title: Pancreatic cellular injury after cardiac surgery with cardiopulmonary bypass: frequency, time course and risk factors.
abstract: 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.
authors: Departments of Anesthesia and Intensive Care Medicine, University Hospital of Liège, Liège, Belgium. Monique.Nys@chu.ulg.ac.be
authors: Monique
authors: M
authors: Nys
authors: Ingrid
authors: I
authors: Venneman
authors: Ginette
authors: G
authors: Deby-Dupont
authors: Jean-Charles
authors: JC
authors: Preiser
authors: Sophie
authors: S
authors: Vanbelle
authors: Adelin
authors: A
authors: Albert
authors: Gérard
authors: G
authors: Camus
authors: Pierre
authors: P
authors: Damas
authors: Robert
authors: R
authors: Larbuisson
authors: Maurice
authors: M
authors: Lamy
mesh_terms: D000368:Aged; D000681:Amylases / Q000097:blood; D002118:Calcium / Q000097:blood; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D007517:Isoamylase / Q000097:blood; D008049:Lipase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000378:metabolism / Q000473:pathology*; D010182:Pancreatic Diseases / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D009195:Peroxidase / Q000097:blood; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000652:urine; D011480:Protease Inhibitors / Q000097:blood; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors; D014357:Trypsin / Q000097:blood / Q000652:urine; D000511:alpha-Macroglobulins / Q000378:metabolism
chemical_list: D011480:Protease Inhibitors; D000511:alpha-Macroglobulins; D009195:Peroxidase; D008049:Lipase; D000681:Amylases; D007517:Isoamylase; D014357:Trypsin; D002118:Calcium