白细胞介素-10：接受静脉-动脉体外膜肺氧合的患者发生急性肾损伤的潜在预插管标记物。

Interleukin-10: A Potential Pre-Cannulation Marker for Development of Acute Kidney Injury in Patients Receiving Veno-Arterial Extracorporeal Membrane Oxygenation.

机构信息

Department of Anesthesiology and Intensive Care, Department of Clinical Sciences, Lund University, Lund, Sweden.

Department of Cardiothoracic and Vascular Surgery, Anesthesia, and Intensive Care, Skåne University Hospital, Lund, Sweden.

出版信息

Blood Purif. 2023;52(7-8):631-641. doi: 10.1159/000531328. Epub 2023 Aug 16.

DOI:10.1159/000531328

PMID:37586332

Abstract

INTRODUCTION

Acute kidney injury (AKI) in patients treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is associated with high mortality. The objective of this study was to investigate whether cytokine levels before the initiation of ECMO treatment could predict AKI. We also aimed to investigate the impact of AKI on 30-day and 1-year mortality.

METHODS

Serum cytokine levels were analyzed in 100 consecutive VA-ECMO-treated patients at pre-cannulation, at 48 h post-cannulation, and at 8 days. Clinical data to establish the incidence and outcome of AKI after the start of ECMO was retrieved from the local ECMO registry.

SETTING

The study was conducted at tertiary care, university hospital. Participants included 100 patients treated with VA-ECMO.

INTERVENTIONS

The blood samples for cytokine analysis were collected before VA-ECMO treatment, at 48 h after VA-ECMO treatment was started, and at 8 days.

RESULTS

Pre-cannulation serum IL-10 levels were significantly higher in patients who developed AKI (212 [38.9, 620.7]) versus those who did not (49.0 [11.9, 102.2]; p = 0.007), and the development of AKI can be predicted by pre-cannulation IL-10 levels (p = 0.025, OR = 1.2 [1.02-1.32]). The development of AKI during ECMO treatment is associated with increased 30-day mortality (p = 0.049) compared to patients who did not develop AKI and had a pre-cannulation estimated glomerular filtration rate ≥ 45 mL/min. The 1-year survival rate for patients with AKI who survived the first 30 days of ECMO treatment is comparable to that of patients without AKI.

CONCLUSION

Increased pre-cannulation IL-10 levels are associated with the development of AKI during VA-ECMO support. AKI is associated with increased 30-day mortality compared to patients with no AKI and better renal function. However, patients with AKI who survive the first 30 days have a 1-year survival rate similar to those without AKI.

摘要

引言

接受静脉-动脉体外膜肺氧合（VA-ECMO）治疗的患者发生急性肾损伤（AKI）与高死亡率相关。本研究的目的是探讨 ECMO 治疗前细胞因子水平是否可以预测 AKI。我们还旨在探讨 AKI 对 30 天和 1 年死亡率的影响。

方法

在预插管时、插管后 48 小时和插管后 8 天，分析了 100 例连续接受 VA-ECMO 治疗的患者的血清细胞因子水平。从当地 ECMO 登记处检索了 ECMO 开始后 AKI 的发生率和结局的临床数据。

设置

该研究在三级护理、大学医院进行。参与者包括 100 例接受 VA-ECMO 治疗的患者。

干预措施

在开始 VA-ECMO 治疗前、VA-ECMO 治疗开始后 48 小时和插管后 8 天采集细胞因子分析的血样。

结果

发生 AKI 的患者（212[38.9,620.7]）与未发生 AKI 的患者（49.0[11.9,102.2]）相比，预插管时血清 IL-10 水平明显更高（p=0.007），并且可以通过预插管时的 IL-10 水平预测 AKI 的发生（p=0.025，OR=1.2[1.02-1.32]）。与未发生 AKI 且预插管估计肾小球滤过率≥45mL/min 的患者相比，ECMO 治疗期间发生 AKI 与 30 天死亡率增加相关（p=0.049）。在 ECMO 治疗的第一个 30 天存活的 AKI 患者的 1 年生存率与无 AKI 的患者相当。