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Thorac Cardiovasc Surg 2021; 69(06): 542-547
DOI: 10.1055/s-0041-1730450
Original Cardiovascular

CIRP Secretion during Cardiopulmonary Bypass Is Associated with Increased Risk of Postoperative Acute Kidney Injury

Wenyan Liu
2   Department of Blood Purification, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
,
Yang Yan
1   Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
,
Dan Han
1   Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
,
Yongxin Li
1   Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
,
Qian Wang
3   Department of Operation and Anesthesia, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
,
Jing Li
1   Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
,
Fengfeng Liu
1   Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
,
Xinglong Zheng 
1   Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
› Author Affiliations Funding This study was supported by grants from National Natural Science Foundation of China (No. 81800581), Natural Science Basic Research Program of Shaanxi (No. 2019JQ-952), Fundamental Research Funds for the Central Universities (No. xjj2018276), and Institutional Foundation of the University (2019QN-17).
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Abstract

Background Systemic inflammation contributes to cardiac surgery–associated acute kidney injury (AKI). Cardiomyocytes and other organs experience hypothermia and hypoxia during cardiopulmonary bypass (CPB), which induces the secretion of cold-inducible RNA-binding protein (CIRP). Extracellular CIRP may induce a proinflammatory response.

Materials and Methods The serum CIRP levels in 76 patients before and after cardiac surgery were determined to analyze the correlation between CIRP levels and CPB time. The risk factors for AKI after cardiac surgery and the in-hospital outcomes were also analyzed.

Results The difference in the levels of CIRP (ΔCIRP) after and before surgery in patients who experienced cardioplegic arrest (CA) was 26-fold higher than those who did not, and 2.7-fold of those who experienced CPB without CA. The ΔCIRP levels were positively correlated with CPB time (r = 0.574, p < 0.001) and cross-clamp time (r = 0.54, p < 0.001). Multivariable analysis indicated that ΔCIRP (odds ratio: 1.003; 95% confidence interval: 1.000–1.006; p = 0.027) was an independent risk factor for postoperative AKI. Patients who underwent aortic dissection surgery had higher levels of CIRP and higher incidence of AKI than other patients. The incidence of AKI and duration of mechanical ventilation in patients whose serum CIRP levels more than 405 pg/mL were significantly higher than those less than 405 pg/mL (65.8 vs. 42.1%, p = 0.038; 23.1 ± 18.2 vs. 13.8 ± 9.2 hours, p = 0.007).

Conclusion A large amount of CIRP was released during cardiac surgery. The secreted CIRP was associated with the increased risk of AKI after cardiac surgery.

Keywords

acute kidney injury - CIRP - cardiac surgery - inflammation

Ethics Approval and Consent to Participate

This study was approved by the ethics committee of the university. The research conformed to the Declaration of Helsinki, and the written informed consent was obtained from all patients prior to the study.




Publication History

Received: 13 January 2021

Accepted: 30 March 2021

Article published online:
07 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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