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Ischemia-modified albumin and adenosine plasma concentrations are associated with severe systemic inflammatory response syndrome after cardiopulmonary bypass.


J Crit Care. 2013 Apr 29;


Authors: Nee L, Giorgi R, Garibaldi V, Bruzzese L, Blayac D, Fromonot J, Kipson N, Bellezza M, Lejeune PJ, Guieu R, Kerbaul F


Abstract

PURPOSE: Severe systemic inflammatory response syndrome (SIRS) occurring after cardiopulmonary bypass (CPB) is a common cause of mortality during cardiac surgery. These syndromes are characterized by vasoplegia and ischemia-reperfusion phenomenom. Adenosine is a strong endogenous vasodilating agent, which may be involved in blood pressure failure during CPB induced by severe SIRS. Ischemia-modified albumin (IMA) is considered as a sensitive marker of tissue ischemia. We examined whether the IMA or adenosine plasma concentrations (APCs) change during a severe SIRS-induced blood pressure failure during CPB. MATERIALS AND METHODS: Plasma concentration and IMA (median [range]) were measured before, during, and after surgery in 86 patients who underwent coronary revascularization under CBP and were correlated to postoperative clinical course. RESULTS: Preoperative APC values (1.45 [0.52-2.11] μmol L(-1) vs 0.36 [0.12-0.66] μmol L(-1)) and IMA (144 [91-198] IU mL(-1) vs 109 [61-183] U mL(-1)) were significantly increased in patients presenting postoperative severe SIRS. Mean durations of mechanical ventilation, stay in the intensive care unit, and requirement of vasoactive drugs were significantly higher in patients with higher APC and IMA, but APC was the best predictive marker a postoperative severe. CONCLUSIONS: Adenosine plasma concentration and IMA concentration are associated with postoperative severe SIRS after CPB.

PMID: 23639429 [PubMed - as supplied by publisher]