Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjane.2019.03.005
Brazilian Journal of Anesthesiology
Scientific Article

Predictive value of plasma cytokines for acute kidney injury following lung resection surgery: prospective observational study

Valor preditivo das citocinas plasmáticas para lesão renal aguda após cirurgia de ressecção pulmonar: estudo observacional prospectivo

Cristina Monteserín Matesanz; Francisco de la Gala; Lisa Rancan; Patricia Piñeiro; Carlos Simón; Alberto Tejedor; Elena Vara; Jorge L. Gonzalez-Cantero; Ignacio Garutti

http://dx.doi.org/10.1016/j.bjane.2019.03.005 Braz J Anesthesiol, vol.69, n3, p.242-252, 2019
PDF English
PDF Português
Downloads: 0
Views: 910

Abstract

Abstract Background and objectives: Patients undergoing lung resection surgery are at risk of developing postoperative acute kidney injury. Determination of cytokine levels allows the detection of an early inflammatory response. We investigated any temporal relationship among perioperative inflammatory status and development of acute kidney injury after lung resection surgery. Furthermore, we evaluated the impact of acute kidney injury on outcome and analyzed the feasibility of cytokines to predict acute kidney injury. Methods: We prospectively analyzed 174 patients scheduled for elective lung resection surgery with intra-operative periods of one-lung ventilation periods. Fiberoptic broncho-alveolar lavage was performed in each lung before and after one-lung ventilation periods for cytokine analysis. As well, cytokine levels were measured from arterial blood samples at five time points. acute kidney injury was diagnosed within 48 h of surgery based on acute kidney injury criteria. We analyzed the association between acute kidney injury and cardiopulmonary complications, length of intensive care unit and hospital stays, intensive care unit re-admission, and short-term and long-term mortality. Results: The incidence of acute kidney injury in our study was 6.9% (12/174). Acute kidney injury patients showed higher plasma cytokine levels after surgery but differences in alveolar cytokines were not detected. Although no patient required renal replacement therapy, acute kidney injury patients had higher incidence of cardiopulmonary complications and increased overall mortality. Plasma interleukin-6 at 6 h was the most predictive cytokine of acute kidney injury (cut-off point at 4.89 pg.mL-1). Conclusions: Increased postoperative plasma cytokine levels are associated with acute kidney injury after lung resection surgery in our study, which worsens the prognosis. Plasma interleukin-6 may be used as an early indicator for patients at risk of developing acute kidney injury after lung resection surgery.

Keywords

Acute kidney injury, Lung resection surgery, One-lung ventilation, Inflammation, Cytokines, Interleukin-6

Resumo

Resumo Justificativa e objetivos: Os pacientes submetidos à cirurgia de ressecção pulmonar apresentam risco de desenvolver lesão renal aguda pós-operatória. A determinação dos níveis de citocinas permite detectar uma resposta inflamatória precoce. Investigamos a relação temporal entre o estado inflamatório perioperatório e o desenvolvimento de lesão renal aguda após cirurgia de ressecção pulmonar. Além disso, avaliamos o impacto da lesão renal aguda no desfecho e analisamos a viabilidade das citocinas para prever este tipo de lesão. Métodos: No total, foram analisados prospectivamente 174 pacientes agendados para cirurgia eletiva de ressecção pulmonar com períodos intraoperatórios de ventilação monopulmonar. Lavado bronco-alveolar com fibra óptica foi realizado em cada pulmão antes e após os períodos de ventilação monopulmonar para análise das citocinas. Os níveis de citocina foram medidos a partir de amostras de sangue arterial em cinco momentos. A lesão renal aguda foi diagnosticada dentro de 48 horas após a cirurgia, com base nos critérios para sua verificação. Analisamos a associação entre lesão renal aguda e complicações cardiopulmonares, tempo de internação em unidade de terapia intensiva e de internação hospitalar, reinternação em unidade de terapia intensiva e mortalidade a curto e longo prazos. Resultados: A incidência de lesão renal aguda no estudo foi de 6,9% (12/174). Os pacientes com lesão renal aguda apresentaram níveis mais altos de citocinas plasmáticas após a cirurgia, mas não foram detectadas diferenças nas citocinas alveolares. Embora nenhum paciente tenha precisado de terapia renal substitutiva, os com lesão renal aguda apresentaram maior incidência de complicações cardiopulmonares e aumento da mortalidade geral. A interleucina-6 plasmática em seis horas foi a citocina mais preditiva de lesão renal aguda (ponto de corte em 4,89 pg.mL-1). Conclusões: O aumento dos níveis plasmáticos de citocinas no pós-operatório está associado à lesão renal aguda após cirurgia de ressecção pulmonar no estudo, o que piora o prognóstico. A interleucina-6 plasmática pode ser usada como um indicador precoce para pacientes com risco de desenvolver lesão renal aguda após cirurgia de ressecção pulmonar.

