BACKGROUND: Patients undergoing complex cardiac surgery (thoracic aorta and valve) are at risk for organ failure and increased resource utilization. Neutrophil gelatinase-associated lipocalin (NGAL) has been found to be an early biomarker for renal injury. Multiplex cytokine immunoassays allow the evaluation of the early inflammatory response. We examined the relationship between early biomarker appearance (NGAL and multiplex cytokines) and organ injury and resource utilization. MATERIALS AND METHODS: NGAL and multiplex cytokine immunoassays were performed at baseline, 1, 6, and 24 h following surgery on 38 patients undergoing thoracic aorta and valve operations. The mean age was 65 y with 26 males and 12 females. Acute kidney injury (AKIN definition), pulmonary failure (>24 h ventilation), and intensive care unit and hospital stays were examined. RESULTS: One hour following complex cardiac surgery, the quartile of patients with the greatest IL-6 response had higher serum NGAL levels compared with the lowest quartile (347 versus 145 ng/mL, P=0.002), and 70% of these patients progressed to clinical kidney injury. Six hours following surgery, the quartile of patients with the greatest IL-10 response had higher serum NGAL compared with the lowest quartile (271 versus 160, P =0.04), more pulmonary failure (60% versus 10%, P =0.01), and longer ICU and hospital stays (P =0.001). CONCLUSIONS: Patients with early elevated biomarkers of inflammation exhibited higher NGAL, more pulmonary failure, and greater resource utilization. Earlier identification of patients at risk for organ injury may allow for earlier intervention and reduce resource utilization.
BACKGROUND:Patients undergoing complex cardiac surgery (thoracic aorta and valve) are at risk for organ failure and increased resource utilization. Neutrophil gelatinase-associated lipocalin (NGAL) has been found to be an early biomarker for renal injury. Multiplex cytokine immunoassays allow the evaluation of the early inflammatory response. We examined the relationship between early biomarker appearance (NGAL and multiplex cytokines) and organ injury and resource utilization. MATERIALS AND METHODS:NGAL and multiplex cytokine immunoassays were performed at baseline, 1, 6, and 24 h following surgery on 38 patients undergoing thoracic aorta and valve operations. The mean age was 65 y with 26 males and 12 females. Acute kidney injury (AKIN definition), pulmonary failure (>24 h ventilation), and intensive care unit and hospital stays were examined. RESULTS: One hour following complex cardiac surgery, the quartile of patients with the greatest IL-6 response had higher serum NGAL levels compared with the lowest quartile (347 versus 145 ng/mL, P=0.002), and 70% of these patients progressed to clinical kidney injury. Six hours following surgery, the quartile of patients with the greatest IL-10 response had higher serum NGAL compared with the lowest quartile (271 versus 160, P =0.04), more pulmonary failure (60% versus 10%, P =0.01), and longer ICU and hospital stays (P =0.001). CONCLUSIONS:Patients with early elevated biomarkers of inflammation exhibited higher NGAL, more pulmonary failure, and greater resource utilization. Earlier identification of patients at risk for organ injury may allow for earlier intervention and reduce resource utilization.
Authors: A Ahsan Ejaz; Tomas D Martin; Richard J Johnson; Almut G Winterstein; Charles T Klodell; Philip J Hess; Ayad K Ali; Elaine M Whidden; Nancy L Staples; James A Alexander; Mary Ann House-Fancher; Thomas M Beaver Journal: J Thorac Cardiovasc Surg Date: 2009-07-03 Impact factor: 5.209
Authors: G M Chertow; J M Lazarus; C L Christiansen; E F Cook; K E Hammermeister; F Grover; J Daley Journal: Circulation Date: 1997-02-18 Impact factor: 29.690
Authors: C M Mangano; L S Diamondstone; J G Ramsay; A Aggarwal; A Herskowitz; D T Mangano Journal: Ann Intern Med Date: 1998-02-01 Impact factor: 25.391
Authors: H J Safi; S A Harlin; C C Miller; D C Iliopoulos; A Joshi; T G Mohasci; R Zippel; G V Letsou; M Tabor Journal: J Vasc Surg Date: 1996-09 Impact factor: 4.268
Authors: J P Gold; M E Charlson; P Williams-Russo; T P Szatrowski; J C Peterson; P A Pirraglia; G S Hartman; F S Yao; J P Hollenberg; D Barbut Journal: J Thorac Cardiovasc Surg Date: 1995-11 Impact factor: 5.209
Authors: G M VanOtteren; R M Strieter; S L Kunkel; R Paine; M J Greenberger; J M Danforth; M D Burdick; T J Standiford Journal: J Immunol Date: 1995-02-15 Impact factor: 5.422
Authors: A Ahsan Ejaz; Bhagwan Dass; Vijaykumar Lingegowda; Michiko Shimada; Thomas M Beaver; Noel I Ejaz; Amer S Abouhamze; Richard J Johnson Journal: Int Urol Nephrol Date: 2012-05-31 Impact factor: 2.370
Authors: David J Hall; Maher Baz; Michael J Daniels; Edward Denmark Staples; Charles T Klodell; Lyle L Moldawer; Thomas M Beaver Journal: Interact Cardiovasc Thorac Surg Date: 2012-07-19