低术后线粒体氧张力是心脏手术后急性肾损伤的早期标志：一项前瞻性观察研究

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2025-04-22 DOI:10.1016/j.jcrc.2025.155088

Bashar N. Hilderink , Reinier F. Crane , Sesmu M. Arbous , Bas van den Bogaard , Janesh Pillay , Nicole P. Juffermans

{"title":"低术后线粒体氧张力是心脏手术后急性肾损伤的早期标志：一项前瞻性观察研究","authors":"Bashar N. Hilderink , Reinier F. Crane , Sesmu M. Arbous , Bas van den Bogaard , Janesh Pillay , Nicole P. Juffermans","doi":"10.1016/j.jcrc.2025.155088","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Dissociation between the micro- and macrocirculation as well as the lack of specificity of current markers to signal impaired tissue oxygenation complicate the timely diagnosis and treatment of tissue hypoperfusion to prevent acute kidney injury (AKI) after cardiac surgery. The newly developed non-invasive technique to measure the mitochondrial oxygenation (mitoPO2) is currently the most downstream bedside marker of tissue oxygenation. The aim was to investigate mitoPO2 as an early marker of postoperative development of AKI.</div></div><div><h3>Methods</h3><div>In a prospective observational study, postoperative mitochondrial oxygen tension was measured to detect AKI (defined by KDIGO) in patients undergoing cardiac surgery.</div></div><div><h3>Results</h3><div>Of 50 included patients, 44 patients had analyzable mitoPO2 signal. 5 patients developed AKI. MitoPO2 at ICU admission was 16(13.8–24.6)mmHg in patients who developed AKI vs 63.4(37.5–77.9) mmHg in patients without AKI (<em>p</em> < 0.001). MitoPO2 predicted AKI (ROC 0.95 (0.89–1.0) with an optimal cut-off value of 30 mmHg (OR 4.4, CI 2.8–6.0, p < 0.001). Also, longer period of time under the mitoPO2 threshold predicted AKI with an AUROC of 0.91(0.80–1.00). In all patients, a decreased mitoPO2 occurred 4 h earlier than an clinically relevant increase in serum lactate. Other markers of tissue hypoperfusion, did not differ between patients with and without AKI.</div></div><div><h3>Conclusions</h3><div>A mitoPO2 value below 30 mmHg at ICU admission as well as the duration below this threshold indicate the development of AKI in cardiac surgery patients, occurring earlier than an increase in lactate above the normal range.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155088"},"PeriodicalIF":3.2000,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Low postoperative mitochondrial oxygen tension is an early marker of acute kidney injury after cardiac surgery: A prospective observational study\",\"authors\":\"Bashar N. Hilderink , Reinier F. Crane , Sesmu M. Arbous , Bas van den Bogaard , Janesh Pillay , Nicole P. Juffermans\",\"doi\":\"10.1016/j.jcrc.2025.155088\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Dissociation between the micro- and macrocirculation as well as the lack of specificity of current markers to signal impaired tissue oxygenation complicate the timely diagnosis and treatment of tissue hypoperfusion to prevent acute kidney injury (AKI) after cardiac surgery. The newly developed non-invasive technique to measure the mitochondrial oxygenation (mitoPO2) is currently the most downstream bedside marker of tissue oxygenation. The aim was to investigate mitoPO2 as an early marker of postoperative development of AKI.</div></div><div><h3>Methods</h3><div>In a prospective observational study, postoperative mitochondrial oxygen tension was measured to detect AKI (defined by KDIGO) in patients undergoing cardiac surgery.</div></div><div><h3>Results</h3><div>Of 50 included patients, 44 patients had analyzable mitoPO2 signal. 5 patients developed AKI. MitoPO2 at ICU admission was 16(13.8–24.6)mmHg in patients who developed AKI vs 63.4(37.5–77.9) mmHg in patients without AKI (<em>p</em> < 0.001). MitoPO2 predicted AKI (ROC 0.95 (0.89–1.0) with an optimal cut-off value of 30 mmHg (OR 4.4, CI 2.8–6.0, p < 0.001). Also, longer period of time under the mitoPO2 threshold predicted AKI with an AUROC of 0.91(0.80–1.00). In all patients, a decreased mitoPO2 occurred 4 h earlier than an clinically relevant increase in serum lactate. Other markers of tissue hypoperfusion, did not differ between patients with and without AKI.</div></div><div><h3>Conclusions</h3><div>A mitoPO2 value below 30 mmHg at ICU admission as well as the duration below this threshold indicate the development of AKI in cardiac surgery patients, occurring earlier than an increase in lactate above the normal range.</div></div>\",\"PeriodicalId\":15451,\"journal\":{\"name\":\"Journal of critical care\",\"volume\":\"88 \",\"pages\":\"Article 155088\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-04-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of critical care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0883944125000759\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of critical care","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0883944125000759","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}

