TY - JOUR
T1 - Correlating Oxygen Delivery During Cardiopulmonary Bypass With the Neurologic Injury Biomarker Ubiquitin C-Terminal Hydrolase L1 (UCH-L1)
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.
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/12
Y1 - 2018/12
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
UR - http://www.scopus.com/inward/record.url?scp=85048324545&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85048324545&partnerID=8YFLogxK
U2 - 10.1053/j.jvca.2018.05.021
DO - 10.1053/j.jvca.2018.05.021
M3 - Article
C2 - 29903683
AN - SCOPUS:85048324545
SN - 1053-0770
VL - 32
SP - 2485
EP - 2492
JO - Journal of cardiothoracic and vascular anesthesia
JF - Journal of cardiothoracic and vascular anesthesia
IS - 6
ER -