Moledina Dennis G, Isguven Selin, McArthur Eric, Thiessen-Philbrook Heather, Garg Amit X, Shlipak Michael, Whitlock Richard, Kavsak Peter A, Coca Steven G, Parikh Chirag R
Program of Applied Translational Research, Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
Institute for Clinical Evaluative Sciences Western, London, Ontario, Canada.
Ann Thorac Surg. 2017 Aug;104(2):613-620. doi: 10.1016/j.athoracsur.2016.11.036. Epub 2017 Feb 21.
Monocyte chemotactic protein-1 (MCP-1; chemokine C-C ligand-2 [CCL-2]) is upregulated in ischemia-reperfusion injury and is a promising biomarker of inflammation in cardiac operations.
We measured preoperative and postoperative plasma MCP-1 levels in adults undergoing cardiac operations to evaluate the association of perioperative MCP-1 levels with acute kidney injury (AKI) and death in Translational Research Investigating Biomarker Endpoints in AKI (TRIBE-AKI), a prospective, multicenter, observational cohort.
Of the 972 participants in the study, AKI developed in 329 (34%), and severe AKI developed in 45 (5%). During a median follow-up of 2.9 years (interquartile range, 2.2 to 3.5 years), 119 participants (12%) died. MCP-1 levels were significantly higher in those who developed AKI and died than in those without AKI and death. Participants with a preoperative MCP-1 level in the highest tertile (>196 pg/mL) had an increased AKI risk than those in the lowest tertile (<147 pg/mL; odds ratio [OR], 1.43l; 95% confidence interval [CI], 1.00 to 2.05). The association appeared similar but was not significant for the severe AKI outcome (OR, 1.48; 95% CI, 0.62 to 3.54). Compared with participants with preoperative MCP-1 level in the lowest tertile, those in the highest tertile had higher adjusted risk of death (hazard ratio, 1.82; 95% CI, 1.40 to 2.38). Similarly, participants in the highest tertile had a higher adjusted risk of death (hazard ratio, 1.95; 95% CI, 1.09-3.49) than those with a postoperative MCP-1 level in the lowest tertile.
Higher plasma MCP-1 is associated with increased AKI and risk of death after cardiac operations. MCP-1 could be used as a biomarker to identify high-risk patients for potential AKI prevention strategies in the setting of cardiac operations.
单核细胞趋化蛋白-1（MCP-1；趋化因子C-C配体-2 [CCL-2]）在缺血再灌注损伤中上调，是心脏手术中炎症的一个有前景的生物标志物。
我们在接受心脏手术的成年人中测量术前和术后血浆MCP-1水平，以评估围手术期MCP-1水平与急性肾损伤（AKI）及死亡的关联，该研究为一项前瞻性、多中心、观察性队列研究——急性肾损伤生物标志物终点的转化研究（TRIBE-AKI）。
在该研究的972名参与者中，329人（34%）发生了AKI，45人（5%）发生了严重AKI。在中位随访2.9年（四分位间距为2.2至3.5年）期间，119名参与者（12%）死亡。发生AKI和死亡者的MCP-1水平显著高于未发生AKI和死亡者。术前MCP-1水平处于最高三分位数（>196 pg/mL）的参与者发生AKI的风险高于处于最低三分位数（<147 pg/mL）的参与者（比值比[OR]为1.43；95%置信区间[CI]为1.00至2.05）。对于严重AKI结局，这种关联似乎相似但无统计学意义（OR为1.48；95% CI为0.62至3.54）。与术前MCP-1水平处于最低三分位数的参与者相比，处于最高三分位数的参与者校正后的死亡风险更高（风险比为1.82；95% CI为1.40至2.38）。同样，与术后MCP-1水平处于最低三分位数的参与者相比，处于最高三分位数的参与者校正后的死亡风险更高（风险比为1.95；95% CI为1.09至3.49）。
较高的血浆MCP-1与心脏手术后AKI增加及死亡风险相关。MCP-1可作为一种生物标志物，用于识别心脏手术中可能需要采取预防AKI策略的高危患者。
