Cemal Levent BİRİNCİOĞLU, Anıl ÖZEN, Ufuk TÜTÜN, Emre BOYSAN, Elif DURUKAN, Veysel BAŞAR, Ertekin Utku ÜNAL, Başak SORAN TÜRKCAN, Sercan TAK

Açık kalp cerrahisi sonrasında akut böbrek hasarının erken bir belirteci olarak serum interlökin-18

Amaç: Bu çalışmada serum interlökin (IL)-18'in akut böbrek hasarının (ABH) erken bir biyobelirteci olup olmadığı araştırıldı.Çalışma planı: Bu prospektif çalışmaya açık kalp cerrahisi yapılan 30 ardışık hasta (22 erkek, 8 kadın; ort. yaş 62.4±9.0 yıl; dağılım 49-78 yıl) dahil edildi. Anestezi indüksiyonu öncesi, kardiyopulmoner baypas (KPB) çıkışı ve KPB çıkışı ikinci saatte serum IL-18 konsantrasyonları çalışıldı. Ameliyat sonrası birinci, ikinci ve üçüncü günlerde serum kreatinin konsantrasyonlarına bakıldı. Akut böbrek hasarı; ameliyat sonrası 48 saatlik dönemde kreatinin değerinin, bazal değerin %50'sinden daha fazla olması veya bazal değerin 0.3 mg/dl üzerinde olması olarak tanımlandı. Hastalar ABH gelişen (n=12) ve ABH gelişmeyen grup (n=18) olarak ikiye ayrıldı. Serum IL-18 değerleri iki grup arasında karşılaştırıldı.Bul gu lar: On iki hastada (%40) ABH gelişti. Tanı ancak serum kreatinin konsantrasyonları ile ameliyat sonrası 24-48 saatlerde konulabildi. Serum IL-18 konsantrasyonları ABH gelişen grupta KPB çıkışı bir miktar azalsa da bu düşüş ABH olmayan grupta daha fazla idi. Tek değişkenli analizlerde KPB çıkışı sonrası ikinci saatte alınan IL-18 konsantrasyonları ABH ile ilişkili bulundu (p=0.031). Serum IL-18 konsantrasyonlarındaki ameliyat öncesi dönem ile KPB çıkışı sonrası ikinci saat arasındaki fark ise istatistiksel olarak anlamlı idi (p=0.017). Alıcı işletim karakteristiği eğrisi analizine göre, KPB çıkışı sonrası ikinci saat serum IL-18 konsantrasyonunun ABH'yi öngörmedeki eşik değeri %58.3 duyarlılık ve %83.3 özgüllük ile 353.7 pg/mL olarak hesaplandı (AUC=0.736).So nuç: Serum IL-18 konsantrasyonu açık kalp cerrahisi sonrası akut böbrek hasarını erken dönemde saptayabilen bir biyobelirteç olarak kullanılabilir.

Serum interleukin-18 as an early marker of acute kidney injury following open heart surgery

Background: This study aims to investigate whether serum interleukin (IL)-18 is an early biomarker of acute kidney injury (AKI). Methods: Thirty consecutive patients (22 males, 8 females; mean age 62.4±9.0 years; range 49 to 78 years) who underwent open- heart surgery were enrolled in this prospective study. Serum IL-18 concentrations were analyzed prior to induction of anesthesia, at weaning from cardiopulmonary bypass (CPB) and two hours after weaning from CPB. Serum creatinine levels were analyzed in the postoperative first, second, and third days. Acute kidney injury was defined as creatinine levels exceeding 50% of the basal value or exceeding the basal value by 0.3 mg/dl at 48 hours postoperatively. The patients were classified into two groups including AKI (n=12) and non-AKI (n=18). Serum IL-18 levels were compared between the groups. Results: Twelve patients (40%) developed AKI. The diagnosis was able to be made using the serum creatinine levels at 24 to 48 hours postoperatively. Although IL-18 concentrations at weaning from CPB decreased slightly in the AKI group, the decrease in the non- AKI presenting group was higher. Using univariate analyses, IL-18 concentrations at two hours after weaning from CPB were found to be related to AKI (p=0.031). The difference in serum IL-18 concentrations between the preoperative period and two hours after weaning from CPB were found to be statistically significant (p=0.017). According to the Receiver operating characteristic curve analysis, the threshold value for AKI prediction of serum IL-18 concentrations at two hours after weaning from CPB was 353.7 pg/ml with a sensitivity of 58.3% and a specificity of 83.3% (AUC=0.736). Conclusion: Serum IL-18 concentration may be used as a biochemical indicator for early detection of acute kidney injury following open heart surgery.

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