Growth Differentiation Factor-15 GDF-15 Levels Are Associated with Cardiac and Renal Injury in Patients Undergoing Coronary Artery Bypass Grafting with Cardiopulmonary BypassReportar como inadecuado




Growth Differentiation Factor-15 GDF-15 Levels Are Associated with Cardiac and Renal Injury in Patients Undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Objective

Growth differentiation factor-15 GDF-15 has been identified as a strong marker of cardiovascular disease; however, no data are available concerning the role of GDF-15 in the occurrence of organ dysfunction during coronary artery bypass grafting CABG associated with cardiopulmonary bypass CPB.

Methods

Five arterial blood samples were taken sequentially in 34 patients from anesthesia induction IND until 24 h after arrival at the intensive care unit ICU. Plasma levels of GDF-15, follistatin-like 1 FLST1, myeloperoxidases MPO, hydroperoxides and plasma antioxidant status PAS were measured at each time-point. Markers of cardiac cardiac-troponin I, cTnI and renal dysfunction neutrophil gelatinase-associated lipocalin, NGAL and other classical biological factors and clinical data were measured.

Results

Plasma GDF-15 levels increased gradually during and after surgery, reaching nearly three times the IND levels in the ICU 3,075±284 ng-L vs. 1,061±90 ng-L, p<0.001. Plasma MPO levels increased dramatically during surgery, attaining their highest level after unclamping UNCLAMP 49±11 ng-mL vs. 1,679±153 ng-mL, p<0.001 while PAS significantly decreased between IND and UNCLAMP p<0.05, confirming the high oxidative status induced by this surgical procedure. ICU levels of GDF-15 correlated positively with cTnI and NGAL p = 0.006 and p = 0.036, respectively, and also with hemoglobin and estimated glomerular filtration rate eGFR. Among all the post-operative biomarkers available, only eGFR, NGAL and GDF-15 measured at ICU arrival were significantly associated with the onset of acute kidney injury AKI. Patients with a EuroSCORE >3 were shown to have higher GDF-15 levels.

Conclusions

During cardiac surgery associated with CPB, GDF-15 levels increased substantially and were associated with markers of cardiac injury and renal dysfunction.



Autor: Abdelkader Kahli, Charles Guenancia, Marianne Zeller, Sandrine Grosjean, Karim Stamboul, Luc Rochette, Claude Girard, Catherine V

Fuente: http://plos.srce.hr/



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