Degradation of endothelial glycocalyx (EG) is associated with inflammation and endothelial dysfunction, which may contribute to the development of acute kidney injury (AKI). We investigated the association between a marker of EG degradation and AKI after valvular heart surgery. Serum syndecan-1 concentrations were measured at induction of anesthesia and discontinuation of cardiopulmonary bypass in 250 patients. Severe AKI was defined as Kidney Disease: Improving Global Outcomes Criteria Stage 2 or 3. Severe AKI occurred in 13 patients (5%). Receiver operating characteristic analysis of preoperative syndecan-1 to predict severe AKI showed area under curve of 0.714 (95% confidence interval (CI), 0.575-0.853; p = 0.009). The optimal cut-off value was 90 ng/mL, with a sensitivity of 61.5% and specificity of 78.5%. In multivariable analysis, both preoperative syndecan-1 ≥ 90 ng/mL and Cleveland Clinic Foundation score independently predicted severe AKI. Severe tricuspid regurgitation was more frequent (42.4% vs. 17.8%, p < 0.001), and baseline right ventricular systolic pressure (41 (33-51) mmHg vs. 33 (27-43) mmHg, p = 0.001) and TNF-α (1.85 (1.37-2.43) pg/mL vs. 1.45 (1.14-1.92) pg/mL, p <0.001) were higher in patients with high preoperative syndecan-1. Patients with high preoperative syndecan-1 had longer hospital stay (16 (12-24) days vs. 13 (11-17) days, p = 0.001). In conclusion, a high preoperative syndecan-1 concentration greater than 90 ng/mL was able to predict severe AKI after valvular heart surgery and was associated with prolonged hospitalization.

译文

:内皮糖萼(EG)的降解与炎症和内皮功能障碍有关,这可能有助于急性肾损伤(AKI)的发展。我们研究了心脏瓣膜手术后EG降解标志物与AKI之间的关联。在250例患者中,在诱导麻醉和停止体外循环时测量了血清syndecan-1的浓度。严重的AKI被定义为肾脏疾病:改善第2阶段或第3阶段的总体结果标准。严重的AKI发生在13例患者中(5%)。术前syndecan-1的接受者操作特征分析可预测严重AKI,显示曲线下面积为0.714(95%置信区间(CI),0.575-0.853; p = 0.009)。最佳临界值为90 ng / mL,灵敏度为61.5%,特异性为78.5%。在多变量分析中,术前syndecan-1≥90 ng / mL和Cleveland Clinic Foundation评分均独立预测严重AKI。严重的三尖瓣关闭不全更为频繁(42.4%vs. 17.8%,p <0.001),基线右室收缩压(41(33-51)mmHg vs. 33(27-43)mmHg,p = 0.001)和TNF-具有高术前syndecan-1的患者的α(1.85(1.37-2.43)pg / mL与1.45(1.14-1.92)pg / mL,p <0.001)更高。术前Syndecan-1高的患者住院时间更长(16(12-24)天,而13(11-17)天,p = 0.001)。总之,术前高浓度syndecan-1大于90 ng / mL能够预测心脏瓣膜手术后的严重AKI并与长期住院相关。

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