Complement activation and lung permeability during cardiopulmonary bypass

Tennenberg, Steven D.; Clardy, Chris W.; Bailey, Warren W.; Solomkin, Joseph S.

doi:10.1016/0003-4975(90)90196-d

Cited by 88 publications

(25 citation statements)

References 18 publications

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“…Thus, it is likely a safe assumption that CPBinduced inflammation has significant deleterious effects on the kidney through similar mechanisms. Despite efforts to produce a CPB system that does not produce contact activation of blood components, this goal has not been realized and CPB still remains a potent proinflammatory stimulus (104,105).…”

Section: Inflammationmentioning

confidence: 99%

Acute Kidney Injury Associated with Cardiac Surgery

Rosner

Okusa²

2006

Clinical Journal of the American Society of Nephrology

904

681

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Acute renal failure (ARF) occurs in up to 30% of patients who undergo cardiac surgery, with dialysis being required in approximately 1% of all patients. The development of ARF is associated with substantial morbidity and mortality independent of all other factors. The pathogenesis of ARF involves multiple pathways. Hemodynamic, inflammatory, and nephrotoxic factors are involved and overlap each other in leading to kidney injury. Clinical studies have identified risk factors for ARF that can be used to determine effectively the risk for ARF in patients who undergo bypass surgery. These high-risk patients then can be targeted for renal protective strategies. Thus far, no single strategy has demonstrated conclusively its ability to prevent renal injury after bypass surgery. Several compounds such as atrial natriuretic peptide and N-acetylcysteine have shown promise, but large-scale trials are needed.Clin -15). ARF that requires dialysis occurs in approximately 1% (1-15). The development of kidney injury is associated with a high mortality, a more complicated hospital course, and a higher risk for infectious complications (1-15). Even minimal changes in serum creatinine that occur in the postoperative period are associated with a substantial decrease in survival (16). Furthermore, the majority of patients who develop ARF that requires dialysis (ARF-D) remain dialysis dependent, leading to significant long-term morbidity and mortality (17). Despite advances in bypass techniques, intensive care, and delivery of hemodialysis, mortality and morbidity associated with ARF have not markedly changed in the last decade (1-15). These data highlight the importance of understanding the pathophysiology of ARF associated with cardiac bypass surgery and implementing specific therapies that are based on this knowledge in well-designed clinical trials. Incidence and Prognosis of ARF after Bypass SurgeryDepending on the definition of ARF, the incidence of ARF varies across studies, with a range of 1 to 30% (1-15). Conlon et al.(1) described a cohort of 2843 patients who underwent cardiopulmonary bypass (CPB) over a 2-yr period. ARF (defined as a rise in serum creatinine Ͼ1 mg/dl above baseline) occurred in 7.9% of patients, and ARF-D occurred in 0.7%. Other studies that used a definition of ARF as a 50% or greater rise in serum creatinine from baseline demonstrated a rate as high as 30% (2-15). Chertow et al. (15) analyzed 42,773 patients who underwent CPB and found an incidence of ARF-D of 1.1%. The incidence of ARF is dependent on the particular type of CPB surgery. Typical coronary artery bypass grafting has the lowest incidence of ARF (approximately 2.5%) and ARF-D (approximately 1%), followed by valvular surgery with an incidence of ARF of 2.8% and ARF-D of 1.7% (18,19). The highest risk group includes combined coronary artery bypass grafting/valvular surgery with an incidence of ARF of 4.6% and ARF-D of 3.3% (18,19) Mortality associated with the development of ARF is as high as 60% in some studies but likely averages 15 to 3...

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Section: Inflammationmentioning

confidence: 99%

Acute Kidney Injury Associated with Cardiac Surgery

Rosner

Okusa²

2006

Clinical Journal of the American Society of Nephrology

904

681

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“…During the early phase of complement activation, the anaphylatoxins C3a and C5a are generated. These mediators induce a broad variety of inflammatory reactions, such as IL-1 and TNF release, [7][8][9] activation of neutrophilic granulocytes and macrophages, 10 contraction of pulmonary vasculature, 11 changes in vascular permeability, 12 and platelet aggregation. 13 Systemic activation of the complement system, as known from patients suffering from sepsis, severe burns or injuries, could induce autodestructive inflammatory reactions, such as adult respiratory distress syndrome (ARDS) or multiple organ failure (MOF).…”

Section: The Complement Systemmentioning

confidence: 99%

Complement activation by recombinant adenoviruses

et al. 2001

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“…A high degree of complement activation in adult and paediatric heart operations with extracorporeal circulation has been proved [3,[15][16][17][18][19][20][21][22][23][24] to bear a direct relation to the duration of the operation [7,8]. Complement activation that has been noted in patients undergoing aortocoronary bypass without the use of extracorporeal circulation is related to the tissue trauma caused by surgical incision.…”

Section: Resultsmentioning

confidence: 99%

Complement activation following cholecystectomy and the effect of gallstones in bile complement

et al. 2010

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Objective: This study was scheduled in an attempt to detect the complement activation following abdominal operations of medium severity with uneventful postoperative course, and the possible effect of gallstones in bile complement. Method: Seventeen patients with cholelithiasis (mean age 58.1 years) were studied after undergoing elective open cholecystectomy. Blood samples were obtained before and immediately after the operation as well as on postoperative days 1, 2, 4 and 5. Complement activation was also measured in bile collected intraoperatively from ten patients (mean age 63.7 years range 47-79) submitted to elective cholecystectomy for cholelithiasis. Bile was also collected intraoperatively from ten other patients (mean age 66.2 years, range 51-78) who were operated electively for benign disease. This bile was incubated with gallstones and complement activation was measured before, immediately after, and at the 30min, 1h and 2h of incubation. Twenty-seven apparently healthy individuals (mean age 41.9 years) were used as controls. Results: (a) Among the complement activation products, only C4d presented a statistically significant postoperative variation (p<0.005) with a peak value between the 1st and 4th postoperative day. (b) C3adesArg and SC5b-9 concentrations were significantly higher in all samples than those of the controls. (c) C3 and C4 levels varied in accordance with the postoperative acute phase reaction as reflected by the CRP values. (d) The levels of all activation products measured in the bile of patients with cholelithiasis were significantly higher than those detected in the bile of patients with benign disease (p<0.005). (e) There was also a great increase in the levels of these products in the bile incubated with gallstones. Conclusions: The uneventful postoperative course following abdominal operations of medium severity is accompanied by a low level activation of the classical complement pathway, and the above results indicate that the presence of gallstones may activate serum complement system directly. Gallstones cause activation of bile complement in vivo. Furthermore, they cause an in vitro activation of bile complement. The in vivo activation of bile complement in the presence of gallstones indicates that they exert a direct effect on the final evolution of the in situ processes Material and MethodsOur study series comprised 17 patients (15 women, 2 men, aged 58,1 +/-5,2 years old who underwent open cholecystectomy for cholelithiasis with an un-

show abstract

Complement activation and lung permeability during cardiopulmonary bypass

Cited by 88 publications

References 18 publications

Acute Kidney Injury Associated with Cardiac Surgery

Acute Kidney Injury Associated with Cardiac Surgery

Complement activation by recombinant adenoviruses

Complement activation following cholecystectomy and the effect of gallstones in bile complement

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