[en] Although often clinically silent, pancreatic cellular injury (PCI) is relatively frequent after cardiac surgery with cardiopulmonary bypass; and its etiology and time course are largely unknown. We defined PCI as the simultaneous presence of abnormal values of pancreatic isoamylase and immunoreactive trypsin (IRT). The frequency and time evolution of PCI were assessed in this condition using assays for specific exocrine pancreatic enzymes. Correlations with inflammatory markers were searched for preoperative risk factors. One hundred ninety-three patients submitted to cardiac surgery were enrolled prospectively. Blood IRT, amylase, pancreatic isoamylase, lipase, and markers of inflammation (alpha1-protease inhibitor, alpha2-macroglobulin, myeloperoxidase) were measured preoperatively and postoperatively until day 8. The postoperative increase in plasma levels of pancreatic enzymes and urinary IRT was biphasic in all patients: early after surgery and later (from day 4 to 8 after surgery). One hundred thirty-three patients (69%) experienced PCI, with mean IRT, isoamylase, and alpha1-protease inhibitor values higher for each sample than that in patients without PCI. By multiple regression analysis, we found preoperative values of plasma IRT >or=40 ng/mL, amylase >or=42 IU/mL, and pancreatic isoamylase >or=20 IU/L associated with a higher incidence of postsurgery PCI (P < 0.005). In the PCI patients, a significant correlation was found between the 4 pancreatic enzymes and urinary IRT, total calcium, myeloperoxidase, alpha1-protease inhibitor, and alpha2-macroglobulin. These data support a high prevalence of postoperative PCI after cardiac surgery with cardiopulmonary bypass, typically biphasic and clinically silent, especially when pancreatic enzymes were elevated preoperatively.
Disciplines :
Hematology Anesthesia & intensive care
Author, co-author :
Nys, Monique ; Centre Hospitalier Universitaire de Liège - CHU > Soins intensifs
Venneman, Ingrid ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Deby-Dupont, G.
Preiser, Jean-Charles ; Université de Liège - ULiège > Services généraux (Faculté de médecine) > Relations académiques et scientifiques (Médecine)
Vanbelle, Sophie ; Université de Liège - ULiège > Département des sciences de la santé publique > Informatique médicale et biostatistique
Albert, Adelin ; Université de Liège - ULiège > Département des sciences de la santé publique > Informatique médicale et biostatistique
Camus, Gérard
Damas, Pierre ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
Larbuisson, Robert ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Lamy, Maurice ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
Language :
English
Title :
Pancreatic cellular injury after cardiac surgery with cardiopulmonary bypass: Frequency, time course and risk factors
Publication date :
May 2007
Journal title :
Shock
ISSN :
1073-2322
Publisher :
Lippincott Williams & Wilkins, Philadelphia, United States - Pennsylvania
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