Author/Authors :
beaver, thomas m. university of florida - division of thoracic and cardiovascular surgery, Gainesville, USA , cobb, jessica a. university of florida - division of thoracic and cardiovascular surgery, Gainesville, USA , koratala, abhilash university of florida - division of nephrology, hypertension and renal transplantation, Gainesville, USA , alquadan, kawther f. university of florida - division of nephrology, hypertension and renal transplantation, Gainesville, USA , ejaz, abutaleb a. university of florida - division of nephrology, hypertension and renal transplantation, Gainesville, USA
Abstract :
bjectives: We investigated the effects of nesiritide (NES) on inflammatory response during cardiac surgery. Materials and Methods: Twenty‑nine cardiac surgery patients were randomized to an infusion of NES at 0.01 mcg/kg/min for 48 h versus placebo (Ctrl). A panel of candidate biomarkers and clinical parameters were measured at predetermined time points. Results: There were no significant differences between the groups with regard to urine neutrophil gelatinase‑associated lipocalin (NES 230.3 + 71.5 ng/mL vs. Ctrl 554.4 + 263.3 ng/mL, P = 0.253) and urine interleukin (IL)‑18 (NES 29.9 + 4.8 pg/mL vs. 254.5 + 118.3 pg/mL, P = 0.090), or to the incidence of acute kidney injury (NES 7.1% vs. Ctrl 13.3%, P = 0.374). A concerted biomarker kinetic pattern of time‑differentiated peak concentrations was observed. IL‑10, inflammatory protein (IP)‑10, IL‑6, IL‑10, IP‑10, monocyte IP (MIP)‑1α, interferon (IFN)‑α, IFN‑α, IL‑1a, IL‑3, and IL‑7 reached peak concentration at 0 h following the end of cardiopulmonary bypass; tumor necrosis factor (TNF)‑α, endothelial growth factor (EGF), granulocyte macrophage‑colony‑stimulating factor (GM‑CSF), IL‑12p40, IL‑17, MIP‑1α, and monocyte chemoattractant protein‑1 at 1 h; IL‑18, vascular EGF (VEGF), IL-13 and IL-1ra at 2 h, TNF-α, G-CSF, IL-1b, IL-2, IL-4, IL-5, and IL-15 at 4 h; and endothelin (ET)-1 and IL-18 at 6 h. At 0 h, the NES group exhibited significant reduction of peak concentrations of IL‑6 (P = 0.009), IL‑10 (P = 0.009), IL‑1α (P = 0.020), IP‑10 (P = 0.001), and IFN‑α (P = 0.032) compared to the Ctrl group. Significant reduction in peak concentrations of TNF‑α (P = 0.007) and MIP1‑α (P = 0.027) at 1 h and ET‑1 (P = 0.020) at 6 h in the NES group compared to the Ctrl group was noted. Conclusion: NES modulated the concerted inflammatory response in cardiac surgery and also attenuated ET‑1 response, thus suggesting that previously observed favorable renal effect may be linked to reduced renal vasoconstriction.
