Zajonz Thomas S, Edinger Fabian, Götze Juliane, Markmann Melanie, Sander Michael, Koch Christian, Schneck Emmanuel
Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen and Marburg, Rudolf-Buchheim-Strasse 7, 35392 Giessen, Germany.
J Clin Med. 2025 Jul 16;14(14):5020. doi: 10.3390/jcm14145020.
Minimized extracorporeal circulation (miECC) was developed to mitigate the adverse effects of cardiopulmonary bypass (CPB), yet its impact on soluble urokinase plasminogen activator receptor (suPAR) is unclear. SuPAR has been linked to adverse outcomes, including acute kidney injury (AKI). This study investigated perioperative suPAR kinetics in patients undergoing cardiac surgery with miECC or conventional CPB (cCPB) and explored its association with AKI, postoperative delirium (POD), and infections. : This study is a secondary analysis of an observational cohort of 79 cardiac surgical patients. It evaluates perioperative suPAR levels and their association with the type of CPB used (miECC vs. cCPB) and postoperative adverse outcomes, including POD, AKI, and infections. Statistical analyses included repeated measures ANOVA, Wilcoxon tests, logistic regression, and ROC curve analysis to assess the predictive value of suPAR for these outcomes. : During surgery, suPAR significantly increased to higher levels with the use of cCPB compared to miECC ( = 0.027; odds ratio of 0.69 [0.57-0.84], < 0.001). The use of miECC was an independent influencing factor on suPAR (-0.41 ± 0.1; < 0.001). Regardless of the type of CPB, suPAR levels differed significantly between patients with and without kidney damage ( = 25; no AKI: 1.6 [1.1-2.0], AKI: 1.7 [1.3-2.4], < 0.001). Multivariate regression analysis showed that AKI was an independent influencing factor on suPAR (-0.49 ± 0.1; < 0.001). SuPAR demonstrated only low predictive value for AKI and could not predict POD. : This study provides evidence that miECC is associated with lower intraoperative suPAR levels, suggesting a reduced inflammatory response compared to cCPB. While suPAR levels were significantly higher in patients with AKI, their predictive value for AKI remains limited. Furthermore, suPAR did not predict POD but was elevated in patients with pneumonia.
为减轻体外循环（CPB）的不良影响，人们研发了微创体外循环（miECC），但其对可溶性尿激酶型纤溶酶原激活物受体（suPAR）的影响尚不清楚。SuPAR与包括急性肾损伤（AKI）在内的不良结局有关。本研究调查了接受miECC或传统CPB（cCPB）心脏手术患者围手术期的suPAR动力学，并探讨其与AKI、术后谵妄（POD）和感染的关系。：本研究是对79例心脏手术患者观察队列的二次分析。它评估围手术期suPAR水平及其与所用CPB类型（miECC与cCPB）和术后不良结局（包括POD、AKI和感染）的关系。统计分析包括重复测量方差分析、Wilcoxon检验、逻辑回归和ROC曲线分析，以评估suPAR对这些结局的预测价值。：手术期间，与miECC相比，使用cCPB时suPAR显著升高至更高水平（ = 0.027；优势比为0.69 [0.57 - 0.84]， < 0.001）。使用miECC是影响suPAR的独立因素（-0.41 ± 0.1； < 0.001）。无论CPB类型如何，有肾损伤和无肾损伤患者的suPAR水平差异显著（ = 25；无AKI：1.6 [1.1 - 2.0]，AKI：1.7 [1.3 - 2.4]， < 0.001）。多因素回归分析表明，AKI是影响suPAR的独立因素（-0.49 ± 0.1； < 0.001）。SuPAR对AKI的预测价值较低，无法预测POD。：本研究提供的证据表明，miECC与术中较低的suPAR水平相关，提示与cCPB相比炎症反应减轻。虽然AKI患者的suPAR水平显著更高，但其对AKI的预测价值仍然有限。此外，suPAR不能预测POD，但在肺炎患者中升高。
