January 2007 and December 2008. The LODS was calculated daily from the first until the seventh postoperative day. Performance was assessed with Hosmer-Lemeshow (HL) goodness-of-fit test (calibration) and receiver operating characteristic (ROC) curves (discrimination) from ICU admission day until day 7. The outcome measure was ICU mortality. A total of 2801 patients (29.6% female) with a mean age of 66.4 ± 10.7 years were included. The ICU mortality rate was 5.2% (n = 147). The mean stay on the ICU was 4.3 ± 6.8 days. Calibration of the LODS was good with no significant difference between expected and observed mortality rates on any day (p ≥ 0.05). The initial LODS had an area under the ROC curve (AUC) of 0.81. The AUC was best on ICU day 3 with a value of 0.93, and declined to 0.85 on ICU day 7. Although the LODS has not previously been validated for cardiac surgery patients it showed reasonable accuracy in prediction of ICU mortality in patients after cardiac surgery.
    Journal of Cardiothoracic Surgery 09/2011; 6:110. DOI:10.1186/1749-8090-6-110 · 1.03 Impact Factor
  • A. M. A. Badreldin · A Kania · M. M. A. Ismail · T Lehmann · J Gummert · T Doenst · K Hekmat
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    ABSTRACT: The accuracy of the logistic EuroSCORE in different patient populations has been questioned. Using the German registry database, the KoronarCHirurgie (KCH) score was introduced as a preoperative risk stratification tool specifically for patients who undergo isolated coronary artery bypass surgery in Germany. However, no direct statistical comparison of this score with the well-established logistic EuroSCORE has been previously performed. The aim of this study was to validate the preoperative German KCH score and to compare it to the logistic EuroSCORE for all coronary artery bypass surgery patients as well as for on-pump and off-pump subgroups. We prospectively included all consecutive adult patients admitted to our department between January 1, 2007 and December 31, 2008, who underwent isolated coronary artery bypass surgery. The logistic EuroSCORE and the KCH-3.0 were calculated on admission to hospital. The outcome was defined as 30-day mortality. We performed calibration (Hosmer-Lemeshow test and Anderson-Grunkemeier Observed/Expected "O/E" mortality ratio) and discrimination (receiver operating characteristic "ROC" test) analyses of both scores. The accuracy of the scores was compared using DeLong's test. A total of 1461 patients (23.96 % females, mean age 66.94 ± 9.43 years) were included. The 30-day mortality rate was 2.87 %. The two models were comparable with regard to the prediction of an individual patient's risk of mortality in the whole study population and in the on-pump and off-pump subgroups (according to the ROC test and DeLong's test). Overall, there was no significant difference between observed and expected mortality according to the Hosmer-Lemeshow test ( P > 0.05). However, the KCH-3.0 was far less likely to overpredict mortality than the logistic EuroSCORE, as demonstrated by the observed mortality/expected mortality (O/E) ratios. The O/E ratio was 0.32 for the logistic EuroSCORE and 0.74 for the KCH-3.0. For the on-pump subgroup the O/E ratios were 0.37 and 0.80, respectively, and 0.24 and 0.63, respectively, for the off-pump subgroup. The KCH-3.0 is more reliable than the logistic EuroSCORE as a preoperative mortality prediction score for patients undergoing isolated coronary artery bypass surgery, providing predicted mortality rates that are closer to the actual mortality rates with a lower overprediction of mortality.
    The Thoracic and Cardiovascular Surgeon 05/2011; 59(7):399-405. DOI:10.1055/s-0030-1270944 · 1.08 Impact Factor
  • A M A Badreldin · F Doerr · M M Ismail · M B Heldwein · T Lehmann · O Bayer · T Doenst · K Hekmat
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    ABSTRACT: Our purpose was to evaluate and compare the accuracy of the "Sequential Organ Failure Assessment" score (SOFA) and the "Cardiac Surgery Score" (CASUS) for the prediction of mortality after cardiac surgery. Between January 1, 2007 and December 31, 2008 we prospectively included all consecutive adult patients admitted to our intensive care unit (ICU) after cardiac surgery. Both scoring systems were calculated daily from the 1st day in the ICU (day of operation) until the 7th ICU day. We evaluated the ICU mortality prediction of both models using calibration and discrimination statistics. 2801 patients (29.6% females) were included. Mean age was 66.9 ± 10.7 years. Intensive care unit mortality was 5.2%. The calibration of the "Sequential Organ Failure Assessment Score" and "Cardiac Surgery Score" was reliable for all days (p ≥ 0.05). CASUS was more accurate in predicting survival and mortality compared to SOFA for all days, as evidenced by the larger areas under the Receiver Operating Characteristic curves. Both CASUS and SOFA are reliable mortality prediction tools after cardiac surgery. However, CASUS was more accurate in predicting the individual patient's risk of mortality. Thus, use of the CASUS in cardiac surgery intensive care units is recommended.
