Groesdonk Heinrich V, Raffel Miriam, Speer Thimoteus, Bomberg Hagen, Schmied Wolfram, Klingele Matthias, Schäfers Hans-Joachim
Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany; Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany.
Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
J Thorac Cardiovasc Surg. 2015 May;149(5):1436-42.e2. doi: 10.1016/j.jtcvs.2014.12.019. Epub 2014 Dec 19.
Nonocclusive mesenteric ischemia may occur after cardiac surgery, commonly in conjunction with the use of cardiopulmonary bypass. Some evidence suggests that endothelin-1 serum levels are increased in patients with mesenteric ischemia, but the association of endothelin-1 and nonocclusive mesenteric ischemia has not been studied. The objective was to investigate whether elevated levels of endothelin-1 could be found in patients exhibiting nonocclusive mesenteric ischemia.
In an observational cohort study, nonocclusive mesenteric ischemia developed in 78 of 865 patients undergoing elective cardiac surgery. Control patients were identified from the cohort through 1:1 propensity score matching. Preoperative and postoperative endothelin-1 serum levels were determined by means of enzyme-linked immunosorbent assay. Odds ratios (with 95% confidence interval) were calculated by logistic regression analyses to determine the risk of endothelin-1 for the development of nonocclusive mesenteric ischemia.
Patients with nonocclusive mesenteric ischemia had higher preoperative (11.3 vs 9.3 pg/mL; P = .001) and postoperative (15.7 vs 11.1 pg/mL, P < .001) levels of endothelin-1 than the controls. The probability of developing nonocclusive mesenteric ischemia increased with each picogram/milliliter endothelin-1 level preoperatively (odds ratio, 1.29; 95% confidence interval, 1.12-1.49) and each picogram/milliliter postoperatively (odds ratio, 2.04; 95% confidence interval, 1.54-2.72). Receiver operating characteristic analyses showed that elevated endothelin-1 serum levels had a high accuracy to predict nonocclusive mesenteric ischemia (optimal cutoff value of 14.5 pg/mL, area under the curve of 0.77, sensitivity 51%, and specificity 94%).
Endothelin-1 seems to predispose patients undergoing cardiac surgery to develop nonocclusive mesenteric ischemia. In addition, it may be a useful marker to identify patients at risk for nonocclusive mesenteric ischemia after cardiac surgery.
非闭塞性肠系膜缺血可能发生在心脏手术后，通常与体外循环的使用有关。一些证据表明，肠系膜缺血患者的内皮素-1血清水平会升高，但内皮素-1与非闭塞性肠系膜缺血之间的关联尚未得到研究。目的是调查在表现出非闭塞性肠系膜缺血的患者中是否能发现内皮素-1水平升高。
在一项观察性队列研究中，865例接受择期心脏手术的患者中有78例发生了非闭塞性肠系膜缺血。通过1:1倾向评分匹配从队列中确定对照患者。术前和术后的内皮素-1血清水平通过酶联免疫吸附测定法测定。通过逻辑回归分析计算比值比（95%置信区间），以确定内皮素-1对发生非闭塞性肠系膜缺血的风险。
非闭塞性肠系膜缺血患者术前（11.3对9.3 pg/mL；P = 0.001）和术后（15.7对11.1 pg/mL，P < 0.001）的内皮素-1水平高于对照组。术前每皮克/毫升内皮素-1水平（比值比，1.29；95%置信区间，1.12 - 1.49）和术后每皮克/毫升（比值比，2.04；95%置信区间，1.54 - 2.72）发生非闭塞性肠系膜缺血的概率都会增加。受试者工作特征分析表明，内皮素-1血清水平升高对预测非闭塞性肠系膜缺血具有较高的准确性（最佳截断值为14.5 pg/mL，曲线下面积为0.77，敏感性为51%，特异性为94%）。
内皮素-1似乎使接受心脏手术的患者易发生非闭塞性肠系膜缺血。此外，它可能是识别心脏手术后有非闭塞性肠系膜缺血风险患者的有用标志物。
