Alkaline Phosphatase in Infant Cardiopulmonary Bypass: Kinetics and Relationship to Organ Injury and Major Cardiovascular Events.
Alkaline Phosphatase in Infant Cardiopulmonary Bypass: Kinetics and Relationship to Organ Injury and Major Cardiovascular Events.
复制标题
DOI：
10.1016/j.jpeds.2017.07.035
复制
发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Wischmeyer P
中科院分区：
文献类型：
--
作者：
Davidson JA;Urban TT;Baird C;Tong S;Woodruff A;Twite M;Jaggers J;Simões EAF;Wischmeyer P
确定婴儿体外循环后碱性磷酸酶（AP）活性和浓度的动力学，包括亚型特异性变化，并测量术后AP活性与主要术后心血管事件、器官损伤/功能障碍和术后支持需求之间的相关性。对120名接受体外循环的≤120日龄婴儿进行了前瞻性队列研究。在6个时间点（术前、复温、术后6、24、48和72 h）评估AP总活性和亚型特异性活性。低AP活性定义为≤ 80 U/L。收集术后24 h内AP浓度和器官损伤/功能障碍的生物标志物。主要心血管事件定义为心脏骤停、机械循环支持或死亡。AP活性丧失主要发生在手术期间（中位数降低89 U/L; P<.0001），继发于骨和肝2亚型的降低。27%的患者在24小时内活动下降。AP活性与血清浓度密切相关（r=0.87-0.91; P<0.0001）。72小时持续低AP活性与重大心脏事件的发生独立相关（OR 5.6; p<0.05）。早期AP活动与随后的血管活性-变力性评分（p<0.001）、峰值乳酸（p<0.0001）、峰值肌酐（p<0.0005）、NT-proBNP（p<0.05）和肠脂肪酸结合蛋白（p<0.005）独立相关。AP活性在婴儿体外循环期间降低，并可能持续降低24小时。活性丧失继发于骨和肝2亚型浓度降低。早期低AP活性与随后的术后支持和器官损伤/功能障碍独立相关，72 h时AP活性持续≤ 80 U/L与主要心血管事件的几率增加独立相关。
To determine the kinetics of alkaline phosphatase (AP) activity and concentration after infant cardiopulmonary bypass including isoform-specific changes, and to measure the association between post-operative AP activity and major post-operative cardiovascular events, organ injury/dysfunction, and post-operative support requirements Prospective cohort study of 120 infants ≤120 days of age undergoing cardiopulmonary bypass. AP total and isoform-specific activity was assessed at 6 time-points (pre-operation, rewarming, 6, 24, 48, and 72h post-operation). Low AP activity was defined as ≤80U/L. AP concentrations and biomarkers of organ injury/dysfunction were collected through 24h post-operation. Major cardiovascular events were defined as cardiac arrest, mechanical circulatory support, or death. AP activity loss occurred primarily during the operation (median decrease 89 U/L; P<.0001) secondary to decreased bone and liver 2 isoforms. Activity declined through 24h in 27% of patients. AP activity strongly correlated with serum concentration (r=0.87-0.91; P<.0001). Persistent low AP activity at 72h was independently associated with occurrence of a major cardiac event (OR 5.6; p<0.05). Early AP activity was independently associated with subsequent vasoactive-inotropic score (p<0.001), peak lactate (p<0.0001), peak creatinine (p<0.0005), NT-proBNP (p<0.05), and intestinal fatty acid binding protein (p<0.005). AP activity decreases during infant cardiopulmonary bypass and may continue to drop for 24h. Activity loss is secondary to decreased bone and liver 2 isoform concentrations. Early low AP activity is independently associated with subsequent post-operative support and organ injury/dysfunction, and persistence of AP activity ≤80U/L at 72h is independently associated with increased odds of major cardiovascular events.
登录
查看更多内容
影响因子：
4.1
作者：
Gaies, Michael G.;Gurney, James G.;Hirsch, Jennifer C.
通讯作者：
Hirsch, Jennifer C.
影响因子：
9.8
作者：
Malagon, I;Onkenhout, W;Hazekamp, MG
通讯作者：
Hazekamp, MG
影响因子：
3.7
作者：
de Jong PR;Schadenberg AW;van den Broek T;Beekman JM;van Wijk F;Coffer PJ;Prakken BJ;Jansen NJ
通讯作者：
Jansen NJ
影响因子：
--
作者：
Muraoka, Izumi;Soyama, Akihiko;Eguchi, Susumu
通讯作者：
Eguchi, Susumu
影响因子：
4.6
作者：
Ascione, R;Talpahewa, S;Angelini, GD
通讯作者：
Angelini, GD