Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Florida College of Medicine, Gainesville, Florida 32610-0286, USA.
J Surg Res. 2011 Jun 15;168(2):168-72. doi: 10.1016/j.jss.2009.09.023. Epub 2009 Oct 6.
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.
NGAL and multiplex cytokine immunoassays were performed at baseline, 1, 6, and 24 h 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 (>24 h ventilation), and intensive care unit and hospital stays were examined.
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).
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.
接受复杂心脏手术（胸主动脉和瓣膜）的患者有发生器官衰竭和增加资源利用的风险。中性粒细胞明胶酶相关脂质运载蛋白（NGAL）已被发现是肾损伤的早期生物标志物。多重细胞因子免疫分析允许评估早期炎症反应。我们研究了早期生物标志物（NGAL 和多重细胞因子）的出现与器官损伤和资源利用之间的关系。
对 38 例接受胸主动脉和瓣膜手术的患者在手术开始后 1、6 和 24 小时进行 NGAL 和多重细胞因子免疫分析。患者的平均年龄为 65 岁，其中男性 26 例，女性 12 例。急性肾损伤（AKIN 定义）、呼吸衰竭（＞24 小时通气）、重症监护病房和住院时间均进行了检查。
在复杂心脏手术后 1 小时，IL-6 反应最强的患者 quartile 的血清 NGAL 水平高于反应最低的 quartile（347 与 145 ng/mL，P=0.002），且 70%的这些患者进展为临床肾损伤。手术后 6 小时，IL-10 反应最强的患者 quartile 的血清 NGAL 水平高于反应最低的 quartile（271 与 160，P=0.04），发生呼吸衰竭的比例更高（60%与 10%，P=0.01），且 ICU 和住院时间更长（P=0.001）。
早期炎症生物标志物升高的患者具有更高的 NGAL、更高的呼吸衰竭发生率和更多的资源利用。更早识别有器官损伤风险的患者可能有助于更早的干预并减少资源的利用。
