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Early biomarkers may predict organ injury following cardiac surgery

Thursday, October 16 2008 | Comments

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What's This? By David MacDougall

Levels of inflammatory cytokines and neutrophil-gelatinase-associated lipocalin (NGAL) measured several hours after complex cardiac surgery identify patients at increased risk of postoperative pulmonary and multi-organ failure, new findings suggest.

Levels of NGAL, an early biomarker for renal injury, and multiple cytokines were measured at baseline and at 1, 6, and 24 hours postoperatively in 38 patients who underwent cardiac valve or thoracic aorta operations. Correlations were examined between NGAL and cytokine levels and patient outcomes including acute renal injury, pulmonary failure (defined as >48 hours of intubation), multiple organ failure, and intensive care unit (ICU) and hospital lengths of stay.

At 1 hour after surgery, the quartile of patients with the greatest increase in interleukin-6 (IL-6) levels from baseline also had the greatest increase in serum NGAL (145%) compared to patients in the lowest IL-6 quartile (68%; P=.05). Among the quartile of patients with the greatest 1-hour postoperative IL-6 response, 70% developed acute renal injury.

At 6 hours after surgery, the quartile of patients with the greatest increase in interleukin-10 (IL-10) levels from baseline had a significantly larger increase in serum NGAL (104%) compared to those in the lowest IL-10 quartile (19%; P=.01).

Compared to patients in the lowest IL-6 quartile at 6 hours after surgery, those in the highest IL-6 quartile had significantly higher rates of pulmonary failure (P=.009) and significantly longer lengths of ICU (P=.03) and hospital (P=.06) stays. Compared to patients in the lowest IL-10 quartile at 6 hours after surgery, those in the highest IL-10 quartile had significantly higher rates of pulmonary failure (P=.01), median time to extubation (P=.004), rates of multi-organ failure (P=.04), and longer lengths of ICU (P=.03) and hospital (P=.001) stays.

"NGAL and inflammatory biomarkers were elevated hours following surgery in those patients who developed increased kidney and pulmonary failure," the researchers concluded. "Timely identification of patients at risk for organ injury may allow for early intervention and reduce resource utilization." (Kim T, et al. Part of: Surgical Forum 7: Cardiothoracic Surgery I)

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