Davidson Jesse, Tong Suhong, Hauck Amanda, Lawson D Scott, Jaggers James, Kaufman Jon, da Cruz Eduardo
Crit Care. 2012 Aug 20;16(4):R160. doi: 10.1186/cc11483.
Limited evidence suggests that serum alkaline phosphatase activity may decrease after cardiac surgery in adults and children. The importance of this finding is not known. Recent studies, however, have identified a potential role for alkaline phosphatase as modulator of inflammation in multiple settings, including during adult cardiopulmonary bypass. We sought to describe the change in alkaline phosphatase activity after cardiothoracic surgery in infants and to assess for a correlation with intensity and duration of post-operative support, markers of inflammation, and short-term clinical outcomes.
Sub-analysis of a prospective observational study on the kinetics of procalcitonin in 70 infants (≤ 90 days old) undergoing cardiothoracic surgery. Subjects were grouped based on the use of cardiopulmonary bypass and delayed sternal closure. Alkaline phosphatase, procalcitonin, and C-reactive protein (CRP) levels were obtained pre-operation and on post-operative day 1. Mean change in alkaline phosphatase activity was determined in each surgical group. Generalized linear modeling and logistic regression were employed to assess for associations between post-operative alkaline phosphatase activity and post-operative support, inflammation, and short term outcomes. Primary endpoints were vasoactive-inotropic score at 24 hours and length of intubation. Secondary endpoints included procalcitonin/CRP levels on post-operative day 1, length of hospital stay, and cardiac arrest or death.
Mean decrease in alkaline phosphatase was 30 U/L (p = 0.01) in the non-bypass group, 114 U/L (p < 0.0001) in the bypass group, and 94 U/L (p < 0.0001) in the delayed sternal closure group. On multivariate analysis, each 10 U/L decrease in alkaline phosphatase activity on post-operative day 1 was independently associated with an increase in vasoactive-inotropic score by 0.7 (p < 0.0001), intubation time by 6% (p < 0.05), hospital stay by 5% (p < 0.05), and procalcitonin by 14% (P < 0.01), with a trend towards increased odds of cardiac arrest or death (OR 1.3; p = 0.06). Post-operative alkaline phosphatase activity was not associated with CRP (p = 0.7).
Alkaline phosphatase activity decreases after cardiothoracic surgery in infants. Low post-operative alkaline phosphatase activity is independently associated with increased procalcitonin, increased vasoactive/inotropic support, prolonged intubation time, and prolonged hospital stay. Alkaline phosphatase may serve as a biomarker and potential modulator of post-operative support and inflammation following cardiothoracic surgery in infants.
有限的证据表明，成人和儿童心脏手术后血清碱性磷酸酶活性可能会降低。这一发现的重要性尚不清楚。然而，最近的研究已经确定碱性磷酸酶在多种情况下作为炎症调节剂的潜在作用，包括在成人体外循环期间。我们试图描述婴儿心胸手术后碱性磷酸酶活性的变化，并评估其与术后支持的强度和持续时间、炎症标志物以及短期临床结果之间的相关性。
对一项关于70例（≤90日龄）接受心胸手术婴儿降钙素原动力学的前瞻性观察性研究进行亚分析。根据是否使用体外循环和延迟胸骨闭合对受试者进行分组。在术前和术后第1天获取碱性磷酸酶、降钙素原和C反应蛋白（CRP）水平。确定每个手术组碱性磷酸酶活性的平均变化。采用广义线性模型和逻辑回归来评估术后碱性磷酸酶活性与术后支持、炎症和短期结果之间的关联。主要终点是术后24小时的血管活性药物-正性肌力药物评分和插管时间。次要终点包括术后第1天的降钙素原/CRP水平、住院时间以及心脏骤停或死亡。
非体外循环组碱性磷酸酶平均下降30 U/L（p = 0.01），体外循环组下降114 U/L（p < 0.0001），延迟胸骨闭合组下降94 U/L（p < 0.0001）。多因素分析显示，术后第1天碱性磷酸酶活性每降低10 U/L与血管活性药物-正性肌力药物评分增加0.7（p < 0.0001）、插管时间增加6%（p < 当）、住院时间增加5%（p < 0.05）以及降钙素原增加14%（P < 0.01）独立相关，且有心脏骤停或死亡几率增加的趋势（OR 1.3；p = 0.06）。术后碱性磷酸酶活性与CRP无关（p = 0.7）。
婴儿心胸手术后碱性磷酸酶活性降低。术后碱性磷酸酶活性低与降钙素原增加、血管活性/正性肌力支持增加、插管时间延长和住院时间延长独立相关。碱性磷酸酶可能作为婴儿心胸手术后术后支持和炎症的生物标志物及潜在调节剂。
