Correlating Oxygen Delivery During Cardiopulmonary Bypass With the Neurologic Injury Biomarker Ubiquitin C-Terminal Hydrolase L1 (UCH-L1)

J. Trent Magruder, Charles D. Fraser, Joshua C. Grimm, Todd C. Crawford, Claude A. Beaty, Alejandro Suarez-Pierre, Ronald L. Hayes, Michael V Johnston, William A Baumgartner

Research output: Contribution to journalArticle

Abstract

Objective: The authors sought to assess the relationship between low oxygen delivery (DO2) during cardiopulmonary bypass (CPB) and a neuron-specific biomarker of neurologic injury, ubiquitin C-terminal hydrolase L1 (UCH-L1). Design: Retrospective analysis of patient charts and prospectively collected blood samples. Setting: University-affiliated tertiary care hospital. Participants: Adult patients undergoing cardiac surgery on CPB. Interventions: Serum UCH-L1 levels were drawn at baseline and 6 and 24 hours after CPB cessation. DO2 was computed from perfusion records, with area-under-the-curve (AUC) computations performed to account for distance of DO2 excursions below predefined DO2 thresholds and the amount of time spent below them. Strokes were defined radiographically using computed tomography and magnetic resonance imaging. Measurements and Main Results: Forty-three adults were included (median age 65 y, interquartile range 59-72). Three patients experienced strokes (imaged at 2, 7, and 8 d postoperatively). Most patients underwent isolated coronary artery bypass grafting (41%, 18 patients) or isolated aortic valve replacement (30%, 13). Median UCH-L1 levels differed from baseline to 6 and 24 hours after CPB (40, 232, and 166 pg/mL, respectively; p < 0.001). On multivariable linear regression analysis controlling for baseline and surgical variables, only DO2 AUC <225 was significantly associated with 6-hour UCH-L1 levels (p = 0.001), whereas only DO2 AUC <300 was significantly associated with 24- hour levels (p < 0.001). The 3 patients who experienced radiographic strokes had nonsignificantly elevated 24-hour UCH-L1 levels compared with control patients (585 v 151 pg/mL, p = 0.11). Conclusions: This is the first study to demonstrate an independent association between DO2 during CPB and elevations of a brain injury biomarker; additional study is needed to clarify the clinical significance of these results.

Original languageEnglish (US)
JournalJournal of Cardiothoracic and Vascular Anesthesia
DOIs
StateAccepted/In press - Jan 1 2018

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Ubiquitin Thiolesterase
Nervous System Trauma
Cardiopulmonary Bypass
Biomarkers
Oxygen
Area Under Curve
Stroke
Tertiary Healthcare
Aortic Valve
Tertiary Care Centers
Coronary Artery Bypass
Brain Injuries
Thoracic Surgery
Linear Models
Perfusion
Tomography
Regression Analysis
Magnetic Resonance Imaging
Neurons

Keywords

  • cardiopulmonary bypass
  • ischemia
  • neurologic injury
  • oxygen delivery
  • perfusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Correlating Oxygen Delivery During Cardiopulmonary Bypass With the Neurologic Injury Biomarker Ubiquitin C-Terminal Hydrolase L1 (UCH-L1). / Magruder, J. Trent; Fraser, Charles D.; Grimm, Joshua C.; Crawford, Todd C.; Beaty, Claude A.; Suarez-Pierre, Alejandro; Hayes, Ronald L.; Johnston, Michael V; Baumgartner, William A.

In: Journal of Cardiothoracic and Vascular Anesthesia, 01.01.2018.

Research output: Contribution to journalArticle

Magruder, J. Trent ; Fraser, Charles D. ; Grimm, Joshua C. ; Crawford, Todd C. ; Beaty, Claude A. ; Suarez-Pierre, Alejandro ; Hayes, Ronald L. ; Johnston, Michael V ; Baumgartner, William A. / Correlating Oxygen Delivery During Cardiopulmonary Bypass With the Neurologic Injury Biomarker Ubiquitin C-Terminal Hydrolase L1 (UCH-L1). In: Journal of Cardiothoracic and Vascular Anesthesia. 2018.
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abstract = "Objective: The authors sought to assess the relationship between low oxygen delivery (DO2) during cardiopulmonary bypass (CPB) and a neuron-specific biomarker of neurologic injury, ubiquitin C-terminal hydrolase L1 (UCH-L1). Design: Retrospective analysis of patient charts and prospectively collected blood samples. Setting: University-affiliated tertiary care hospital. Participants: Adult patients undergoing cardiac surgery on CPB. Interventions: Serum UCH-L1 levels were drawn at baseline and 6 and 24 hours after CPB cessation. DO2 was computed from perfusion records, with area-under-the-curve (AUC) computations performed to account for distance of DO2 excursions below predefined DO2 thresholds and the amount of time spent below them. Strokes were defined radiographically using computed tomography and magnetic resonance imaging. Measurements and Main Results: Forty-three adults were included (median age 65 y, interquartile range 59-72). Three patients experienced strokes (imaged at 2, 7, and 8 d postoperatively). Most patients underwent isolated coronary artery bypass grafting (41{\%}, 18 patients) or isolated aortic valve replacement (30{\%}, 13). Median UCH-L1 levels differed from baseline to 6 and 24 hours after CPB (40, 232, and 166 pg/mL, respectively; p < 0.001). On multivariable linear regression analysis controlling for baseline and surgical variables, only DO2 AUC <225 was significantly associated with 6-hour UCH-L1 levels (p = 0.001), whereas only DO2 AUC <300 was significantly associated with 24- hour levels (p < 0.001). The 3 patients who experienced radiographic strokes had nonsignificantly elevated 24-hour UCH-L1 levels compared with control patients (585 v 151 pg/mL, p = 0.11). Conclusions: This is the first study to demonstrate an independent association between DO2 during CPB and elevations of a brain injury biomarker; additional study is needed to clarify the clinical significance of these results.",
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AU - Magruder, J. Trent

