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There is increasing evidence that genetic variability influences patients' early morbidity after cardiac surgery performed using cardiopulmonary bypass (CPB). The use of mortality as an outcome measure in cardiac surgical genetic association studies is rare. We publish the 30-day and 5-year survival analyses with focus on pre-, intra-, postoperative variables, biochemical parameters, and genetic variants in the INFLACOR (INFLAmmation in Cardiac OpeRations) cohort. In a prospectively recruited cohort of 518 adult Polish Caucasians, who underwent cardiac surgery in which CPB was used, the clinical data, biochemical parameters, IL-6, soluble ICAM-1, TNFα, soluble E-selectin, and 10 single nucleotide polymorphisms were evaluated for their association with 30-day and 5-year mortality. The 30-day mortality was associated with: pre-operative prothrombin international normalized ratio, intra-operative blood lactate, postoperative serum creatine phosphokinase, and acute kidney injury requiring renal replacement therapy (AKI-RRT) in logistic regression. Factors that determined the 5-year survival included: pre-operative NYHA class, history of peripheral artery disease and severe chronic obstructive pulmonary disease, intra-operative blood transfusion; and postoperative peripheral hypothermia, myocardial infarction, infection, and AKI-RRT in Cox regression. Serum levels of IL-6 and ICAM-1 measured three hours after the operation were associated with 30-day and 5-year mortality, respectively. The ICAM1 rs5498 was associated with 30-day and 5-year survival with borderline significance. Different risk factors determined the early (30-day) and late (5-year) survival after adult cardiac surgery in which cardiopulmonary bypass was used. Future genetic association studies in cardiac surgical patients should account for the identified chronic and perioperative risk factors.
EN
Background: Acute respiratory distress syndrome (ARDS) is a serious complication after cardiac surgery with a variety of clinical risk factors. It was hypothesized that genome variants predispose these patients to it. Material and methods: A cohort of 509 adult Caucasians undergoing on-pump cardiac surgery were observed for postoperative ARDS defined by the Berlin definition. Clinical variables and 10 single-nucleotide variants of genes involved in inflammatory pathways were analyzed for associations with four groups, defined by paO2/fiO2 (PF) ratio: 1) no ARDS (PF > 300 mmHg), 2) mild ARDS (200 < PF ≤ 300 mm Hg), 3) moderate ARDS (100 < PF ≤ 200 mm Hg), and 4) severe ARDS (PF ≤ 100 mmHg). Variables remaining in trends at p < 0.05 were considered significant. Results: The prevalence of ARDS was 7.9%. Only LBP1 rs2232582 remained in a genotypic trend with ARDS aggravation (p = 0.08). Clinical variables associated with ARDS aggravation: impaired left ventricular ejection fraction (p = 0.04), pulmonary hypertension (p = 0.01), intraoperative hypotension (p = 0.009), and postoperative day 1 white blood cell count (p = 0.015). More aggravated ARDS was associated with longer mechanical ventilation (p=0.01) and length of stay in ICU (p = 0.002). Conclusions: The borderline association with LBP1 rs2232582 and the identified risk factors suggest possible involvement of the LPS-LBP1 pathway in ARDS of the INFLACOR cohort.
EN
Background Acute respiratory distress syndrome (ARDS) is a serious complication after cardiac surgery with a variety of clinical risk factors. It was hypothesized that genome variants predispose these patients to it. Material and methods A cohort of 509 adult Caucasians undergoing on-pump cardiac surgery were observed for postoperative ARDS defined by the Berlin definition. Clinical variables and 10 single-nucleotide variants of genes involved in inflammatory pathways were analyzed for associations with four groups, defined by paO2/fiO2 (PF) ratio: 1) no ARDS (PF > 300 mmHg), 2) mild ARDS (200 < PF ≤ 300 mm Hg), 3) moderate ARDS (100 < PF ≤ 200 mm Hg), and 4) severe ARDS (PF ≤ 100 mmHg). Variables remaining in trends at p < 0.05 were considered significant. Results The prevalence of ARDS was 7.9%. Only LBP1 rs2232582 remained in a genotypic trend with ARDS aggravation (p = 0.08). Clinical variables associated with ARDS aggravation: impaired left ventricular ejection fraction (p = 0.04), pulmonary hypertension (p = 0.01), intraoperative hypotension (p = 0.009), and postoperative day 1 white blood cell count (p = 0.015). More aggravated ARDS was associated with longer mechanical ventilation (p=0.01) and length of stay in ICU (p = 0.002). Conclusions The borderline association with LBP1 rs2232582 and the identified risk factors suggest possible involvement of the LPS-LBP1 pathway in ARDS of the INFLACOR cohort.
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