Xu Jingfang, Wang Zhigang, Zhang Qingyan, Wang Dongjin, Jiang Chunming, Wang Hengjin
Department of Nephrology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 210008 Nanjing, Jiangsu, China.
Department of Cardio-thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, 210008 Nanjing, Jiangsu, China.
Rev Cardiovasc Med. 2022 Oct 25;23(11):363. doi: 10.31083/j.rcm2311363. eCollection 2022 Nov.
Acute kidney injury (AKI) is a relatively common complication after surgery for type A acute aortic dissection (ATAAD) and is associated with a poor prognosis. Preclinical models suggest that toll-like receptor 4 (TLR4) may participate in the pathogenesis of AKI. However, the correlation of serum TLR4 and post-operative AKI has not been studied in ATAAD patients. This study aimed to explore the possibility of using serum TLR4 levels to predict AKI and 30-day mortality in patients undergoing ATAAD surgery.
A prospective, single-center cohort study was conducted and enrolled a total of 64 patients undergoing ATAAD surgery. The level of serum TLR4 was measured and compared before and within 24 hours after the completion of surgery.
Thirty-five (54.7%) patients developed AKI, including 7 (10.9%) diagnosed with severe AKI (Kidney Disease Improving Global Outcomes (KDIGO) stage 3). TLR4 levels at 0-hour,1-hour, 3-hour, and 6-hour after intensive care unit (ICU) admission were significantly different between patients with or without AKI. Further analysis showed that the difference was most significant at 0-hour after ICU admission which corresponded to an area under the curve (AUC) of 0.886 (95% confidence interval (CI), 0.800 to 0.973). For severe AKI, the AUC of TLR4 was the highest with 0.923 (0.852 to 0.995) at 1-hour after ICU admission. TLR4 levels before surgery and at 0-hour, 1-hour, as well as 3-hour after ICU admission were significantly different between survivors and non-survivors. Furthermore, we found that the serum level of TLR4 upon ICU admission could be used to predict the 30-day mortality with AUC of 0.805 (0.648 to 0.962).
Serum TLR4 levels can be used as a biomarker to predict the occurrence of AKI and 30-day mortality in patients undergoing ATAAD surgery.
ChiCTR2200057197.
急性肾损伤（AKI）是A型急性主动脉夹层（ATAAD）手术后相对常见的并发症，且与预后不良相关。临床前模型表明，Toll样受体4（TLR4）可能参与AKI的发病机制。然而，ATAAD患者血清TLR4与术后AKI的相关性尚未得到研究。本研究旨在探讨利用血清TLR4水平预测接受ATAAD手术患者发生AKI及30天死亡率的可能性。
进行了一项前瞻性、单中心队列研究，共纳入64例接受ATAAD手术的患者。在手术完成前及术后24小时内测量并比较血清TLR4水平。
35例（54.7%）患者发生AKI，其中7例（10.9%）被诊断为严重AKI（改善全球肾脏病预后组织（KDIGO）3期）。入住重症监护病房（ICU）后0小时、1小时、3小时和6小时时，发生AKI与未发生AKI的患者之间TLR4水平存在显著差异。进一步分析显示，入住ICU后0小时差异最为显著，对应的曲线下面积（AUC）为0.886（95%置信区间（CI），0.800至0.973）。对于严重AKI，入住ICU后1小时TLR4的AUC最高，为0.923（0.852至0.995）。存活者与非存活者术前及入住ICU后0小时、1小时和3小时的TLR4水平存在显著差异。此外，我们发现入住ICU时血清TLR4水平可用于预测30天死亡率，AUC为0.805（0.648至0.962）。
血清TLR4水平可作为预测接受ATAAD手术患者发生AKI及30天死亡率的生物标志物。
ChiCTR2200057197。
