Zoe M Perkins, Derek K Smith, Patricia G Yancey, MacRae F Linton, Loren E Smith
{"title":"High-Density Lipoprotein Anti-Inflammatory Capacity and Acute Kidney Injury After Cardiac and Vascular Surgery: A Prospective Observational Study.","authors":"Zoe M Perkins, Derek K Smith, Patricia G Yancey, MacRae F Linton, Loren E Smith","doi":"10.1097/CCM.0000000000006440","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Acute kidney injury (AKI) predicts death after cardiac and vascular surgery. Higher preoperative high-density lipoprotein (HDL) concentrations are associated with less postoperative AKI. In animals, HDL's anti-inflammatory capacity to suppress endothelial cell adhesion molecule expression reduces kidney damage due to ischemia and hemorrhagic shock. The objective of this study is to evaluate the statistical relationship between HDL anti-inflammatory capacity and AKI after major cardiac and vascular surgery.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Setting: </strong>Quaternary medical center.</p><p><strong>Patients: </strong>One hundred adults with chronic kidney disease on long-term statin therapy undergoing major elective cardiac and vascular surgery.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Apolipoprotein B-depleted serum collected at anesthetic induction was incubated with tumor necrosis factor alpha stimulated human endothelial cells. Reverse transcriptase-polymerase chain reaction was used to measure intercellular adhesion molecule-1 (ICAM-1) messenger RNA. Enzyme-linked immunosorbent assay assays were used to measure apolipoprotein A-I and postoperative soluble ICAM-1 concentrations in patient plasma. HDL concentration did not correlate with HDL ICAM-1 suppression capacity (Spearman R = 0.05; p = 0.64). Twelve patients (12%) were found to have dysfunctional, pro-inflammatory HDL. Patients with pro-inflammatory HDL had a higher rate of postoperative AKI than patients with anti-inflammatory HDL ( p = 0.046). After adjustment for AKI risk factors, a higher preoperative HDL capacity to suppress endothelial ICAM-1 was independently associated with lower odds of AKI (odds ratio, 0.88; 95% CI, 0.80-0.98; p = 0.016). The association between HDL anti-inflammatory capacity and postoperative AKI was independent of HDL concentration ( p = 0.018). Further, a higher long-term statin dose was associated with higher HDL capacity to suppress endothelial ICAM-1 ( p = 0.045).</p><p><strong>Conclusions: </strong>Patients with chronic kidney disease undergoing cardiac and vascular surgery who have dysfunctional, pro-inflammatory HDL have a higher risk of postoperative AKI compared with patients with anti-inflammatory HDL. Conversely, a higher HDL anti-inflammatory capacity is associated with a lower risk of postoperative AKI, independent of HDL concentration. Higher long-term statin dose is associated with higher HDL anti-inflammatory capacity.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"e616-e626"},"PeriodicalIF":7.7000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11620948/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/CCM.0000000000006440","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/15 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: Acute kidney injury (AKI) predicts death after cardiac and vascular surgery. Higher preoperative high-density lipoprotein (HDL) concentrations are associated with less postoperative AKI. In animals, HDL's anti-inflammatory capacity to suppress endothelial cell adhesion molecule expression reduces kidney damage due to ischemia and hemorrhagic shock. The objective of this study is to evaluate the statistical relationship between HDL anti-inflammatory capacity and AKI after major cardiac and vascular surgery.
Design: Prospective observational study.
Setting: Quaternary medical center.
Patients: One hundred adults with chronic kidney disease on long-term statin therapy undergoing major elective cardiac and vascular surgery.
Interventions: None.
Measurements and main results: Apolipoprotein B-depleted serum collected at anesthetic induction was incubated with tumor necrosis factor alpha stimulated human endothelial cells. Reverse transcriptase-polymerase chain reaction was used to measure intercellular adhesion molecule-1 (ICAM-1) messenger RNA. Enzyme-linked immunosorbent assay assays were used to measure apolipoprotein A-I and postoperative soluble ICAM-1 concentrations in patient plasma. HDL concentration did not correlate with HDL ICAM-1 suppression capacity (Spearman R = 0.05; p = 0.64). Twelve patients (12%) were found to have dysfunctional, pro-inflammatory HDL. Patients with pro-inflammatory HDL had a higher rate of postoperative AKI than patients with anti-inflammatory HDL ( p = 0.046). After adjustment for AKI risk factors, a higher preoperative HDL capacity to suppress endothelial ICAM-1 was independently associated with lower odds of AKI (odds ratio, 0.88; 95% CI, 0.80-0.98; p = 0.016). The association between HDL anti-inflammatory capacity and postoperative AKI was independent of HDL concentration ( p = 0.018). Further, a higher long-term statin dose was associated with higher HDL capacity to suppress endothelial ICAM-1 ( p = 0.045).
Conclusions: Patients with chronic kidney disease undergoing cardiac and vascular surgery who have dysfunctional, pro-inflammatory HDL have a higher risk of postoperative AKI compared with patients with anti-inflammatory HDL. Conversely, a higher HDL anti-inflammatory capacity is associated with a lower risk of postoperative AKI, independent of HDL concentration. Higher long-term statin dose is associated with higher HDL anti-inflammatory capacity.
目的:急性肾损伤(AKI)预示着心脏和血管手术后的死亡。术前高密度脂蛋白(HDL)浓度越高,术后急性肾损伤越轻。在动物体内,高密度脂蛋白具有抑制内皮细胞粘附分子表达的抗炎能力,可减少缺血和失血性休克对肾脏的损伤。本研究旨在评估高密度脂蛋白抗炎能力与心脏和血管大手术后 AKI 之间的统计学关系:前瞻性观察研究:患者干预措施:无:测量和主要结果将麻醉诱导时收集的载脂蛋白 B 贫化血清与肿瘤坏死因子α刺激的人内皮细胞进行孵育。逆转录酶聚合酶链反应用于测量细胞间粘附分子-1(ICAM-1)信使 RNA。酶联免疫吸附测定法用于测量患者血浆中载脂蛋白 A-I 和术后可溶性 ICAM-1 的浓度。高密度脂蛋白浓度与高密度脂蛋白 ICAM-1 抑制能力无关(Spearman R = 0.05;p = 0.64)。发现有 12 名患者(12%)的高密度脂蛋白功能失调,具有促炎性。促炎性高密度脂蛋白患者的术后 AKI 发生率高于抗炎性高密度脂蛋白患者(p = 0.046)。调整 AKI 风险因素后,术前高密度脂蛋白抑制内皮 ICAM-1 的能力越高,发生 AKI 的几率越低(几率比 0.88;95% CI,0.80-0.98;p = 0.016)。高密度脂蛋白抗炎能力与术后 AKI 之间的关系与高密度脂蛋白浓度无关(p = 0.018)。此外,较高的长期他汀剂量与较高的高密度脂蛋白抑制内皮 ICAM-1 的能力相关(p = 0.045):结论:与具有抗炎性高密度脂蛋白的患者相比,接受心脏和血管手术的慢性肾脏病患者如果高密度脂蛋白具有功能障碍和促炎性,术后发生 AKI 的风险更高。相反,高密度脂蛋白抗炎能力越强,术后发生 AKI 的风险越低,这与高密度脂蛋白浓度无关。长期服用他汀类药物剂量越高,高密度脂蛋白抗炎能力越强。
期刊介绍:
Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient.
Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.