מתוך medicontext.co.il
By Joene Hendry
WESTPORT, CT (Reuters Health) – Low serum endotoxin core antibody titers prior to cardiopulmonary bypass surgery are associated with a greater incidence of acute renal injury, as indicated by a greater post-operative rise in fractional creatinine, Dr. Mark Stafford-Smith reports.
Dr. Stafford-Smith and colleagues at Duke University Medical Center in Durham, North Carolina analyzed the correlation between pre-surgical endotoxin antibody levels and post-surgical creatinine levels in the blood of 461 patients undergoing elective cardiac surgery. Dr. Stafford-Smith presented the findings Tuesday at the American Society of Anesthesiologists meeting in New Orleans.
"Most things that are known to increase the risk of heart surgery and related kidney injury are either linked to the magnitude of the actual surgery itself…or another coexisting medical condition," Dr. Stafford-Smith noted in an interview with Reuters Health. The new findings pertain to "an 'immunity' that is unrelated to either group of factors we commonly associate with changing risk," he pointed out.
The researchers report that creatinine levels increased 31.3% from baseline to peak post-surgery levels in the 279 patients with low antibody levels (at or below 80 international units per milliliter). Creatinine levels increased by only 20.9% in the 182 patients with high antibody levels, a statistically significant difference.
The association between low preoperative titers of serum endotoxin core antibody and postoperative creatinine rise was independent of factors such as age, gender and diabetes. "The high or low levels of the antibody do not have any important relation to other conditions," Dr. Stafford-Smith reported, noting that this represents "a new way of looking at risk for complications after surgery."
"The hope is that this will lead to a treatment that will protect the kidneys and improve outcome after heart surgery," he said. "Potential approaches include boosting immunity before surgery, or finding other ways such as drugs to reduce the circulating endotoxin."
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