    The Thoracic and Cardiovascular Surgeon 04/2011; 60(1):35-42. DOI:10.1055/s-0030-1270943 · 1.08 Impact Factor
  • Akmal M.A. Badreldin · Christoph Schelenz · Torsten Bossert · Khosro Hekmat
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 01/2011; 39(1):134. DOI:10.1016/j.ejcts.2010.04.011 · 2.81 Impact Factor
  • A M A Badreldin · A Kroener · M B Heldwein · F Doerr · H Vogt · M M Ismail · T Bossert · K Hekmat
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    ABSTRACT: We aimed to validate the usefulness of CASUS derivatives for cardiac surgery patients and their reliability for daily decision making. We included, prospectively, the data of all adult cardiac surgery patients who had an ICU stay of at least 12 hours between 20 January 2003 and 14 October 2005 in the Department of Cardiothoracic Surgery of the University of Cologne, Germany. Data were collected until ICU discharge and included initial, maximum, mean, and total CASUS values. δ CASUS (difference from initial value) was calculated at 48 and 96 hours postoperatively. The predictive efficacy of the derivatives was tested with calibration and discrimination statistics. 2372 patients were included with a mean age of 66.2 ± 11.2 years. ICU mortality was 3.6 % (n =85). Mean ICU stay was 3.0 ± 6.1 days. The discrimination was very good for all derivatives (area under the curve ranged between 0.988 and 0.926). The calibration was also good except for the total CASUS, which showed a significant difference between the expected and observed mortality. Increased δ CASUS at 48 hours (1038 patients) and 96 hours (435 patients) correlated with an increase in mortality (23.1 % and 42.9 %, respectively), and conversely a decreased mortality rate was observed with decreasing values (1.9 % and 3.8 %, respectively). CASUS derivatives including δ CASUS have a good prognostic value for cardiac surgery patients with regard to the prediction of mortality and survival during ICU stay, with the exception of total CASUS which was not informative.
    The Thoracic and Cardiovascular Surgeon 10/2010; 58(7):392-7. DOI:10.1055/s-0030-1250080 · 1.08 Impact Factor
  • Khosro Hekmat · Matthias B Heldwein · Fabian Doerr · Akmal M A Badreldin
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 10/2010; DOI:10.1016/j.ejcts.2010.09.003 · 2.81 Impact Factor
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    Akmal M. A. Badreldin · Torsten Bossert · Stefan Kluegl · Khosro Hekmat
    Interactive Cardiovascular and Thoracic Surgery 05/2010; 10(5):769-769. DOI:10.1510/icvts.2009.228270A1 · 1.11 Impact Factor
  • Akmal M. A. Badreldin · Khosro Hekmat
    Interactive Cardiovascular and Thoracic Surgery 05/2010; 10(5):770-770. DOI:10.1510/icvts.2009.228270A2 · 1.11 Impact Factor
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    ABSTRACT: The purpose of this study was to develop a specific postoperative score in intensive care unit (ICU) cardiac surgical patients for the assessment of organ dysfunction and survival. To prove the reliability of the new scoring system, we compared its performance to existing ICU scores. This prospective study consisted of all consecutive adult patients admitted after cardiac surgery to our ICU over a period of 5.5 years. Variables were evaluated using the patients of the first year who stayed in ICU for at least 24h. The reproducibility was then tested in two validation sets using all patients. Performance was assessed with the Hosmer-Lemeshow (HL) goodness-of-fit test and receiver operating characteristic (ROC) curves and compared with the Acute Physiology and Chronic Health Evaluation (APACHE II) and Multiple Organ Dysfunction Score (MODS). The outcome measure was defined as 30-day mortality. A total of 6007 patients were admitted to the ICU after cardiac surgery. Mean HL values for the new score were 5.8 (APACHE II, 11.3; MODS, 9.7) for the construction set, 7.2 (APACHE II, 8.0; MODS, 4.5) for the validation set I and 4.9 for the validation set II. The mean area under the ROC curve was 0.91 (APACHE II, 0.86; MODS, 0.84) for