The Inflammatory Response in Cardiac Surgery: An Overview of the Pathophysiology and Clinical Implications

Corral-Velez, Vicente; López-Delgado, Juan Carlos; Betancur-Zambrano, Nelson L.; Lopez-Suñe, N; Rojas-Lora, Mariel; Torrado, Herminia; Ballús, J.

doi:10.2174/1871528114666150529120801

Cited by 50 publications

(54 citation statements)

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“…The independent risk factors found in our study, such as history of hypertension, insulin dependent diabetes, mechanical ventilation, CPB duration, and erythrocyte transfusion, were in accord with a previous study [ 9 ], while early postoperative fever (>38 °C in the first 72 h), which is rarely caused by an infection [ 22 ], was found for the first time (to the best of our knowledge) to be an independent risk factor for CSA-AKI. The underlying mechanism was thought to be related to systemic inflammatory responses, which is one of the postoperative complications in patients undergoing cardiac surgery with CPB [ 23 ]. These findings may be of importance in light of the renal protection in this setting due to CSA-AKI being significantly associated with higher postoperative mortality [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Ulinastatin administration is associated with a lower incidence of acute kidney injury after cardiac surgery: a propensity score matched study

Wan¹,

Xie²,

Gendoo³

et al. 2016

Crit Care

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BackgroundSystemic inflammation is involved in the development of acute kidney injury (AKI) after cardiac surgery with cardiopulmonary bypass (CPB). Ulinastatin, a urinary trypsin inhibitor (UTI), possesses a variety of anti-inflammatory effects. Therefore, we hypothesized that the administration of ulinastatin would reduce the occurrence of AKI in patients undergoing cardiac surgery with CPB.MethodsA retrospective propensity score matched analysis was used to evaluate the effect of ulinastatin on the development of AKI in patients undergoing first documented cardiac surgery with CPB between January 2008 and December 2012 in our hospital. Multiple logistic regression models were also employed to identify the association between UTI administration and development of AKI.ResultsA total of 2072 patients who underwent cardiac surgery with CPB met the inclusion criteria. Before propensity score matching, variables such as age, baseline creatinine, CPB duration, red blood cells transfused, and hematocrit were statistically different between the ulinastatin (UTI) group and the control group. On the basis of propensity scores, 409 UTI patients were successfully matched to the 409 patients from among those 1663 patients without UTI administration. After propensity score matching, no statistically significant differences in the baseline characteristics were found between the UTI group and the control group. The propensity score matched cohort analysis revealed that AKI and the need for renal replacement therapy occurred more frequently in the control group than in the UTI group (40.83 % vs. 30.32 %, P = 0.002; 2.44 % vs. 0.49 %, P = 0.02, respectively). However, there were no significant differences in mortality, length of intensive care unit stay, and length of hospital stay between the UTI group and the control group. Using multivariate logistic regression analysis, we found ulinastatin played a protective role in the development of AKI after cardiac surgery (odds ratio 0.71, 95 % confidence interval 0.56–0.90, P = 0.005).ConclusionsThis study shows that ulinastatin was associated with a lower incidence of AKI after cardiac surgery, suggesting that the administration of ulinastatin may be favorable for those patients undergoing cardiac surgery with CPB.

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Section: Discussionmentioning

confidence: 99%

Ulinastatin administration is associated with a lower incidence of acute kidney injury after cardiac surgery: a propensity score matched study

Wan¹,

Xie²,

Gendoo³

et al. 2016

Crit Care

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“…The main study outcome was the presence of a postoperative IR during ICU admission after CS, which was defined as a needed for vasopressor support for at least 48 hours in order to maintain an adequate mean arterial pressure (MAP), based on the patient’s previous MAP prior to CS 12…”

Section: Methodsmentioning

confidence: 99%

Evaluation of the delta of immature platelet fraction as a predictive biomarker of inflammatory response after cardiac surgery

et al. 2019

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AimsCardiac surgery (CS) can induce an inflammatory response (IR) that is associated with poorer outcomes. Immature platelets are among the factors that may be associated with IR development. We aimed to evaluate whether immature platelet fraction (IPF) could be a predictive biomarker for IR and whether IPF could improve the prognosis assessment of IR for Acute Physiologic and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) following CS.MethodsThree-hundred and twenty-seven (327) patients who underwent CS were enrolled during the study period. IR was defined according to the need for vasopressor support (>48 hours). Perioperative variables and outcomes were registered in our database. IPF was measured immediately following CS and at 24 hours by Sysmex XN analyzer and the difference between both measurements (ΔIPF) was calculated. To assess the relationship between ΔIPF and IR, univariate and multivariate logistic regression were performed. To analyse the additive value of ΔIPF in APACHE II and SOFA scores in predicting IR, an area under the receiver operating characteristic (AUROC) curve was calculated.ResultsAmong 327 patients included, 60 patients (18.3%) developed IR. Multivariate analysis showed ΔIPF was significantly associated with IR (OR: 1.26; 95% CI: 1.01 to 1.56; p=0.038). The combination of ΔIPF with scores improved the AUROC for IR prediction: 0.629 vs 0.728 (p=0.010) for APACHE II and 0.676 vs 0.715 (p=0.106) for SOFA.ConclusionThese findings suggested that ΔIPF may be a useful and low-cost biomarker for the early identification of patients at risk of IR development.

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“…Many stimuli like emotional or physical stress, drugs can trigger mast cell degranulation. Cardiopulmonary bypass is known to induce systemic inflammatory response [5]. General guidelines for safe surgery in patients with mastocytosis recommend avoiding potentially harmful agents and blocking the cascade of factors released by mast cells.…”

Section: Discussionmentioning

confidence: 99%

Case report on aortic valve replacement in adult woman with systemic mastocytosis (RCD code: VIII)

Różewicz-Juraszek

Hryniewiecki²,

Faber³

et al. 2017

Journal of Rare Cardiovascular Diseases

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We present a case of a 50 year-old woman who was referred to our department with severe symptomatic aortic stenosis and systemic mastocytosis. Conventional mechanical aortic valve replacement was performed successfully with the use of perioperative protocol based on dexamethasone, cetirizine and ranitidine. The only postoperative event was an onset of atrial fibrillation which was treated with amiodarone infusion. 8 days after surgery the patient was discharged home. JRCD 2017; 3 (2): 54-55

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The Inflammatory Response in Cardiac Surgery: An Overview of the Pathophysiology and Clinical Implications

Cited by 50 publications

References 0 publications

Ulinastatin administration is associated with a lower incidence of acute kidney injury after cardiac surgery: a propensity score matched study

Ulinastatin administration is associated with a lower incidence of acute kidney injury after cardiac surgery: a propensity score matched study

Evaluation of the delta of immature platelet fraction as a predictive biomarker of inflammatory response after cardiac surgery

Case report on aortic valve replacement in adult woman with systemic mastocytosis (RCD code: VIII)

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