Abstract
PurposePostoperative respiratory failure is a major problem which can prolong the stay in the intensive care unit in patients undergoing cardiac surgery. We measured the serum levels of the soluble isoform of the receptor for advanced glycation end products (sRAGE), and we studied its association with postoperative respiratory failure.MethodsEighty-seven patients undergoing elective cardiac surgery were enrolled in this multicenter observational study in three university hospitals. Serum biomarker levels were measured perioperatively, and clinical data were collected for 7 days postoperatively. The duration of mechanical ventilation was studied for 28 days.ResultsSerum levels of sRAGE elevated immediately after surgery (median, 1751 pg/mL; interquartile range (IQR) 1080–3034 pg/mL) compared with the level after anesthetic induction (median, 884 pg/mL; IQR, 568–1462 pg/mL). Postoperative sRAGE levels in patients undergoing off-pump coronary artery bypass grafting (median, 1193 pg/mL; IQR 737–1869 pg/mL) were significantly lower than in patients undergoing aortic surgery (median, 1883 pg/mL; IQR, 1406–4456 pg/mL; p = 0.0024) and valve surgery (median, 2302 pg/mL; IQR, 1447–3585 pg/mL; p = 0.0005), and postoperative sRAGE correlated moderately with duration of cardiopulmonary bypass (rs = 0.44, p<0.0001). Receiver operating characteristic curve analysis demonstrated that postoperative sRAGE had a predictive performance with area under the curve of 0.81 (95% confidence interval 0.71–0.88) for postoperative respiratory failure, defined as prolonged mechanical ventilation >3 days. The optimum cutoff value for prediction of respiratory failure was 3656 pg/mL, with sensitivity and specificity of 62% and 91%, respectively.ConclusionsSerum sRAGE levels elevated immediately after cardiac surgery, and the range of elevation was associated with the morbidity of postoperative respiratory failure. Early postoperative sRAGE levels appear to be linked to cardiopulmonary bypass, and may have predictive performance for postoperative respiratory failure; however, large-scale validation studies are needed.
Highlights
Respiratory failure is a relatively common postsurgical complication, which can prolong the duration of stay in the intensive care unit (ICU) in patients undergoing cardiac surgery [1,2]
We previously reported that the soluble isotype of receptor for advanced glycation end products (RAGE) can be used as a biomarker of alveolar epithelial injury in an experimental study and in patients with acute lung injury [12]
Because several recent reports suggested that extrapulmonary inflammation [16,17] could influence the serum levels of sRAGE, we studied whether we could eliminate the contribution of systemic inflammation to the postoperative serum levels of sRAGE in our study cohort
Summary
Respiratory failure is a relatively common postsurgical complication, which can prolong the duration of stay in the intensive care unit (ICU) in patients undergoing cardiac surgery [1,2]. Evaluation for postoperative lung condition is limited to ventilatory parameters, arterial blood gas analysis and a radiographic approach. These methods are most common in clinical practice; they might not reflect the degree of damage to the lung tissue immediately after surgery. Early prediction for high-risk patients for development of respiratory failure enables early initiation of effective therapy and preventive intervention. In this context, plasma biomarkers may have potential to improve predicting performance
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