Shigeta Ayako, Tanabe Nobuhiro, Naito Akira, Yokota Hajime, Kato Fumiaki, Jujo-Sanada Takayuki, Sakao Seiichiro, Ishida Keiichi, Masuda Masahisa, Tatsumi Koichiro
Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Respirology, Chibaken Saiseikai Narashino Hospital, Narashino, Japan.
JTCVS Open. 2021 Oct 21;8:618-629. doi: 10.1016/j.xjon.2021.10.007. eCollection 2021 Dec.
Soluble CD40 ligand (sCD40L) is associated with some pathobiological states. However, whether sCD40L in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who underwent pulmonary endarterectomy (PEA) is associated with perioperative pulmonary hemodynamics and surgical outcomes has not been elucidated. Here we aimed to investigate whether sCD40L is a useful serologic biomarker of poor surgical outcome of PEA in patients with CTEPH.
Ninety patients with CTEPH who underwent PEA were enrolled. Independent preoperative parameters were examined, including sCD40L related to lower cardiac index (CI), higher pulmonary vascular resistance (PVR), and poor surgical outcomes after PEA, according to the multivariate logistic regression analysis. In addition, the area under the curve (AUC) value of sCD40L to predict poor surgical outcomes was compared with the AUCs of D-dimer and C-reactive protein (CRP). The generalizability of this study model was tested by a 5-fold cross-validation analysis.
Multivariate logistic regression analysis showed that high sCD40L level was related to postoperative lower CI, higher PVR, and poor surgical outcomes independent of other preoperative parameters. The AUC value of sCD40L to predict poor surgical outcomes was higher than those of D-dimer and CRP. A sCD40L cutoff value of 1.45 ng/mL predicted poor surgical outcomes with 79.3% sensitivity and 67.3% specificity. The 5-fold cross-validation analysis showed the effectiveness of our model's performance.
Preoperative sCD40L level could be a promising serologic biomarker associated with poor surgical outcomes in CTEPH. In addition to known preoperative parameters, the biomarker might have the potential to identify patients at high risk of PEA, thereby reducing the mortality rates.
可溶性CD40配体（sCD40L）与某些病理生物学状态相关。然而，接受肺动脉内膜剥脱术（PEA）的慢性血栓栓塞性肺动脉高压（CTEPH）患者的sCD40L是否与围手术期肺血流动力学及手术结果相关尚不清楚。在此，我们旨在研究sCD40L是否是CTEPH患者PEA手术结果不佳的有用血清生物标志物。
纳入90例行PEA的CTEPH患者。根据多因素逻辑回归分析，检查独立的术前参数，包括与低心指数（CI）、高肺血管阻力（PVR）以及PEA术后手术结果不佳相关的sCD40L。此外，将sCD40L预测手术结果不佳的曲线下面积（AUC）值与D-二聚体和C反应蛋白（CRP）的AUC值进行比较。通过五折交叉验证分析检验本研究模型的可推广性。
多因素逻辑回归分析显示，高sCD40L水平与术后低CI、高PVR以及手术结果不佳相关，且独立于其他术前参数。sCD40L预测手术结果不佳的AUC值高于D-二聚体和CRP。sCD40L临界值为1.45 ng/mL时，预测手术结果不佳的灵敏度为79.3%，特异度为67.3%。五折交叉验证分析显示了我们模型性能的有效性。
术前sCD40L水平可能是CTEPH患者手术结果不佳的一种有前景的血清生物标志物。除了已知的术前参数外，该生物标志物可能有潜力识别PEA高风险患者，从而降低死亡率。
