Abstract
BackgroundAcute lung injury (ALI) induced by cardiopulmonary bypass (CPB, CPB-ALI) is a common and serious complication after cardiac surgery. And infants and young children are more prone to CPB-ALI. The purpose of this study was to investigate the perioperative changes of plasma gelsolin (pGSN) in patients below 3years of age with cardiac surgeries and CPB, and determine whether pGSN are associated with the occurrence and severity of CPB-ALI.MethodsSeventy-seven consecutive patients ≤3 years of age with congenital heart diseases (CHD) performed on open heart surgery with CPB were finally enrolled, and assigned to ALI and non-ALI groups according to the American-European Consensus Criteria. Plasma concentrations of gelsolin and total protein were measured at following 8 time points: before CPB (a), after CPB (b), 2 hours after CPB (c), 6 hours after CPB (d), 12 hours after CPB (e), 24 hours after CPB (f), 48 hours after CPB (g) and 72 hours after CPB (h).ResultsTwenty-seven (35.1%) patients developed CPB-ALI in the study, including eleven (14.3%) patients with ARDS. The earliest significant drop of pGSN and normalized pGSN (pGSNN) of ALI group both occurred at 6 hours after CPB (p = 0.04 and p < 0.01), which was much earlier than those of non-ALI group (48 hours, p = 0.03 and 24 hours, p < 0.01); PGSN of ALI group before CPB and 6 hours after CPB were both significantly lower than those of non-ALI group (p < 0.01); PGSNN of ALI group before CPB and 6 hours after CPB were both significantly lower than those of non-ALI group (p < 0.01, p = 0.04); PGSN before CPB was the only independent risk factor predicting the occurrence of CPB-ALI (OR, 1.023; 95% CI, 1.007-1.039; p < 0.01) with an AUC of 0.753 (95% CI, 0.626-0.880); The optimal cutoff value of pGSN before CPB was 264.2 mg/L, with a sensitivity of 58.3% and a specificity 94.7%. And lower pGSN before CPB was significantly associated with the severity of CS-AKI (r = −0.45, p < 0.01).ConclusionsPatients developing CPB-ALI had lower plasma gelsolin reservoir and a much more amount and rapid consumption of plasma gelsolin early after operation. PGSN before CPB was an early and sensitive predictor of CPB-ALI in infants and young children undergoing cardiac surgery, and was negatively correlated with the severity of CPB-ALI.
Highlights
Acute lung injury (ALI) induced by cardiopulmonary bypass (CPB, CPB-ALI) is a common and serious complication after cardiac surgery
Acute lung injury induced by cardiopulmonary bypass, a common and serious complication in patients undergoing cardiac surgery necessitating CPB, may impair both lung mechanics and gas exchange, and becomes an important factor of morbidity and mortality after surgery [1,2]. 2% of those patients may develop into acute respiratory distress syndrome (ARDS) resulting in a mortality of 15% to 50% [3]
The purpose of this study was to investigate the perioperative changes of plasma gelsolin (pGSN) level in patients below 3 years of age undergoing cardiac surgeries with CPB, and determine whether pGSN levels are associated with the occurrence and severity of CPB-ALI
Summary
Acute lung injury (ALI) induced by cardiopulmonary bypass (CPB, CPB-ALI) is a common and serious complication after cardiac surgery. Emerging data have demonstrated that pGSN, as an inflammatory mediator-binding protein, functions as a lipid carrier with strong binding affinity to several plasma lipids such as lipopolysaccharide exdotxin, lipoteichoic acid, lysophosphatidic acid, β-amyloid peptide and platelet-activating factor, etc., and plays a role in localizing inflammation and prevent systemic escape of pro-inflammatory lipids [9,10,11,12] Consistent with these proposed functions, declining pGSN level has be proved to be associated with a variety of acute clinical conditions, such as sepsis, myocardial infarction, major trauma, burn, allogeneic stem cell transplantation and acute liver injury, etc. PGSN levels are inversely related to the clinical outcome under these conditions [13,14,15,16,17,18]
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