The role of plasma gelsolin in cardiopulmonary bypass induced acute lung injury in infants and young children: a pilot study

BMC Anesthesiology

ShanShan Shi²  Chi Chen³  DongYan Zhao³  XiWang Liu³  BaoLi Cheng¹  ShuiJing Wu¹  Ru Lin³  LinHua Tan²  XiangMing Fang¹  Qiang Shu³ 

[1] Department of Anesthesiology, the First Affiliated Hospital, Medical College, Zhejiang University, No. 79, Qingchun Road, Hangzhou 310003, P R China

[2] Surgical Intensive Care Unit, Children’s Hospital, Medical College, Zhejiang University, No. 57, Zhugan Lane, Hangzhou 310003, P R China

[3] Department of Thoracic & Cardiovascular Surgery, Children’s Hospital, Medical College, Zhejiang University, and Zhejiang Key Laboratory for Diagnosis and Therapy of Neonatal Diseases, No. 57, Zhugan Lane, Hangzhou 310003, P R China

关键词: Congenital heart disease;    Young children;    Infant;    Cardiopulmonary bypass;    Cardiac surgery;    Acute lung injury;    Plasma gelsolin;   

Others  :  1084508
DOI  :  10.1186/1471-2253-14-67

 received in 2013-07-15, accepted in 2014-07-30,  发布年份 2014

【 摘 要 】

Background

Acute 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.

Methods

Seventy-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).

Results

Twenty-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 (pGSN_N) 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); PGSN_N 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).

Conclusions

Patients 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.

【 授权许可】

   
2014 Shi et al.; licensee BioMed Central Ltd.

【 图 表 】

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