AU - Fraser, Charles D.

AU - Grimm, Joshua C.

AU - Crawford, Todd C.

AU - Beaty, Claude A.

AU - Suarez-Pierre, Alejandro

AU - Hayes, Ronald L.

AU - Johnston, Michael V

AU - Baumgartner, William A

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N2 - Objective: The authors sought to assess the relationship between low oxygen delivery (DO2) during cardiopulmonary bypass (CPB) and a neuron-specific biomarker of neurologic injury, ubiquitin C-terminal hydrolase L1 (UCH-L1). Design: Retrospective analysis of patient charts and prospectively collected blood samples. Setting: University-affiliated tertiary care hospital. Participants: Adult patients undergoing cardiac surgery on CPB. Interventions: Serum UCH-L1 levels were drawn at baseline and 6 and 24 hours after CPB cessation. DO2 was computed from perfusion records, with area-under-the-curve (AUC) computations performed to account for distance of DO2 excursions below predefined DO2 thresholds and the amount of time spent below them. Strokes were defined radiographically using computed tomography and magnetic resonance imaging. Measurements and Main Results: Forty-three adults were included (median age 65 y, interquartile range 59-72). Three patients experienced strokes (imaged at 2, 7, and 8 d postoperatively). Most patients underwent isolated coronary artery bypass grafting (41%, 18 patients) or isolated aortic valve replacement (30%, 13). Median UCH-L1 levels differed from baseline to 6 and 24 hours after CPB (40, 232, and 166 pg/mL, respectively; p < 0.001). On multivariable linear regression analysis controlling for baseline and surgical variables, only DO2 AUC <225 was significantly associated with 6-hour UCH-L1 levels (p = 0.001), whereas only DO2 AUC <300 was significantly associated with 24- hour levels (p < 0.001). The 3 patients who experienced radiographic strokes had nonsignificantly elevated 24-hour UCH-L1 levels compared with control patients (585 v 151 pg/mL, p = 0.11). Conclusions: This is the first study to demonstrate an independent association between DO2 during CPB and elevations of a brain injury biomarker; additional study is needed to clarify the clinical significance of these results.

AB - Objective: The authors sought to assess the relationship between low oxygen delivery (DO2) during cardiopulmonary bypass (CPB) and a neuron-specific biomarker of neurologic injury, ubiquitin C-terminal hydrolase L1 (UCH-L1). Design: Retrospective analysis of patient charts and prospectively collected blood samples. Setting: University-affiliated tertiary care hospital. Participants: Adult patients undergoing cardiac surgery on CPB. Interventions: Serum UCH-L1 levels were drawn at baseline and 6 and 24 hours after CPB cessation. DO2 was computed from perfusion records, with area-under-the-curve (AUC) computations performed to account for distance of DO2 excursions below predefined DO2 thresholds and the amount of time spent below them. Strokes were defined radiographically using computed tomography and magnetic resonance imaging. Measurements and Main Results: Forty-three adults were included (median age 65 y, interquartile range 59-72). Three patients experienced strokes (imaged at 2, 7, and 8 d postoperatively). Most patients underwent isolated coronary artery bypass grafting (41%, 18 patients) or isolated aortic valve replacement (30%, 13). Median UCH-L1 levels differed from baseline to 6 and 24 hours after CPB (40, 232, and 166 pg/mL, respectively; p < 0.001). On multivariable linear regression analysis controlling for baseline and surgical variables, only DO2 AUC <225 was significantly associated with 6-hour UCH-L1 levels (p = 0.001), whereas only DO2 AUC <300 was significantly associated with 24- hour levels (p < 0.001). The 3 patients who experienced radiographic strokes had nonsignificantly elevated 24-hour UCH-L1 levels compared with control patients (585 v 151 pg/mL, p = 0.11). Conclusions: This is the first study to demonstrate an independent association between DO2 during CPB and elevations of a brain injury biomarker; additional study is needed to clarify the clinical significance of these results.

KW - cardiopulmonary bypass

KW - ischemia

KW - neurologic injury

KW - oxygen delivery

KW - perfusion

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