DSpace Collection:https://hdl.handle.net/10171/189542024-03-28T19:06:01Z2024-03-28T19:06:01ZSulforaphane pretreatment prevents systemic inflammation and renal injury in response to cardiopulmonary bypasshttps://hdl.handle.net/10171/690662024-02-19T06:06:18Z2014-01-01T00:00:00ZTitle: Sulforaphane pretreatment prevents systemic inflammation and renal injury in response to cardiopulmonary bypass
Abstract: Objectives: Systemic inflammatory responses are a major cause of morbidity and mortality in patients
undergoing cardiac surgery with cardiopulmonary bypass. However, the underlying molecular mechanisms
for systemic inflammation in response to cardiopulmonary bypass are poorly understood.
Methods: A porcine model was established to study the signaling pathways that promote systemic inflammation
in response to cardiac surgery with cardiopulmonary bypass under well-controlled experimental conditions. The
influence of sulforaphane, an anti-inflammatory compound derived from green vegetables, on inflammation and
injury in response to cardiopulmonary bypass was also studied. Intracellular staining and flow cytometry were
performed to measure phosphorylation of p38 mitogen-activated protein kinase and the transcription factor
nuclear factor-kB in granulocytes and mononuclear cells.
Results: Surgery with cardiopulmonary bypass for 1 to 2 hours enhanced phosphorylation of p38 (2.5-fold)
and nuclear factor-kB (1.6-fold) in circulating mononuclear cells. Cardiopulmonary bypass also modified
granulocytes by activating nuclear factor-kB (1.6-fold), whereas p38 was not altered. Histologic analyses
revealed that cardiopulmonary bypass promoted acute tubular necrosis. Pretreatment of animals with
sulforaphane reduced p38 (90% reduction) and nuclear factor-kB (50% reduction) phosphorylation in
leukocytes and protected kidneys from injury.
Conclusions: Systemic inflammatory responses after cardiopulmonary bypass were associated with activation
of p38 and nuclear factor-kB pathways in circulating leukocytes. Inflammatory responses to cardiopulmonary
bypass can be reduced by sulforaphane, which reduced leukocyte activation and protected against renal injury.
(J Thorac Cardiovasc Surg 2014;148:690-7)2014-01-01T00:00:00ZTiming of renal replacement therapy after cardiac surgery: a retrospective multicenter Spanish Cohort Studyhttps://hdl.handle.net/10171/690332024-02-12T06:09:36Z2011-01-01T00:00:00ZTitle: Timing of renal replacement therapy after cardiac surgery: a retrospective multicenter Spanish Cohort Study
Abstract: Background: The optimal time to initiate renal replacement therapy (RRT) in cardiac surgery-associated acute kidney injury (CSA-AKI) is unknown. Evidence suggests that the early use of RRT in critically ill patients is associated with improved outcomes. We studied the effects of time to initiation of RRT on outcome in patients with CSA-AKI. Methods: This was a retrospective observational multicenter study (24 Spanish hospitals). We analyzed data on 203 patients who required RRT after cardiac surgery in 2007. The cohort was divided into 2 groups based on the time at which RRT was initiated: in the early RRT group, therapy was initiated within the first 3 days after cardiac surgery; in the late group, RRT was begun after the 3rd day. Multivariate nonconditional logistic and linear regression models were used to adjust for potential confounders. Results: In-hospital mortality was significantly higher in the late RRT group compared with early RRT patients (80.4 vs. 53.2%; p < 0.001; adjusted odds ratio of 4.1, 95% CI: 1.6–10.0). Also, patients in the late RRT group had longer adjusted hospital stays by 11.6 days (95% CI: 1.4–21.9) and higher adjusted percentage increases in creatinine at discharge compared with baseline by 67.7% (95% CI: 28.5–106.4). Conclusions: Patients who undergo early initiation of RRT after CSA-AKI have improved survival rates and renal function at discharge and decreased lengths of hospital stay.2011-01-01T00:00:00ZInfluence of chemotherapy within 30 days before ICU admission on mortality in critically ill medical patients with cancerhttps://hdl.handle.net/10171/689822024-02-12T06:09:01Z2019-01-01T00:00:00ZTitle: Influence of chemotherapy within 30 days before ICU admission on mortality in critically ill medical patients with cancer
Abstract: Background: The main objective was to determine whether the administration of chemotherapy (CT) during the month before
intensive care unit (ICU) admission of medical patients with cancer influences the survival rate. The design was a single-institution
observational cohort study in an ICU of a tertiary university hospital. Methods: Our cohort included 248 oncology patients
admitted to the ICU from 2005 to 2014 due to nonsurgical problems. Seventy-six (30.6%) patients had received CT in the month
before admission (CT group) and 172 did not receive CT (control group). The main outcome measures were ICU, hospital, 30-
day, 90-day, and 1-year mortalities. We performed survival analysis using the Kaplan-Meier estimator, comparing both groups
using the log-rank test, and multivariate analysis using Cox regression adjusted for gender, age, maximum Sequential Organ Failure
Assessment (SOFA), and delta maximum SOFA to calculate the hazard ratios (HRs) and their respective 95% confidence intervals.