Palavras-chave

Lesão renal aguda, Cirurgia de ressecção pulmonar, Ventilação monopulmonar, Inflamação, Citocinas, Interleucina-6

References

Licker M, Cartier V, Robert J. Risk factors of acute kidney injury according to RIFLE criteria after lung cancer surgery. Ann Thorac Surg. 2011;91:844-50.

Ishikawa S, Griesdale DEG, Lohser J. Acute kidney injury after lung resection surgery. Anesth Analg. 2012;114:1256-62.

Ahn HJ, Kim JA, Lee AR. The risk of acute kidney injury from fluid restriction and hydroxyethyl starch in thoracic surgery. Anesth Analg. 2016;122:186-93.

Amar D, Zhang H, Park B. Inflammation and outcome after general thoracic surgery. Eur J Cardio-Thoracic Surg. 2007;32:431-4.

Nechemia-Arbely Y, Barkan D, Pizov G. IL-6/IL-6R axis plays a critical role in acute kidney injury. J Am Soc Nephrol. 2008;19:1106-15.

McBride WT, Armstrong MA, McBride SJ. Immunomodulation: an important concept in modern anaesthesia. Anaesthesia. 1996;51:465-73.

de la Gala F, Piñeiro P, Reyes I. Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomized controlled trial comparing intravenous and inhalational anaesthesia. Br J Anaesth. 2017;119:655-63.

Mehta RL, Kellum JA, Shah SV. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.

Takenaka K, Ogawa E, Wada H. Systemic inflammatory response syndrome and surgical stress in thoracic surgery. J Crit Care. 2006;21:48-53.

Breunig A, Gambazzi F, Beck-Schimmer B. Cytokine and chemokine response in the lungs, pleural fluid and serum in thoracic surgery using one-lung ventilation. J Inflamm. 2011;8:32.

de la Gala F, Piñeiro P, Garutti I. Systemic and alveolar inflammatory response in the dependent and nondependent lung in patients undergoing lung resection surgery. Eur J Anaesthesiol. 2015;32:872-80.

Sakamoto K, Arakawa H, Mita S. Elevation of circulating interleukin 6 after surgery: factors influencing the serum level. Cytokine. 1994;6:181-6.

Mårtensson J, Bellomo R. Sepsis-induced acute kidney injury. Crit Care Clin. 2015;31:649-60.

Andres-Hernando A, Dursun B, Altmann C. Cytokine production increases and cytokine clearance decreases in mice with bilateral nephrectomy. Nephrol Dial Transplant. 2012;27:4339-47.

Liu KD, Glidden DV, Eisner MD. Predictive and pathogenetic value of plasma biomarkers for acute kidney injury in patients with acute lung injury. Crit Care Med. 2007;35:2755-61.

Greenberg JH, Whitlock R, Zhang WR. Interleukin-6 and interleukin-10 as acute kidney injury biomarkers in pediatric cardiac surgery. Pediatr Nephrol. 2015;30:1519-27.

Zhang WR, Garg AX, Coca SG. Plasma IL-6 and IL-10 concentrations predict AKI and long-term mortality in adults after cardiac surgery. J Am Soc Nephrol. 2015;26:3123-32.

Zakrzewski D, Janas J, Heretyk H. Inflammatory response and postoperative kidney failure in patients with diabetes type 2 or impaired glucose tolerance undergoing heart valve surgery. Kardiol Pol. 2010;68:530-6.

Gonsowski CT, Laster MJ, Eger EI. Toxicity of compound A in rats. Effect of increasing duration of administration. Anesthesiology. 1994;80:566-73.

Bennet SJ, Berry OMB, Goddard J. Acute renal dysfunction following hip fracture. Injury. 2010;41:335-8.

Kheterpal S, Tremper KK, Heung M. Development and validation of an acute kidney injury risk index for patients undergoing general surgery: results from a national data set. Anesthesiology. 2009;110:505-15.

Kim MY, Jang HR, Huh W. Incidence, risk factors, and prediction of acute kidney injury after off-pump coronary artery bypass grafting. Ren Fail. 2011;33:316-22.

Calvert S, Shaw A. Perioperative acute kidney injury. Perioper Med (London, England). 2012;1:6.

Abelha F, Botelho M, Fernandes V. Determinants of postoperative acute kidney injury. Crit Care. 2009;13:R79.

Fink-Neuboeck N, Lindenmann J, Bajric S. Clinical impact of interleukin 6 as a predictive biomarker in the early diagnosis of postoperative systemic inflammatory response syndrome after major thoracic surgery: a prospective clinical trial. Surgery. 2016;160:443-53.

5dc5674a0e8825735b593254 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections