Deniau Benjamin, Ludes Pierre-Olivier, Khalifeh-Ballan Pamela, Fenninger Luc, Kindo Michel, Collange Olivier, Geny Bernard, Noll Eric, Azibani Fériel, Mebazaa Alexandre, Pottecher Julien
Department of Anaesthesia, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 75010 Paris, France.
UMR-S 942, INSERM, MASCOT, Paris University, 75018 Paris, France.
Biomedicines. 2025 Mar 26;13(4):800. doi: 10.3390/biomedicines13040800.
Acute respiratory distress syndrome (ARDS) is a life-threatening condition that frequently complicates high-risk cardiac surgery. We evaluated the circulating levels and transpulmonary gradient of intracellular proteins in patients at risk of developing ARDS after cardiac surgery using large scale-proteomics. We enrolled sixteen patients undergoing high-risk cardiac surgery, followed by planned ICU admission. Circulating levels of intracellular proteins were measured at the onset of the surgical procedure, at ICU admission (H0), and 24 h (H24) after surgery in blood samples simultaneously drawn from both the pulmonary artery and the left atrium. The primary endpoint was the occurrence of ARDS between ICU admission and the subsequent 48 h. Among the studied proteins, the levels of intracellular lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) were higher at H24 in the pulmonary artery in patients who developed ARDS (6.96; 95% CI [6.83-7.23]) compared to patients who did not (6.48; 95% CI [6.27-6.66]), -value = 0.016. The transpulmonary gradient of intracellular LOX-1 levels was not significantly different between ARDS and non-ARDS patients at H0 but it was more negative at H24 in ARDS (-0.23; 95% CI [-0.27, -0.14]) than in non-ARDS patients (0.03; 95% CI [-0.14, 0.32]; -value= 0.031), with a hazard ratio HR = 0.39 (95% CI [0.18-0.86]); -value= 0.035. The area under the ROC curve of H24 LOX-1 transpulmonary gradient to predict ARDS occurrence was 0.83 (95% CI [0.62-1.00]). The transpulmonary gradient of intracellular LOX-1 levels was negatively associated with the occurrence of ARDS within the first 48 h after high-risk cardiac surgery, suggesting that lung trapping of LOX-1 may be linked to postoperative ARDS.
急性呼吸窘迫综合征（ARDS）是一种危及生命的疾病，常使高危心脏手术出现并发症。我们使用大规模蛋白质组学技术评估了心脏手术后有发生ARDS风险的患者细胞内蛋白质的循环水平和跨肺梯度。我们纳入了16例接受高危心脏手术且计划入住重症监护病房（ICU）的患者。在手术开始时、入住ICU时（H0）以及术后24小时（H24），从肺动脉和左心房同时采集血样，测量细胞内蛋白质的循环水平。主要终点是入住ICU至随后48小时内ARDS的发生情况。在研究的蛋白质中，发生ARDS的患者肺动脉中细胞内凝集素样氧化低密度脂蛋白受体-1（LOX-1）水平在H24时（6.96；95%可信区间[6.83 - 7.23]）高于未发生ARDS的患者（6.48；95%可信区间[6.27 - 6.66]），P值 = 0.016。在H0时，ARDS患者和非ARDS患者细胞内LOX-1水平的跨肺梯度无显著差异，但在H24时，ARDS患者（-0.23；95%可信区间[-0.27, -0.14]）的跨肺梯度比非ARDS患者（0.03；95%可信区间[-0.14, 0.32]）更负，P值 = 0.031，风险比HR = 0.39（95%可信区间[0.18 - 0.86]）；P值 = 0.035。用于预测ARDS发生的H24时LOX-1跨肺梯度的ROC曲线下面积为0.83（95%可信区间[0.62 - 1.00]）。高危心脏手术后最初48小时内，细胞内LOX-1水平的跨肺梯度与ARDS的发生呈负相关，这表明LOX-1在肺内潴留可能与术后ARDS有关。