This association was also evaluated by a graphic representation of survival. Results: The CT group presented an ICU mortality rate
of 27.6% versus 25.5% in the control group. The multivariate analysis adjusted for age, sex, and delta maximum SOFA showed
significant differences between the groups (HR: 2.12; P ¼ .009). The hospital mortality rate was 55.3% in the CT group compared to
45.4% in the control group (adjusted HR: 1.81; P ¼ .003). At 30 days, the mortality rate was 56.6% in the CT group compared to
46.5% in the control group (adjusted HR: 1.69; P ¼ .008). Mortality at 90 days was 65.8% in the CT group versus 59.9% in the
control group (adjusted HR: 1.47; P ¼ .03). One-year mortality was also higher in the CT group (79% vs 72.7%, adjusted HR: 1.44;
P ¼ .02). Conclusion: The administration of CT in the month before ICU admission in patients with cancer was associated with
higher mortality in the ICU, in the hospital, and 30 and 90 days after admission when adjusted for the increase in organ failure
measured by delta maximum SOFA. We provide useful new information for decision-making about ICU management of patients
with cancer.2019-01-01T00:00:00ZExternal validation and comparison of three scores to predict renal replacement therapy after cardiac surgery: A multicenter cohorthttps://hdl.handle.net/10171/689802024-02-12T06:08:56Z2011-01-01T00:00:00ZTitle: External validation and comparison of three scores to predict renal replacement therapy after cardiac surgery: A multicenter cohort
Abstract: Purpose: Cardiac surgery-associated acute kidney injury requiring renal replacement therapy (RRT) is
independently associated with mortality. Several risk scores have been developed to predict the need
for RRT after cardiac surgery. We have compared and verified the external validity of the three main
available scores for RRT prediction after cardiac surgery: the Thakar score, the Mehta tool, and the
Simplified Renal Index.
Methods: The risk scores were calculated in a cohort of 1084 adult patients, 248 of whom required
RRT, who underwent open-heart surgery in 24 Spanish hospitals in 2007. The performance of the
systems was determined by examining their discrimination (areas under the receiver operating characteristic curves (aROC) and calibration (Lemeshow-Hosmer chi-square goodness-of-fit statistics).
Results: The aROCs in the Thakar score, the Mehta tool, and the Simplified Renal Index were 0.82,
0.76 and 0.79, respectively. The three scoring systems were poorly calibrated and tended to underestimate the actual need for RRT.
Conclusions: The Thakar score and the Simplified Renal Index discriminated well between low - and
high-risk patients in our cohort, and Thakar outperformed the Mehta tool. These best-performing
scores may aid in the selection of optimal therapy, facilitate the planning of hospital resource utilization, improve preoperative counseling, select participants for clinical trials of renal-protective therapies and enable an accurate comparison between different institutions or surgeons.2011-01-01T00:00:00Z