High-Density Lipoprotein Anti-Inflammatory Capacity and Acute Kidney Injury After Cardiac and Vascular Surgery: A Prospective Observational Study.

Autor:	Perkins ZM; Alabama College of Osteopathic Medicine, Dothan, AL., Smith DK; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN., Yancey PG; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN., Linton MF; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.; Department of Pharmacology, Vanderbilt University, Nashville, TN., Smith LE; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2024 Oct 15. Date of Electronic Publication: 2024 Oct 15.
DOI:	10.1097/CCM.0000000000006440
Abstrakt:	Objectives: Acute kidney injury (AKI) predicts death after cardiac and vascular surgery. Higher preoperative high-density lipoprotein (HDL) concentrations are associated with less postoperative AKI. In animals, HDL's anti-inflammatory capacity to suppress endothelial cell adhesion molecule expression reduces kidney damage due to ischemia and hemorrhagic shock. The objective of this study is to evaluate the statistical relationship between HDL anti-inflammatory capacity and AKI after major cardiac and vascular surgery. Design: Prospective observational study. Setting: Quaternary medical center. Patients: One hundred adults with chronic kidney disease on long-term statin therapy undergoing major elective cardiac and vascular surgery. Interventions: None. Measurements and Main Results: Apolipoprotein B-depleted serum collected at anesthetic induction was incubated with tumor necrosis factor alpha stimulated human endothelial cells. Reverse transcriptase-polymerase chain reaction was used to measure intercellular adhesion molecule-1 (ICAM-1) messenger RNA. Enzyme-linked immunosorbent assay assays were used to measure apolipoprotein A-I and postoperative soluble ICAM-1 concentrations in patient plasma. HDL concentration did not correlate with HDL ICAM-1 suppression capacity (Spearman R = 0.05; p = 0.64). Twelve patients (12%) were found to have dysfunctional, pro-inflammatory HDL. Patients with pro-inflammatory HDL had a higher rate of postoperative AKI than patients with anti-inflammatory HDL (p = 0.046). After adjustment for AKI risk factors, a higher preoperative HDL capacity to suppress endothelial ICAM-1 was independently associated with lower odds of AKI (odds ratio, 0.88; 95% CI, 0.80-0.98; p = 0.016). The association between HDL anti-inflammatory capacity and postoperative AKI was independent of HDL concentration (p = 0.018). Further, a higher long-term statin dose was associated with higher HDL capacity to suppress endothelial ICAM-1 (p = 0.045). Conclusions: Patients with chronic kidney disease undergoing cardiac and vascular surgery who have dysfunctional, pro-inflammatory HDL have a higher risk of postoperative AKI compared with patients with anti-inflammatory HDL. Conversely, a higher HDL anti-inflammatory capacity is associated with a lower risk of postoperative AKI, independent of HDL concentration. Higher long-term statin dose is associated with higher HDL anti-inflammatory capacity. Competing Interests: Drs. Yancey, Linton, and L. E. Smith received support for article research from the National Institutes of Health (NIH). Dr. Linton’s institution received funding from the National Heart, Lung, and Blood Institute (PO1), Novartis, and Sanofi; he received funding from Regeneron, Ionis, Merck, Patient-Centered Outcomes Research Institute, AMGEN, and REGENXBIO. Dr. L. E. Smith’s institution received funding from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
Databáze:	MEDLINE
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