Interleukin-6 and interleukin-10 as acute kidney injury biomarkers in pediatric cardiac surgery.
Interleukin-6 and interleukin-10 as acute kidney injury biomarkers in pediatric cardiac surgery.
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DOI：
10.1007/s00467-015-3088-4
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发表时间：
2015-09
期刊：
影响因子：
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通讯作者：
TRIBE-AKI Consortium
中科院分区：
文献类型：
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作者：
Greenberg JH;Whitlock R;Zhang WR;Thiessen-Philbrook HR;Zappitelli M;Devarajan P;Eikelboom J;Kavsak PA;Devereaux PJ;Shortt C;Garg AX;Parikh CR;TRIBE-AKI Consortium
接受心脏手术的儿童可能对体外循环（CPB）表现出明显的炎症反应。炎症被认为是导致急性肾损伤（AKI）的重要病理生理过程。本研究的目的是评估两种炎症细胞因子白细胞介素(IL)-6和IL-10与CPB手术后儿童AKI和其他不良结局的关系。这是调查AKI （TRIBE-AKI）队列生物标志物终点的转化研究的一个子研究，包括106名1个月至18岁接受CPB的儿童。术前、术后第1天（术后6小时内）和第3天分别测定血浆IL-6和IL-10。24例（23%）患者被诊断为2/3期AKI，定义为至少两倍的基线血清肌酐或透析。2/3期AKI患者术前IL-6明显高于无2/3期AKI患者(中位（IQR）， 2.6 （0.6-4.9) vs 0.6 (0.6-2.2), p=0.03）。在对临床和人口学变量进行校正后，术前最高的IL-6分位数与最低分位数相比，2/3期AKI的风险增加了6倍（校正OR为6.41 (CI: 1.16-35.35)）。术后IL-6、IL-10明显升高，术后第1天达到峰值。术后第一时间，2/3期AKI患者与非AKI患者之间IL-6和IL-10无显著差异。第3天IL-6升高与住院时间延长相关（p=0.0001）。术前血浆IL-6与2/3期AKI的发展相关，可能是资源利用的预后指标。
Children undergoing cardiac surgery may exhibit a pronounced inflammatory response to cardiopulmonary bypass (CPB). Inflammation is recognized as an important pathophysiologic process leading to acute kidney injury (AKI). The aim of this study was to evaluate the association of two inflammatory cytokines interleukin (IL)-6 and IL-10 with AKI and other adverse outcomes in children after CPB surgery. This is a sub-study of the Translational Research Investigating Biomarker Endpoints in AKI (TRIBE-AKI) cohort, including 106 children from 1 month to 18 years old undergoing CPB. Plasma IL-6 and IL-10 were measured preoperatively and postoperatively on days 1 (within 6 hours after surgery) and 3. Stage 2/3 AKI, defined by atleast a doubling of baseline serum creatinine or dialysis, was diagnosed in 24 (23%) patients. Preoperative IL-6 was significantly higher in patients with stage 2/3 AKI vs. without stage 2/3 AKI (median (IQR), 2.6 (0.6-4.9) vs. 0.6 (0.6-2.2), p=0.03). After adjustment for clinical and demographic variables, the highest preoperative IL-6 tertile was associated with a six-fold increased risk for stage 2/3 AKI compared with the lowest tertile (adjusted OR 6.41 (CI: 1.16-35.35)). IL-6 and IL-10 increased significantly after surgery, peaking postoperatively on day 1. First postoperative IL-6 and IL-10 did not significantly differ between patients with vs. without stage 2/3 AKI. Elevated IL-6 on day 3 was associated with longer hospital stay (p=0.0001). Preoperative plasma IL-6 is associated with development of stage 2/3 AKI and may be prognostic of resource utilization.