Preoperative endothelial dysfunction for the prediction of acute kidney injury after cardiac surgery using cardiopulmonary bypass: a pilot study based on a second analysis of the MONS study.

Acute kidney injury Cardiac surgery Cardiopulmonary bypass Endothelium response Microcirculation Postoperative AKI Preoperative assessment

Journal

Perioperative medicine (London, England)
ISSN: 2047-0525
Titre abrégé: Perioper Med (Lond)
Pays: England
ID NLM: 101609072

Informations de publication

Date de publication:
29 Feb 2024
Historique:
received: 07 05 2023
accepted: 13 02 2024
medline: 1 3 2024
pubmed: 1 3 2024
entrez: 29 2 2024
Statut: epublish

Résumé

Up to 42% of patients develop acute kidney injury (AKI) after cardiac surgery. The aim of this study was to describe the relationship between preoperative microcirculatory function and postoperative AKI after cardiac surgery using cardiopulmonary bypass (CPB). The prospective observational cohort MONS enrolled 60 patients scheduled for valvular (n = 30, 50%) or coronary (n = 30, 50%) surgery using CPB. Preoperative microcirculation was assessed during preoperative consultation from January 2019 to April 2019 at the University Hospital of Angers, France, using endothelium-dependent and endothelium-independent reactivity tests on the forearm (iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), respectively). Skin blood flow was measured by laser speckle contrast imaging. The primary endpoint was the occurrence of AKI according to the KDIGO classification during the hospital stay. Forty-three (71.7%) patients developed AKI during the in-hospital follow-up, and 15 (25%) were classified as KDIGO stage 1, 20 (33%) KDIGO stage 2, and 8 (13%) KDIGO stage 3. Regarding preoperative microcirculation, a higher peak amplitude of vasodilation in response to iontophoresis of ACh was found in patients with postoperative occurrence of AKI (35 [20-49] vs 23 [9-44] LSPU, p = 0.04). Iontophoresis of SNP was not significantly different according to AKI occurrence (34 [22-49] vs 36 [20-50] LSPU, p = 0.95). In a multivariable model, the preoperative peak amplitude at iontophoresis of ACh was independently associated with postoperative AKI (OR 1.045 [1.001-1.092], p = 0.045). The preoperative peak amplitude of endothelium-dependent vasodilation is independently associated with the postoperative occurrence of AKI. Clinical-Trials.gov, NCT03631797. Registered 15 August 2018, https://clinicaltrials.gov/ct2/show/NCT03631797.

Sections du résumé

BACKGROUND BACKGROUND
Up to 42% of patients develop acute kidney injury (AKI) after cardiac surgery. The aim of this study was to describe the relationship between preoperative microcirculatory function and postoperative AKI after cardiac surgery using cardiopulmonary bypass (CPB).
METHODS METHODS
The prospective observational cohort MONS enrolled 60 patients scheduled for valvular (n = 30, 50%) or coronary (n = 30, 50%) surgery using CPB. Preoperative microcirculation was assessed during preoperative consultation from January 2019 to April 2019 at the University Hospital of Angers, France, using endothelium-dependent and endothelium-independent reactivity tests on the forearm (iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), respectively). Skin blood flow was measured by laser speckle contrast imaging. The primary endpoint was the occurrence of AKI according to the KDIGO classification during the hospital stay.
RESULTS RESULTS
Forty-three (71.7%) patients developed AKI during the in-hospital follow-up, and 15 (25%) were classified as KDIGO stage 1, 20 (33%) KDIGO stage 2, and 8 (13%) KDIGO stage 3. Regarding preoperative microcirculation, a higher peak amplitude of vasodilation in response to iontophoresis of ACh was found in patients with postoperative occurrence of AKI (35 [20-49] vs 23 [9-44] LSPU, p = 0.04). Iontophoresis of SNP was not significantly different according to AKI occurrence (34 [22-49] vs 36 [20-50] LSPU, p = 0.95). In a multivariable model, the preoperative peak amplitude at iontophoresis of ACh was independently associated with postoperative AKI (OR 1.045 [1.001-1.092], p = 0.045).
CONCLUSIONS CONCLUSIONS
The preoperative peak amplitude of endothelium-dependent vasodilation is independently associated with the postoperative occurrence of AKI.
TRIAL REGISTRATION BACKGROUND
Clinical-Trials.gov, NCT03631797. Registered 15 August 2018, https://clinicaltrials.gov/ct2/show/NCT03631797.

Identifiants

DOI: 10.1186/s13741-024-00364-0 PMID: 38424616
pubmed: 38424616
doi: 10.1186/s13741-024-00364-0
pii: 10.1186/s13741-024-00364-0
doi:

Banques de données

ClinicalTrials.gov
['NCT03631797']

Types de publication

Journal Article

Langues

eng

Pagination

12

Informations de copyright

© 2024. The Author(s).

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Auteurs

Stanislas Abrard (S)

Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5 Pl d'Arsonval, Lyon, 69437, France. Stanislas.abrard@chu-lyon.fr.
MitoVasc Institut, UMR INSERM 1083 ‑ CNRS 6015, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France. Stanislas.abrard@chu-lyon.fr.
Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, Cedex 08, Lyon, 69373, France. Stanislas.abrard@chu-lyon.fr.

Antoine Streichenberger (A)

Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5 Pl d'Arsonval, Lyon, 69437, France.

Jérémie Riou (J)

Department of Methodology and Biostatistics Delegation to Clinical Research and Innovation, Angers University Hospital, 4 Rue Larrey, 49933, Angers, France.
Micro Et Nanomedecines Translationnelles, MINT, UMR INSERM 1066 - CNRS 6021, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France.

Jeanne Hersant (J)

MitoVasc Institut, UMR INSERM 1083 ‑ CNRS 6015, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France.
Department of Vascular Medicine, University Hospital of Angers, 4 Rue Larrey, 49933, Angers, France.

Emmanuel Rineau (E)

MitoVasc Institut, UMR INSERM 1083 ‑ CNRS 6015, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France.
Department of Anesthesiology and Intensive Care, University Hospital of Angers, 4 Rue Larrey, 49933, Angers, France.

Matthias Jacquet-Lagrèze (M)

Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, Cedex 08, Lyon, 69373, France.
CarMeN Laboratory, UMR INSERM 1060, Université Claude Bernard Lyon 1, 59 Bd Pinel, Bron, 69500, France.
Department of Anesthesiology and Intensive Care Medicine, Hospices Civils de Lyon, University Hospital Louis Pradel, 59 Bd Pinel, Bron, 69500, France.

Olivier Fouquet (O)

MitoVasc Institut, UMR INSERM 1083 ‑ CNRS 6015, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France.
Department of Cardiac Surgery, University Hospital of Angers, 4 Rue Larrey, 49933, Angers, France.

Samir Henni (S)

MitoVasc Institut, UMR INSERM 1083 ‑ CNRS 6015, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France.
Department of Vascular Medicine, University Hospital of Angers, 4 Rue Larrey, 49933, Angers, France.

Thomas Rimmelé (T)

Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5 Pl d'Arsonval, Lyon, 69437, France.
Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, Cedex 08, Lyon, 69373, France.
Pathophysiology of Injury-Induced Immunosuppression, EA7426, Hospices Civils de Lyon - BioMérieux - University Claude Bernard Lyon 1, 5 Pl d'Arsonval, Lyon, 69437, France.

Classifications MeSH