Background: The phase angle (PhA) can be used for prognostic assessments in critically ill patients. This study describes the perioperative course of PhA and associated risk indicators in a cohort of ...elective cardiac surgical patients. Methods: The PhA was measured in 168 patients once daily until postoperative day (POD) seven. Patients were split into two groups depending on their median preoperative PhA and analyzed for several clinical outcomes; logistic regression models were used. Results: The PhA decreased from preoperative (6.1° ± 1.9°) to a nadir on POD 2 (3.5° ± 2.5°, mean difference −2.6° (95% CI, −3.0°; −2.1°; p < 0.0001)). Patients with lower preoperative PhA were older (71.0 ± 9.1 vs. 60.9 ± 12.0 years; p < 0.0001) and frailer (3.1 ± 1.3 vs. 2.3 ± 1.1; p < 0.0001), needed more fluids (8388 ± 3168 vs. 7417 ± 2459 mL, p = 0.0287), and stayed longer in the ICU (3.7 ± 4.5 vs. 2.6 ± 3.8 days, p = 0.0182). Preoperative PhA was independently influenced by frailty (OR 0.77; 95% CI 0.61; 0.98; p = 0.0344) and cardiac function (OR 1.85; 95%CI 1.07; 3.19; p = 0.028), whereas the postoperative PhA decline was independently influenced by higher fluid balances (OR 0.86; 95% CI 0.75; 0.99; p = 0.0371) and longer cardiopulmonary bypass times (OR 0.99; 95% CI 0.98; 0.99; p = 0.0344). Conclusion: Perioperative PhA measurement is an easy-to-use bedside method that may critically influence risk evaluation for the outcome of cardiac surgery patients.
Early detection of acute kidney injury (AKI) is crucial for timely intervention and improved patient outcomes after cardiac surgery. This study aimed to evaluate the potential of urinary collectrin ...as a novel biomarker for AKI in this patient population.
In this prospective, observational cohort study, 63 patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB) were studied at the Medical University of Vienna between 2016 and 2018. We collected urine samples prospectively at four perioperative time points, and urinary collectrin was measured using an enzyme-linked immunosorbent assay. Patients were divided into two groups, AKI and non-AKI, defined by Kidney Disease: Improving Global Outcomes Guidelines, and differences between groups were analyzed.
Postoperative AKI was found in 19 (30%) patients. Urine sample analysis revealed an inverse correlation between urinary collectrin and creatinine and AKI stages, as well as significant changes in collectrin levels during the perioperative course. Baseline collectrin levels were 5050 ± 3294 pg/mL, decreased after the start of CPB, reached their nadir at the end of surgery, and began to recover slightly on postoperative day (POD) 1. The most effective timepoint for distinguishing between AKI and non-AKI patients based on collectrin levels was POD 1, with collectrin levels of 2190 ± 3728 pg/mL in AKI patients and 3768 ± 3435 pg/mL in non-AKI patients (
= 0.01).
Urinary collectrin shows promise as a novel biomarker for the early detection of AKI in patients undergoing cardiac surgery on CPB. Its dynamic changes throughout the perioperative period, especially on POD 1, provide valuable insights for timely diagnosis and intervention. Further research and validation studies are needed to confirm its clinical usefulness and potential impact on patient outcomes.
Interleukin-6 (IL-6) can cause pro- and anti-inflammatory effects via different signaling pathways. This prospective study investigated the perioperative kinetics of IL-6, soluble IL-6 receptor ...(sIL-6R), and soluble glycoprotein 130 (sgp130) in elective patients undergoing cardiopulmonary bypass (CPB). IL-6, sIL-6R, and sgp130 were measured simultaneously and consecutively at 19 timepoints until the 10th postoperative day (POD). The proportion of pro- and anti-inflammatory pathways were determined by calculating sIL-6R/IL-6 and sIL-6R/sgp130 ratios. We analyzed 93 patients. IL-6 increased during surgery with reaching a plateau two hours after CPB and peaking on POD 1 (188.5 pg mL
(IQR, 126.6; 309.2)). sIL-6R decreased at the beginning of the surgical procedure, reaching a nadir level on POD 2 (26,311 pg mL
(IQR, 22,222; 33,606)). sgp130 dropped immediately after CPB initiation (0.13 ng mL
(IQR, 0.12; 0.15)), followed by a continuous recovery until POD10. The sIL-6R/IL-6 ratio decreased substantially at the beginning of the procedure, reaching a nadir on POD 1 (149.7 (IQR, 82.4; 237.4)), while the sIL-6R/sgp130 ratio increased simultaneously until 6 h post CPB (0.219 (IQR 0.18; 0.27)). In conclusion, IL-6 exhibited high inter-individual variability reflecting an inhomogeneous inflammatory response. Pro-inflammatory effects and overwhelming inflammation were rare and predominantly anti-inflammatory effects were found.