引用次数: 0

摘要

背景：微循环和大循环之间的分离，以及缺乏特异性的标志物来指示组织氧合受损，使得及时诊断和治疗组织灌注不足以预防心脏手术后急性肾损伤（AKI）变得复杂。线粒体氧合（mitoPO2）的无创测量技术是目前最下游的组织氧合床边标志物。目的是研究mitoPO2作为AKI术后发展的早期标志物。方法在一项前瞻性观察研究中，通过测量术后线粒体氧张力来检测心脏手术患者的AKI（由KDIGO定义）。结果50例患者中，44例有可分析的mitoPO2信号。5例发生AKI。AKI患者入院时MitoPO2为16(13.8-24.6)mmHg，非AKI患者为63.4(37.5-77.9)mmHg (p <；0.001)。MitoPO2预测AKI (ROC 0.95(0.89-1.0)，最佳临界值为30 mmHg (OR 4.4, CI 2.8-6.0, p <；0.001)。此外，较长的mitoPO2阈值下时间预测AKI， AUROC为0.91（0.80-1.00）。在所有患者中，mitoPO2下降比临床相关的血清乳酸升高早4小时发生。其他组织灌注不足的标志物在AKI患者和非AKI患者之间没有差异。结论ICU入院时mitoPO2值低于30 mmHg及持续时间低于该阈值提示心脏手术患者发生AKI，发生时间早于乳酸升高高于正常范围。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Low postoperative mitochondrial oxygen tension is an early marker of acute kidney injury after cardiac surgery: A prospective observational study

Background

Dissociation between the micro- and macrocirculation as well as the lack of specificity of current markers to signal impaired tissue oxygenation complicate the timely diagnosis and treatment of tissue hypoperfusion to prevent acute kidney injury (AKI) after cardiac surgery. The newly developed non-invasive technique to measure the mitochondrial oxygenation (mitoPO2) is currently the most downstream bedside marker of tissue oxygenation. The aim was to investigate mitoPO2 as an early marker of postoperative development of AKI.

Methods

In a prospective observational study, postoperative mitochondrial oxygen tension was measured to detect AKI (defined by KDIGO) in patients undergoing cardiac surgery.

Results

Of 50 included patients, 44 patients had analyzable mitoPO2 signal. 5 patients developed AKI. MitoPO2 at ICU admission was 16(13.8–24.6)mmHg in patients who developed AKI vs 63.4(37.5–77.9) mmHg in patients without AKI (p < 0.001). MitoPO2 predicted AKI (ROC 0.95 (0.89–1.0) with an optimal cut-off value of 30 mmHg (OR 4.4, CI 2.8–6.0, p < 0.001). Also, longer period of time under the mitoPO2 threshold predicted AKI with an AUROC of 0.91(0.80–1.00). In all patients, a decreased mitoPO2 occurred 4 h earlier than an clinically relevant increase in serum lactate. Other markers of tissue hypoperfusion, did not differ between patients with and without AKI.

Conclusions

A mitoPO2 value below 30 mmHg at ICU admission as well as the duration below this threshold indicate the development of AKI in cardiac surgery patients, occurring earlier than an increase in lactate above the normal range.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.