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Predictive value of plasma cytokines for acute kidney injury following lung resection surgery: prospective observational study / Valor preditivo das citocinas plasmáticas para lesão renal aguda após cirurgia de ressecção pulmonar: estudo observacional prospectivo
Monteserín Matesanz, Cristina; de la Gala, Francisco; Rancan, Lisa; Piñeiro, Patricia; Simón, Carlos; Tejedor, Alberto; Vara, Elena; Gonzalez-Cantero, Jorge L; Garutti, Ignacio.
  • Monteserín Matesanz, Cristina; Gregorio Marañón University General Hospital. Department of Anesthesiology. Madrid. ES
  • de la Gala, Francisco; Gregorio Marañón University General Hospital. Department of Anesthesiology. Madrid. ES
  • Rancan, Lisa; Complutense University of Madrid. Medical Faculty. Department of Biochemistry and Molecular Biology III. Madrid. ES
  • Piñeiro, Patricia; Gregorio Marañón University General Hospital. Department of Anesthesiology. Madrid. ES
  • Simón, Carlos; Gregorio Marañón University General Hospital. Department of Thoracic Surgery. Madrid. ES
  • Tejedor, Alberto; Gregorio Marañón University General Hospital. Department of Nephrology. Madrid. ES
  • Vara, Elena; Complutense University of Madrid. Medical Faculty. Department of Biochemistry and Molecular Biology III. Madrid. ES
  • Gonzalez-Cantero, Jorge L; Gregorio Marañón University General Hospital. Department of Radiology. Madrid. ES
  • Garutti, Ignacio; Gregorio Marañón University General Hospital. Department of Anesthesiology. Madrid. ES
Rev. bras. anestesiol ; 69(3): 242-252, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1013413
ABSTRACT
Abstract Background and

objectives:

Patients undergoing lung resection surgery are at risk of developing postoperative acute kidney injury. Determination of cytokine levels allows the detection of an early inflammatory response. We investigated any temporal relationship among perioperative inflammatory status and development of acute kidney injury after lung resection surgery. Furthermore, we evaluated the impact of acute kidney injury on outcome and analyzed the feasibility of cytokines to predict acute kidney injury.

Methods:

We prospectively analyzed 174 patients scheduled for elective lung resection surgery with intra-operative periods of one-lung ventilation periods. Fiberoptic broncho-alveolar lavage was performed in each lung before and after one-lung ventilation periods for cytokine analysis. As well, cytokine levels were measured from arterial blood samples at five time points. acute kidney injury was diagnosed within 48 h of surgery based on acute kidney injury criteria. We analyzed the association between acute kidney injury and cardiopulmonary complications, length of intensive care unit and hospital stays, intensive care unit re-admission, and short-term and long-term mortality.

Results:

The incidence of acute kidney injury in our study was 6.9% (12/174). Acute kidney injury patients showed higher plasma cytokine levels after surgery but differences in alveolar cytokines were not detected. Although no patient required renal replacement therapy, acute kidney injury patients had higher incidence of cardiopulmonary complications and increased overall mortality. Plasma interleukin-6 at 6 h was the most predictive cytokine of acute kidney injury (cut-off point at 4.89 pg.mL-1).

Conclusions:

Increased postoperative plasma cytokine levels are associated with acute kidney injury after lung resection surgery in our study, which worsens the prognosis. Plasma interleukin-6 may be used as an early indicator for patients at risk of developing acute kidney injury after lung resection surgery.
RESUMO
Resumo Justificativa e

objetivos:

Os pacientes submetidos à cirurgia de ressecção pulmonar apresentam risco de desenvolver lesão renal aguda pós-operatória. A determinação dos níveis de citocinas permite detectar uma resposta inflamatória precoce. Investigamos a relação temporal entre o estado inflamatório perioperatório e o desenvolvimento de lesão renal aguda após cirurgia de ressecção pulmonar. Além disso, avaliamos o impacto da lesão renal aguda no desfecho e analisamos a viabilidade das citocinas para prever este tipo de lesão.

Métodos:

No total, foram analisados prospectivamente 174 pacientes agendados para cirurgia eletiva de ressecção pulmonar com períodos intraoperatórios de ventilação monopulmonar. Lavado bronco-alveolar com fibra óptica foi realizado em cada pulmão antes e após os períodos de ventilação monopulmonar para análise das citocinas. Os níveis de citocina foram medidos a partir de amostras de sangue arterial em cinco momentos. A lesão renal aguda foi diagnosticada dentro de 48 horas após a cirurgia, com base nos critérios para sua verificação. Analisamos a associação entre lesão renal aguda e complicações cardiopulmonares, tempo de internação em unidade de terapia intensiva e de internação hospitalar, reinternação em unidade de terapia intensiva e mortalidade a curto e longo prazos.

Resultados:

A incidência de lesão renal aguda no estudo foi de 6,9% (12/174). Os pacientes com lesão renal aguda apresentaram níveis mais altos de citocinas plasmáticas após a cirurgia, mas não foram detectadas diferenças nas citocinas alveolares. Embora nenhum paciente tenha precisado de terapia renal substitutiva, os com lesão renal aguda apresentaram maior incidência de complicações cardiopulmonares e aumento da mortalidade geral. A interleucina-6 plasmática em seis horas foi a citocina mais preditiva de lesão renal aguda (ponto de corte em 4,89 pg.mL-1).

Conclusões:

O aumento dos níveis plasmáticos de citocinas no pós-operatório está associado à lesão renal aguda após cirurgia de ressecção pulmonar no estudo, o que piora o prognóstico. A interleucina-6 plasmática pode ser usada como um indicador precoce para pacientes com risco de desenvolver lesão renal aguda após cirurgia de ressecção pulmonar.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Postoperative Complications / Pulmonary Surgical Procedures / Cytokines / Acute Kidney Injury Type of study: Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Limits: Aged / Female / Humans / Male Language: English Journal: Rev. bras. anestesiol Journal subject: Anesthesiology Year: 2019 Type: Article Affiliation country: Spain Institution/Affiliation country: Complutense University of Madrid/ES / Gregorio Marañón University General Hospital/ES

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Full text: Available Index: LILACS (Americas) Main subject: Postoperative Complications / Pulmonary Surgical Procedures / Cytokines / Acute Kidney Injury Type of study: Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Limits: Aged / Female / Humans / Male Language: English Journal: Rev. bras. anestesiol Journal subject: Anesthesiology Year: 2019 Type: Article Affiliation country: Spain Institution/Affiliation country: Complutense University of Madrid/ES / Gregorio Marañón University General Hospital/ES