Blood and urinary cytokine balance and renal outcomes at cardiac surgery

• Published in: BMC nephrology Vol. 22; no. 1; p. 406
• Main Authors: McBride, William T, Kurth, Mary Jo, Domanska, Anna, Watt, Joanne, McLean, Gavin, Joseph, Jijin, Lamont, John V, Fitzgerald, Peter, Ruddock, Mark W
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.12.2021; BioMed Central; BMC
• Subjects: Acute kidney injury; Acute Kidney Injury - blood; Acute Kidney Injury - urine; Acute renal failure; Aged; Biomarkers; Biomarkers - blood; Biomarkers - urine; Blood; Cardiac surgery; Cardiac Surgical Procedures; Causes of; Complications; Cytokines; Cytokines - blood; Cytokines - urine; Diabetes; Fatty acid-binding protein; Female; Health aspects; Heart; Heart surgery; Humans; Hypotheses; IL-1RA; Inflammation; Interleukin 1 receptor antagonist; Interleukin 1 receptors; Interleukin 12; Interleukin 6; Interleukin 8; IP-10 protein; Ischemia; Kidney diseases; Laboratories; Male; Middle Aged; Nephrology; Patients; Plasma; Postoperative Complications - blood; Postoperative Complications - urine; Prevention; Proteins; Reperfusion; Risk factors; Statistical analysis; Surgery; TNFsr2; Tumor necrosis factor-TNF; Tumor necrosis factor-α; Urine; Vascular endothelial growth factor; United Kingdom; United Kingdom > UK; Northern Ireland; IL-1RA; Cytokines; TNFsr2; IL-12p40; Acute kidney injury; Biomarkers; H-FABP; Cardiac surgery; Midkine
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-021-02621-6

Increased perioperative pro-inflammatory biomarkers, renal hypoperfusion and ischemia reperfusion injury (IRI) heighten cardiac surgery acute kidney injury (CS-AKI) risk. Increased urinary anti-inflammatory cytokines attenuate risk. We evaluated whether blood and urinary anti-inflammatory biomarkers, when expressed as ratios with biomarkers of inflammation, hypoperfusion and IRI are increased in CS-AKI patients. Preoperative and 24-h postoperative blood and urinary pro-inflammatory and anti-inflammatory cytokines, blood VEGF and H-FABP (hypoperfusion biomarkers), and MK, a biomarker for IRI, were measured in 401 cardiac surgery patients. Pre- and postoperative concentrations of biomarkers and selected ratios thereof, were compared between non-CS-AKI and CS-AKI patients. Compared with non-CS-AKI, blood pro-inflammatory (pre- and post-op TNFα, IP-10, IL-12p40, MIP-1α, NGAL; pre-op IL-6; post-op IL-8, MK) and anti-inflammatory (pre- and post-op sTNFsr1, sTNFsr2, IL-1RA) biomarkers together with urinary pro-inflammatory (pre- and post-op uIL-12p40; post-op uIP-10, uNGAL) and anti-inflammatory (pre- and post-op usTNFsr1, usTNFsr2, uIL-1RA) biomarkers, were significantly higher in CS-AKI patients. Urinary anti-inflammatory biomarkers, when expressed as ratios with biomarkers of inflammation (blood and urine), hypoperfusion (blood H-FABP and VEGF) and IRI (blood MK) were decreased in CS-AKI. In contrast, blood anti-inflammatory biomarkers expressed as similar ratios with blood biomarkers were increased in CS-AKI. The urinary anti-inflammatory response may protect against the injurious effects of perioperative inflammation, hypoperfusion and IRI. These finding may have clinical utility in bioprediction and earlier diagnosis of CS-AKI and informing future therapeutic strategies for CS-AKI patients.