IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy,
Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy,
Cardiorenal Med. 2019;9(5):308-315. doi: 10.1159/000500480. Epub 2019 Jun 25.
Cardiorenal syndrome (CRS) type 1 is characterized by a rapid worsening of cardiac function that leads to acute kidney injury (AKI). This study evaluated the role of lipopolysaccharide (LPS) in the development of AKI in patients with acute heart failure (AHF) and its relationship with renal parameters, to enable a better comprehension of the pathophysiology of CRS type 1.
We enrolled 32 AHF patients, 15 of whom were classified as having CRS type 1. Eight of these 15 exhibited AKI at the time of admission (caused by AHF) and the other 7 developed AKI during their stay in hospital (in the first 48 h). We evaluated the plasmatic LPS concentrations as well as conventional (serum creatinine [sCr] and urea) and unconventional (neutrophil gelatinase-associated lipocalin [NGAL] and cystatin C) renal markers.
LPS levels were significantly higher in the CRS type 1 patients. No significant difference in LPS level was found in patients who were admitted with AKI and those developed AKI in hospital, but there was a tendency towards a higher level of LPS in CRS type 1 patients admitted with AKI. The LPS concentrations at admission were similar in CRS type 1 survivors (n = 12) and nonsurvivors (n = 3) (p = 0.22). We observed a positive correlation between LPS level and NGAL, Scr at admission and peak Scr during hospitalization and urea at admission.
CRS type 1 patients present with an increased level of LPS and there is a direct correlation between LPS and renal parameters. This pilot research is the first study to explore the premise of LPS as novel pathophysiological factor in CRS type 1.
心肾综合征（CRS）1 型的特征为心功能迅速恶化，导致急性肾损伤（AKI）。本研究评估了脂多糖（LPS）在急性心力衰竭（AHF）患者 AKI 发展中的作用及其与肾脏参数的关系，以便更好地理解 CRS 1 型的病理生理学。
我们纳入了 32 例 AHF 患者，其中 15 例被分类为 CRS 1 型。这 15 例中有 8 例在入院时（由 AHF 引起）出现 AKI，另外 7 例在住院期间（前 48 小时内）出现 AKI。我们评估了血浆 LPS 浓度以及常规（血清肌酐[sCr]和尿素）和非常规（中性粒细胞明胶酶相关脂质运载蛋白[NGAL]和胱抑素 C）肾脏标志物。
CRS 1 型患者的 LPS 水平明显升高。入院时伴有 AKI 的患者与住院期间发生 AKI 的患者之间 LPS 水平无显著差异，但入院时伴有 AKI 的 CRS 1 型患者的 LPS 水平有升高趋势。CRS 1 型幸存者（n = 12）和非幸存者（n = 3）的入院时 LPS 浓度相似（p = 0.22）。我们观察到 LPS 水平与 NGAL、入院时的 sCr 和住院期间的峰值 sCr 以及入院时的尿素呈正相关。
CRS 1 型患者的 LPS 水平升高，LPS 与肾脏参数之间存在直接相关性。这项初步研究首次探索了 LPS 作为 CRS 1 型新型病理生理学因素的前提。
