The online version of this article (doi:10.1186/1471-2253-14-67) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
SSS participated in the design of the study and drafted the manuscript. CC and SJW collected the clinical data and blood samples of the patients, and helped to draft the manuscript. DYZ carried out the statistical analysis and helped to draft the manuscript. BLC and XWL carried out the ELISA test. RL and LHT participated in the design of the study and coordination and helped to draft the manuscript. QS and XMF participated in the design of the study and critical revision of the article for the important content. All authors had read and approved the final manuscript.
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.
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).
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 (pGSNN) 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); PGSNN 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).
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.
Kwiatkowski DJ, Mehl R, lzumo S, Nadal-Ginard B, Yin HL: Muscle is the major source of plasma gelsolin. J Biol Chem. 1988, 263: 8239-8243. PubMed
Matsuoka Y, Saito M, LaFrancois J, Saito M, Gaynor K, Olm V, Wang L, Casey E, Lu Y, Shiratori C, Lemere C, Duff K: Novel therapeutic approach for the treatment of Alzheimer's disease by peripheral administration of agents with an affinity to beta-amyloid. J Neurosci. 2003, 23: 29-33. PubMed
Di Nubile MJ, Stossel TP, Ljunghusen OC, Ferrara JL, Antin JH: Prognostic implications of declining plasma gelsolin levels after allogeneic stem cell transplantation. Blood. 2002, 100: 4367-4371. 10.1182/blood-2002-06-1672. CrossRef
Hatakeyama N, Matsuda N: Mechanisms of Inflammatory Response and Organ Dysfunction: Organ-Protective Strategy by Anesthetics. Curr Pharm Des. 2014, doi:10.2174/1381612820666140204105229
Vlaar AP, Hofstra JJ, Determann RM, Veelo DP, Paulus F, Levi M, Zeerleder S, Vroom MB, Schultz MJ, Juffermans NP: Transfusion-related acute lung injury in cardiac surgery patients is characterized by pulmonary inflammation and coagulopathy: A prospective nested case–control study. Crit Care Med. 2012, 40: 2813-2820. CrossRefPubMed
Sievers H, Freand K, Eleftheriadis S, Fischer T, Kuppe H, Kraatz EG, Bechtel JF: Lung protection during total cardiopulmonary bypass byisolated lung perfusion: result sofanovel perfusions tratery. Ann Thorac Surg. 2003, 76: 516-521. 10.1016/S0003-4975(03)00347-3. CrossRef
Suzuki T: Additional lung-protective perfusion techniques during cardiopulmonary bypass. Ann Thorac Cardiovasc Surg. 2010, 16: 150-155. PubMed
- The role of plasma gelsolin in cardiopulmonary bypass induced acute lung injury in infants and young children: a pilot study
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