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Risk factors of acute respiratory distress syndrome after on-pump cardiac surgery in the INFLACOR cohort study

100%
Kowalik M. M., Lango R., Łoś A., Chmara M., Brzeziński M., Lewandowski K., Klapkowski A., Rogowski J.
European Journal of Translational and Clinical Medicine
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2020
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vol. 3
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issue 1
24-33
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.
2
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Risk factors of acute respiratory distress syndrome after on-pump cardiac surgery in the INFLACOR cohort study

100%
Kowalik M. M., Lango R., Łoś A., Chmara M., Brzeziński M., Lewandowski K., Klapkowski A., Rogowski J.
|
2020
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vol. 3
|
issue 1
24-33
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.
3
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Clinical, biochemical and genetic risk factors for 30-day and 5-year mortality in 518 adult patients subjected to cardiopulmonary bypass during cardiac surgery - the INFLACOR study

75%
Kowalik M., Lango R., Siondalski P., Chmara M., Brzeziński M., Lewandowski K., Jagielak D., Klapkowski A., Rogowski J.
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2018
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vol. 65
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issue 2
241-250
EN
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.
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Lipokalina neutrofilowa jako wskaźnik ostrego uszkodzenia nerek u dzieci po zabiegach kardiochirurgicznych w krążeniu pozaustrojowym

63%
Jander A., Markiewicz M., Lukamowicz J., Romak J., Krajewski W., Tkaczyk M.
Pediatria i Medycyna Rodzinna
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2011
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vol. 7
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issue 4
326-331
EN
Acute kidney injury (AKI) is a frequent complication of cardiopulmonary bypass. The paucity of early, predictive, non-invasive biomarkers has impaired our ability to institute potentially effective therapy as soon as possible. The most promising new biomarker is neutrophil gelatinase-associated lipocalin (NGAL). The aim of the study was to assess the urine and serum level of NGAL in children undergoing cardiopulmonary bypass (CPB) due to severe congenital heart disease. Material and methods: We prospectively studied 48 children (17 girls and 31 boys) after CPB, which were divided in two group: with and without acute kidney injury defined as a 50% increase in serum creatinine from baseline. Serum and urine samples were collected before and after 2, 4, 12, 24, 48 hours of the CPB beginning. Results: Twenty-four (54%) children developed AKI. Serum NGAL rose from 26 ng/ml at baseline to 60 ng/ml after 2 and 65 ng/ml after 4 hours post-procedure outstripping creatinine rise (12 hours). Serum concentration was not different in both group (AKI and non- AKI). Urine concentration of NGAL rose in differently in both group (AKI, non-AKI) in 2 (median 62 vs 27 ng/ml; p=0.01) and 4 hours (median 28 vs 13 ng/ml; p=0.056). Conclusion: Urine and serum concentration of NGAL raises in children undergoing cardiopulmonary bypass. NGAL can be useful as a early biomarker of acute kidney injury.
PL
Wstęp: Ostre uszkodzenie nerek (OUN) jest częstym powikłaniem zabiegów kardiochirurgicznych z wykorzystaniem krążenia pozaustrojowego. Wczesne rozpoznanie OUN wpływa na rokowanie, poszukuje się więc nowych biomarkerów wyprzedzających wzrost stężenia kreatyniny. Wykazano, że podwyższone stężenie lipokaliny neutrofilowej (NGAL) jest wczesnym markerem prognostycznym OUN. Celem naszego badania było określenie zmian stężenia NGAL w surowicy i w moczu u dzieci operowanych w krążeniu pozaustrojowym z powodu skomplikowanych wad wrodzonych układu krążenia. Materiał i metody: Badanie prospektywne przeprowadzono u 48 dzieci (17 dziewcząt i 31 chłopców) operowanych w krążeniu pozaustrojowym z powodu wrodzonych wad serca. Średni wiek wynosił 25±38 miesięcy. Stężenie NGAL w moczu i surowicy (metodą immunoenzymatyczną) i stężenie kreatyniny oznaczano przed i seryjnie po zabiegu. Według kryteriów ostrego uszkodzenia nerek (wzrost stężenia kreatyniny o 50% do wartości wyjściowej w czasie 72 godzin od zabiegu) grupę badaną podzielono na dwie podgrupy: dzieci z OUN – 26 i bez OUN – 22. Wyniki: W całej grupie badanej mediana stężenia NGAL przed zabiegiem wynosiła 26 ng/ml i wzrastała w 2. (60 ng/ml) i 4. godzinie (65 ng/ml), wyprzedzając wzrost stężenia kreatyniny, który następował w 12. godzinie po zabiegu. Stężenie NGAL w surowicy nie różniło się istotnie w obu grupach. Z kolei stężenie NGAL w moczu wzrastało, ale także różniło się istotnie pomiędzy grupami w 2. (mediana 62 vs 27 ng/ml; p=0,01) i 4. (mediana 28 vs 13 ng/ml; p=0,056) godzinie po zabiegu, z tendencją do utrzymywania się zmian także w 12. godzinie po nim (mediana 10 vs 6 ng/ml). Wnioski: Badanie potwierdziło, że po zabiegach kardiochirurgicznych u dzieci w krążeniu pozaustrojowym obserwuje się narastanie stężenia NGAL w surowicy i w moczu. Oba te wskaźniki mogą być wykorzystane jako wczesny wskaźnik ostrego uszkodzenia nerek.
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