the new score in the construction set, 0.88 (APACHE II, 0.84; MODS, 0.84) in the validation set I and 0.92 in the validation set II. Most of general ICU scoring systems use extensive data collection and focus on the first day of ICU stay. Despite this fact, general scores do not perform well in the prediction of outcome in cardiac surgical patients. Our new 10-variable risk index performs very well, with calibration and discrimination very high, better than general severity systems, and it is an appropriate tool for daily risk stratification in ICU cardiac surgery patients. Thus, it may serve as an expert system for diagnosing organ failure and predicting mortality in ICU cardiac surgical patients.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2010; 38(1):104-9. DOI:10.1016/j.ejcts.2010.01.053 · 2.81 Impact Factor
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    ABSTRACT: Gaseous embolism is a possible complication during off-pump coronary surgery with the use of a blower and can cause ischemic injuries. We describe two different possible mechanisms of carbon-dioxide embolization. Out of 2196 coronary bypass surgeries, between 1 January 2007 and 31 December 2009, there were 977 off-pump operations. Two off-pump cases (0.2%) had gaseous (carbon-dioxide) emboli that migrated against blood stream proximally through T-anastomoses and then into the native coronary vessels. These emboli caused a temporary haemodynamic deterioration in other territories. Two types of T-anastomoses were included [saphenous vein on left internal thoracic artery (LITA) or right internal thoracic artery (RITA) on LITA]. Simple procedures and measurements were necessary but enough to regain haemodynamic stability. There was no effect on the postoperative outcome. We have concluded that carbon-dioxide emboli can also cause massive but temporary haemodynamic deterioration during off-pump surgery despite higher solubility in blood. The blower should be used only when a bull-dog clamp is applied on the graft. Also, proper de-airing and flushing of grafts is very important and avoids consequences of the trapped small emboli.
    Interactive Cardiovascular and Thoracic Surgery 02/2010; 10(5):766-9. DOI:10.1510/icvts.2009.228270 · 1.11 Impact Factor
  • Mohamed M Ismail · Akmal M A Badreldin · Matthias Heldwein · Khosro Hekmat
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    ABSTRACT: Third-generation mobile phones, UMTS (Universal Mobile Telecommunication System), were recently introduced in Europe. The safety of these devices with regard to their interference with implanted pacemakers is as yet unknown and is the point of interest in this study. The study comprised 100 patients with permanent pacemaker implantation between November 2004 and June 2005. Two UMTS cellular phones (T-Mobile, Vodafone) were tested in the standby, dialing, and operating mode with 23 single-chamber and 77 dual-chamber pacemakers. Continuous surface electrocardiograms (ECGs), intracardiac electrograms, and marker channels were recorded when calls were made by a stationary phone to cellular phone. All pacemakers were tested under a "worst-case scenario," which includes a programming of the pacemaker to unipolar sensing and pacing modes and inducing of a maximum sensitivity setting during continuous pacing of the patient. Patients had pacemaker implantation between June 1990 and April 2005. The mean age was 68.4 +/- 15.1 years. Regardless of atrial and ventricular sensitivity settings, both UMTS mobile phones (Nokia 6650 and Motorola A835) did not show any interference with all tested pacemakers. In addition, both cellular phones did not interfere with the marker channels and the intracardiac ECGs of the pacemakers. Third-generation mobile phones are safe for patients with permanent pacemakers. This is due to the high-frequency band for this system (1,800-2,200 MHz) and the low power output between 0.01 W and 0.25 W.
    Pacing and Clinical Electrophysiology 02/2010; 33(7):860-4. DOI:10.1111/j.1540-8159.2010.02707.x · 1.25 Impact Factor