The cytokine balance during CABG surgery with and without cardiopulmonary bypass

Azab, S. R. El; Doha, Nagwa M.; Rady, Ayman A; El-Sayed, Abeer E.; abdrabo, mahmoud mohamed

doi:10.1016/j.egja.2010.05.003

Cited by 4 publications

(2 citation statements)

References 25 publications

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“…This linear association on day 3 was statistically significant and stronger than serum creatinine for predicting length of hospital stay [4]. To our surprise, there was only a weak correlation between the inflammatory biomarkers and CPB time compared with published reports in adults [28,29], suggesting that distinct pathways may mediate inflammation in children. This is the largest research study to examine perioperative IL-6 and IL-10 levels in children after cardiac surgery and their association with AKI.…”

Section: Discussionmentioning

confidence: 49%

Interleukin-6 and interleukin-10 as acute kidney injury biomarkers in pediatric cardiac surgery

et al. 2015

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Background Children undergoing cardiac surgery may exhibit a pronounced inflammatory response to cardiopulmonary bypass (CPB). Inflammation is recognized as an important pathophysiologic process leading to acute kidney injury (AKI). The aim of this study was to evaluate the association of two inflammatory cytokines interleukin (IL)-6 and IL-10 with AKI and other adverse outcomes in children after CPB surgery. Methods This is a sub-study of the Translational Research Investigating Biomarker Endpoints in AKI (TRIBE-AKI) cohort, including 106 children from 1 month to 18 years old undergoing CPB. Plasma IL-6 and IL-10 were measured preoperatively and postoperatively on days 1 (within 6 hours after surgery) and 3. Results Stage 2/3 AKI, defined by atleast a doubling of baseline serum creatinine or dialysis, was diagnosed in 24 (23%) patients. Preoperative IL-6 was significantly higher in patients with stage 2/3 AKI vs. without stage 2/3 AKI (median (IQR), 2.6 (0.6-4.9) vs. 0.6 (0.6-2.2), p=0.03). After adjustment for clinical and demographic variables, the highest preoperative IL-6 tertile was associated with a six-fold increased risk for stage 2/3 AKI compared with the lowest tertile (adjusted OR 6.41 (CI: 1.16-35.35)). IL-6 and IL-10 increased significantly after surgery, peaking postoperatively on day 1. First postoperative IL-6 and IL-10 did not significantly differ between patients with vs. without stage 2/3 AKI. Elevated IL-6 on day 3 was associated with longer hospital stay (p=0.0001). Conclusions Preoperative plasma IL-6 is associated with development of stage 2/3 AKI and may be prognostic of resource utilization.

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Section: Discussionmentioning

confidence: 49%

Interleukin-6 and interleukin-10 as acute kidney injury biomarkers in pediatric cardiac surgery

et al. 2015

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“…High plasma concentrations of these cytokines are associated with increased risk of AKI after cardiac surgery 14 . In ammation is the direct result of surgical stress and CPB, with higher levels of pro-in ammatory cytokines reported in patients undergoing on-pump cardiac surgery compared to off-pump surgery 15 .…”

Section: Pathophysiology and Risk Factorsmentioning

confidence: 99%

Postoperative 20% Albumin Vs Standard Care and Acute Kidney Injury After High-risk Cardiac Surgery (ALBICS): Study Protocol for a Randomised Trial

Balachandran

Banneheke²,

Pakavakis³

et al. 2021

Preprint

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BackgroundAcute kidney injury (AKI) is a common complication of cardiac surgery. Factors such as cardiopulmonary bypass, aortic cross-clamping and surgical stress may precipitate renal hypoperfusion and ischaemia, inflammation, and oxidative stress are associated with development of AKI. Albumin’s pharmacological properties and widespread availability have the potential to mitigate these factors. However, the effect of albumin on cardiac surgery associated AKI is unknown.ObjectiveTo evaluate the impact of postoperative 20% albumin infusion on kidney function after high-risk cardiac surgery.MethodsWe designed an open label, multicentre, randomised controlled trial – the ALBICS study (ALBumin Infusion and acute kidney injury following Cardiac Surgery). A total of 590 patients undergoing high-risk cardiac surgery (combined procedure or estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2) will be enrolled into the study and randomly allocated to receive a postoperative 20% albumin infusion or standard care in a 1:1 ratio, stratified by centre and baseline renal function. The study fluid will be administered upon arrival in intensive care for 16 hours. Patients will be followed up until 28 days after surgery or until discharge from the hospital. The primary outcome is the proportion of patients who develop AKI in both groups. Secondary outcomes to be measured are proportions of AKI stage II and III, 28-day mortality, mechanical ventilation time and length of stay in intensive care and hospital.ConclusionThis trial aims to determine if a postoperative infusion of concentrated albumin reduces the risk of AKI following high-risk cardiac surgery. Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN1261900135516703. Registered 03 October 2019 – retrospectively registered, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378383.

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Effect of cardiopulmonary bypass on cytochrome P450 enzyme activity: implications for pharmacotherapy

Adiraju

Shekar

Smith

et al. 2017

Drug Metabolism Reviews

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For patients undergoing cardiopulmonary bypass (CPB) during cardiac surgery, there are well-documented changes in the pharmacokinetics (PK) of commonly administered drugs. Although multiple factors potentially underpin these changes, there has been scant research attention on the impact of CPB to alter the activities of cytochrome P450 (CYP) isoenzymes. PK changes during cardiac surgery with CPB have the potential to adversely affect the safety and efficacy of pharmacotherapy and increase the risk of drug-drug interactions. Clinically significant changes in drug PK during CPB are likely to be prominent for drugs where CYP metabolism is a major clearance (CL) mechanism. However, clinical data from patients undergoing CPB surgery in support of this hypothesis are lacking, leaving a significant knowledge gap. In this review, we address the effects of CPB on the release of pro-inflammatory cytokines, in surgeries with and without CPB, both pre and post initiation of surgery. We reviewed literature to explore the relationship between the release of pro-inflammatory cytokines, and the expression and activities of CYP enzymes. Through this approach, we provide new insight on the effects of CPB on the PK of drugs administered to patients in the clinical setting. Future research to address this knowledge gap will have considerable impact to assist clinicians with optimizing pharmacotherapy in this patient population.

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The cytokine balance during CABG surgery with and without cardiopulmonary bypass

Cited by 4 publications

References 25 publications

Interleukin-6 and interleukin-10 as acute kidney injury biomarkers in pediatric cardiac surgery

Interleukin-6 and interleukin-10 as acute kidney injury biomarkers in pediatric cardiac surgery

Postoperative 20% Albumin Vs Standard Care and Acute Kidney Injury After High-risk Cardiac Surgery (ALBICS): Study Protocol for a Randomised Trial

Effect of cardiopulmonary bypass on cytochrome P450 enzyme activity: implications for pharmacotherapy

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