Early Blood Biomarkers Predict Organ Injury and Resource Utilization Following Complex Cardiac Surgery
Early Blood Biomarkers Predict Organ Injury and Resource Utilization Following Complex Cardiac Surgery
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DOI：
10.1016/j.jss.2009.09.023
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发表时间：
2011-06-01
影响因子：
2.2
通讯作者：
Beaver, Thomas Mark
中科院分区：
文献类型：
--
作者：
Kim, Tad;Arnaoutakis, George J.;Beaver, Thomas Mark
背景资料。接受复杂心脏手术(胸主动脉和瓣膜)的患者面临器官衰竭和资源利用率增加的风险。已发现中性粒细胞明胶酶相关脂钙蛋白(NGAL)是肾损伤的早期生物标志物。多重细胞因子免疫分析可以评估早期炎症反应。我们研究了早期生物标记物的出现(NGAL和多种细胞因子)与器官损伤和资源利用的关系。材料和方法。对38例胸主动脉和瓣膜手术患者在术前、术后1、6和24小时进行NGAL和多种细胞因子免疫分析。平均年龄65岁，男26例，女12例。检查急性肾损伤(类似定义)、肺功能衰竭(24小时呼吸机)、重症监护病房和住院天数。复杂心脏手术后1小时，IL-6反应最高的四分位数患者血清NGAL水平高于最低四分位数的患者(347vs145 ng/mL，P=0.002)，其中70%的患者进展为临床肾损害。术后6h，IL-10反应最高的四分位数患者血清NGAL高于最低四分位数的患者(271vs160，P=0.04)，肺功能衰竭较多(60%比10%，P=0.001)，ICU和住院时间较长(P=0.001)。早期炎症生物标志物升高的患者表现出更高的NGAL，更多的肺衰竭，以及更高的资源利用率。及早识别有器官损伤风险的患者可能会允许更早的干预并减少资源利用。(C)2011 Elsevier Inc.保留所有权利。
Background. Patients undergoing complex cardiac surgery (thoracic aorta and valve) are at risk for organ failure and increased resource utilization. Neutrophil gelatinase-associated lipocalin (NGAL) has been found to be an early biomarker for renal injury. Multiplex cytokine immunoassays allow the evaluation of the early inflammatory response. We examined the relationship between early biomarker appearance (NGAL and multiplex cytokines) and organ injury and resource utilization.Materials and Methods. NGAL and multiplex cytokine immunoassays were performed at baseline, 1, 6, and 24h following surgery on 38 patients undergoing thoracic aorta and valve operations. The mean age was 65 y with 26 males and 12 females. Acute kidney injury (AKIN definition), pulmonary failure (>24h ventilation), and intensive care unit and hospital stays were examined.Results. One hour following complex cardiac surgery, the quartile of patients with the greatest IL-6 response had higher serum NGAL levels compared with the lowest quartile (347 versus 145 ng/mL, P = 0.002), and 70% of these patients progressed to clinical kidney injury. Six hours following surgery, the quartile of patients with the greatest IL-10 response had higher serum NGAL compared with the lowest quartile (271 versus 160, P = 0.04), more pulmonary failure (60% versus 10%, P = 0.01), and longer ICU and hospital stays (P = 0.001).Conclusions. Patients with early elevated biomarkers of inflammation exhibited higher NGAL, more pulmonary failure, and greater resource utilization. Earlier identification of patients at risk for organ injury may allow for earlier intervention and reduce resource utilization. (C) 2011 Elsevier Inc. All rights reserved.