Platelet-leukocyte aggregates - a predictor for acute kidney injury after cardiac surgery.
Platelet-leukocyte aggregates - a predictor for acute kidney injury after cardiac surgery.
复制标题
血小板白细胞聚集——心脏手术后急性肾损伤的预测因子
DOI：
10.1080/0886022x.2021.1948864
复制
发表时间：
2021-12
期刊：
影响因子：
3
通讯作者：
Zhou J
中科院分区：
文献类型：
--
作者：
Yang S;Huang X;Liao J;Li Q;Chen S;Liu C;Ling L;Zhou J
摘要 背景 急性肾损伤（AKI）是心脏手术后最常见的并发症之一。然而，尚未确定用于 AKI 早期诊断的有效生物标志物。血小板白细胞聚集体（PLA）参与炎症和凝血，导致血管病变和组织破坏。我们设计了一项前瞻性研究来评估 PLA 是否可以作为心脏手术后早期诊断 AKI 的良好生物标志物。方法 纳入计划接受瓣膜置换手术的风湿性心脏病患者。在以下五个时间点收集血样：（a）在基线。 (b) 体外循环结束时。 (c) 到达重症监护病房 (ICU)。 (d) 进入 ICU 四小时后。 (e) 入住 ICU 后 20 小时。收集后，样品立即用于通过流式细胞术进行PLA测定。结果共登记244例患者，其中15例根据KDIGO指南血清肌酐诊断为AKI。与基线相比，AKI 组术后 20 h 的 PLAs 水平显着升高（双向重复测量方差分析，p<0.01）。术前 PLA 高于 6.8% 的患者显示发生 AKI 的风险增加（多变量逻辑回归；p = 0.01；调整优势比，1.05；95% 置信区间，1.01–1.09）。结论 PLAs是风湿性心脏病患者瓣膜置换术后发生AKI的独立危险因素。
Abstract Background Acute kidney injury (AKI) is one of the most common complications after cardiac surgery. However, effective biomarker used for early diagnosis of AKI has not been identified. Platelet-leukocyte aggregates (PLAs) participate in inflammation and coagulation, leading to vascular lesions and tissue destruction. We designed a prospective study to assess whether PLAs can serve as a good biomarker for early diagnosis of AKI after cardiac surgery. Methods Patients with rheumatic heart disease scheduled to undergo valve replacement surgery were enrolled. Blood samples were collected at five timepoints as follows: (a) At baseline. (b) At the end of extracorporeal circulation. (c) Arrival at intensive care unit (ICU). (d) Four-hours after the admission to ICU. (e) Twenty hours after the admission to ICU. After collection, the samples were immediately used for PLAs measurement by flow cytometry. Results A total of 244 patients were registered, and 15 of them were diagnosed with AKI according to the serum creatinine of KDIGO guidelines. The PLAs levels in AKI group were significantly increased 20 h after surgery (two-way repeated measure analysis of variance, p < 0.01) compared with that at baseline. Patients whose preoperative PLAs were higher than 6.8% showed increased risk of developing AKI (multivariate logistic regression; p = 0.01; adjusted odds ratio, 1.05; 95% confidence interval, 1.01–1.09). Conclusion PLAs is an independent risk factor for AKI after valve replacement among patients with rheumatic heart disease.