Serum interleukin-6 and interleukin-8 are early biomarkers of acute kidney injury and predict prolonged mechanical ventilation in children undergoing cardiac surgery: a case-control study.
Serum interleukin-6 and interleukin-8 are early biomarkers of acute kidney injury and predict prolonged mechanical ventilation in children undergoing cardiac surgery: a case-control study.
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DOI：
10.1186/cc7940
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Faubel S
中科院分区：
文献类型：
--
作者：
Liu KD;Altmann C;Smits G;Krawczeski CD;Edelstein CL;Devarajan P;Faubel S
急性肾损伤（AKI）与高死亡率相关。需要可以识别早期AKI受试者（血清肌酐升高前）的新生物标志物，以促进适当的治疗。本研究的目的是测试血清细胞因子作为AKI和长期机械通气生物标志物的作用。这是一项对接受心脏手术的儿童进行的病例对照研究。AKI定义为3天内血清肌酐较基线升高50%。血清白细胞介素（IL）-1 β、IL-5、IL-6、IL-8、IL-10、IL-17、干扰素（IFN）-γ、肿瘤坏死因子-α（TNF-α）、粒细胞集落刺激因子（G-CSF）水平，和粒细胞-巨噬细胞集落刺激因子（GM-CSF）使用基于珠粒的多重细胞因子试剂盒结合流式细胞仪进行测量。基于蛋白质检测和Luminex LabMAP多重系统的18例病例和21例对照。用单分析物ELISA确认IL-6和IL-8的水平;还用单分析物ELISA测量IL-18。使用Wilcoxon秩和检验，并在多变量logistic回归分析中调整年龄、性别、种族和既往心脏手术后，体外循环（CPB）后2和12小时的IL-6水平以及2、12和24小时的IL-8水平与AKI的发生相关。在AKI患者中，通过受试者工作曲线（ROC）分析，2小时时的IL-6水平对长期机械通气（定义为术后机械通气超过24小时）具有极好的预测价值，ROC曲线下面积为0.95。在所有患者中，2小时的IL-8水平对延长机械通气具有极好的预测价值。血清IL-18水平在有和没有AKI的患者之间没有差异。血清IL-6和IL-8值在接受CPB手术的患者中早期识别AKI。此外，在AKI患者中，高IL-6水平与长期机械通气相关，表明AKI患者中的循环细胞因子可能对其他器官（包括肺）产生有害影响。
Acute kidney injury (AKI) is associated with high mortality rates. New biomarkers that can identify subjects with early AKI (before the increase in serum creatinine) are needed to facilitate appropriate treatment. The purpose of this study was to test the role of serum cytokines as biomarkers for AKI and prolonged mechanical ventilation. This was a case-control study of children undergoing cardiac surgery. AKI was defined as a 50% increase in serum creatinine from baseline within 3 days. Levels of serum interleukin (IL)-1β, IL-5, IL-6, IL-8, IL-10, IL-17, interferon (IFN)-γ, tumor necrosis factor-α (TNF-α), granulocyte colony-stimulating factor (G-CSF), and granulocyte-macrophage colony-stimulating factor (GM-CSF) were measured using a bead-based multiplex cytokine kit in conjunction with flow-based protein detection and the Luminex LabMAP multiplex system in 18 cases and 21 controls. Levels of IL-6 and IL-8 were confirmed with single-analyte ELISA; IL-18 was also measured with single-analyte ELISA. IL-6 levels at 2 and 12 hours after cardiopulmonary bypass (CPB) and IL-8 levels at 2, 12 and 24 hours were associated with the development of AKI using the Wilcoxon rank-sum test and after adjustment for age, gender, race, and prior cardiac surgery in multivariate logistic regression analysis. In patients with AKI, IL-6 levels at 2 hours had excellent predictive value for prolonged mechanical ventilation (defined as mechanical ventilation for more than 24 hours postoperatively) by receiver operator curve (ROC) analysis, with an area under the ROC curve of 0.95. IL-8 levels at 2 hours had excellent predictive value for prolonged mechanical ventilation in all patients. Serum IL-18 levels were not different between those with and without AKI. Serum IL-6 and IL-8 values identify AKI early in patients undergoing CPB surgery. Furthermore, among patients with AKI, high IL-6 levels are associated with prolonged mechanical ventilation, suggesting that circulating cytokines in patients with AKI may have deleterious effects on other organs, including the lungs.
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