Cardiac surgery associated acute kidney injury (CSA-AKI) is a major complication associated with a high mortality.(1) Early prediction of AKI using biomarkers has become increasingly popular in ...recent years.(2) The localisation of the damage in the kidney has not yet been investigated. Hence, we aim to differentiate whether the damage is glomerular or tubular using two brand new biomarkers: Podocin(3), a biomarker that selectively reflects glomerular damage, and Nephrin, which reflects both glomerular and tubular damage.(4)
In this prospective cohort study, we analysed 63 patients who underwent elective cardiac surgery on cardiopulmonary bypass (CPB) at the Medical University of Vienna.
Urine samples were collected at the beginning of the operation, 30 min after start of CPB, at the end of surgery and on postoperative day 1 (POD1).
Quantitative measurement of Podocin as well as Nephrin was performed by an enzyme-linked immunosorbent assay (ELISA) with a 96-well plate human Podocin ELISA (Human Podocin ELISA Kit, Abcam, Cambridge, UK) and human Nephrin ELISA (Nephrin ELISA Kit, Lifespan Biosciences, Seattle, USA). Patients were grouped in two groups: patients without postoperative AKI and with AKI (noAKI, AKI) according to KDIGO-criteria.(5) Differences between groups were analysed using a student's t-test.
We report 63 patients (25 female), with a mean age of 67.1±11,6 years. In 12.7% (n=8) CABG, in 57.1% (n=36) a valve, in 28.6% (n=18) a combined procedure and in one case (1.6%) a Bentall procedure was performed. According to the KDIGO-criteria 5, 19 patients (30.2%) suffered from acute kidney injury, none of them needed renal replacement therapy. The time on CPB was not significantly different (150.75±55.91min for noAKI vs. 153.47±58.27min for AKI, p=0.8642). The SAPS3-Score tended to be higher in patients with AKI (45.74±10.76) than in patients without AKI (42.53±7.63), but the difference was not significant (p=0.2513).
The baseline of Podocin was 25.57±76.10pg/ml vs. 12.99±8.20pg/ml (noAKI vs. AKI). For Podocin, we did not find any significant difference between groups at any timepoint.
The baseline of Nephrin was 31146.8±16602.52 pg/ml vs. 34786.3±24489 pg/ml (noAKI vs. AKI). For Nephrin, there were no significant differences between the two groups at baseline, 30min after start of the CPB or on POD1, but we found a significant difference at the end of the surgery (32356.6±34226,7 pg/ml for noAKI vs. 54120.5±33725.2pg/ml for AKI; p=0.02515).
As there is only a difference in Nephrin-levels but not in Podocin-levels between patients with AKI and without AKI, our data suggests that patients with CSA-AKI have a damage to the renal tubule and not to the glomerulum.
It remains unclear whether intraoperative lung-protective strategies can reduce the rate of respiratory complications after cardiac surgery, partly because low-risk patients have been studied in the ...past. The authors established a screening model to easily identify a high-risk group for severe pulmonary complications (ie, pneumonia or acute respiratory distress syndrome) that may be the ideal target population for the assessment of the potential benefits of such measures.
Retrospective observational trial.
Departments of cardiac surgery and cardiac anesthesia of a university hospital.
Consecutive patients undergoing cardiac surgery on cardiopulmonary bypass and subsequent treatment at a dedicated cardiosurgical intensive care unit between January 2019 and March 2021.
None.
Of the 2,572 patients undergoing surgery, 84 (3.3%) developed pneumonia/acute respiratory distress syndrome that significantly affected the outcome (ie, longer ventilatory support 66% vs 11%, higher reintubation rate 39% vs 3%), prolonged length of intensive care unit 33 ± 36 vs 4 ± 10 days and hospital stay 10 ± 15 vs 6 ± 7 days, and higher in-hospital 43% vs 9% as well as 30-day 7% vs 3% mortality). The screening model for severe pulmonary complications included left ventricular ejection fraction <52%, EuroSCORE II (European System for Cardiac Operative Risk Evaluation II) >5.9, cardiopulmonary bypass time >123 minutes, left ventricular assist device or aortic repair surgery, and bronchodilatory therapy. A cutoff for the predicted risk of 2.5% showed optimal sensitivity and specificity, with an area under the receiver operating characteristic curve of 0.82.
The authors suggest that future research on intraoperative lung-protective measures focuses on this high-risk population, primarily aiming to mitigate severe forms of postoperative pulmonary dysfunction associated with poor outcomes and increased resource consumption.
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