title: Soluble isoform of the receptor for advanced glycation end products as a biomarker for postoperative respiratory failure after cardiac surgery.
abstract: OBJECTIVE
  Postoperative respiratory failure is a major problem which can prolong the stay in the intensive care unit in patients undergoing cardiac surgery. We measured the serum levels of the soluble isoform of the receptor for advanced glycation end products (sRAGE), and we studied its association with postoperative respiratory failure.
  
  
  METHODS
  Eighty-seven patients undergoing elective cardiac surgery were enrolled in this multicenter observational study in three university hospitals. Serum biomarker levels were measured perioperatively, and clinical data were collected for 7 days postoperatively. The duration of mechanical ventilation was studied for 28 days.
  
  
  RESULTS
  Serum levels of sRAGE elevated immediately after surgery (median, 1751 pg/mL; interquartile range (IQR) 1080-3034 pg/mL) compared with the level after anesthetic induction (median, 884 pg/mL; IQR, 568-1462 pg/mL). Postoperative sRAGE levels in patients undergoing off-pump coronary artery bypass grafting (median, 1193 pg/mL; IQR 737-1869 pg/mL) were significantly lower than in patients undergoing aortic surgery (median, 1883 pg/mL; IQR, 1406-4456 pg/mL; p=0.0024) and valve surgery (median, 2302 pg/mL; IQR, 1447-3585 pg/mL; p=0.0005), and postoperative sRAGE correlated moderately with duration of cardiopulmonary bypass (rs  =0.44, p<0.0001). Receiver operating characteristic curve analysis demonstrated that postoperative sRAGE had a predictive performance with area under the curve of 0.81 (95% confidence interval 0.71-0.88) for postoperative respiratory failure, defined as prolonged mechanical ventilation >3 days. The optimum cutoff value for prediction of respiratory failure was 3656 pg/mL, with sensitivity and specificity of 62% and 91%, respectively.
  
  
  CONCLUSIONS
  Serum sRAGE levels elevated immediately after cardiac surgery, and the range of elevation was associated with the morbidity of postoperative respiratory failure. Early postoperative sRAGE levels appear to be linked to cardiopulmonary bypass, and may have predictive performance for postoperative respiratory failure; however, large-scale validation studies are needed.
authors.affiliation: Department of Anesthesiology, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo, Japan. uchida.mane@tmd.ac.jp
authors.forename: Tokujiro
authors.initials: T
authors.lastname: Uchida
authors.forename: Nagara
authors.initials: N
authors.lastname: Ohno
authors.forename: Miho
authors.initials: M
authors.lastname: Asahara
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Yamada
authors.forename: Osamu
authors.initials: O
authors.lastname: Yamaguchi
authors.forename: Makoto
authors.initials: M
authors.lastname: Tomita
authors.forename: Koshi
authors.initials: K
authors.lastname: Makita
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood*; D020033:Protein Isoforms / Q000097:blood; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic / Q000097:blood*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000097:blood*
chemical_list: D020033:Protein Isoforms; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic
references.citation: Eur J Cardiothorac Surg. 2004 Apr;25(4):548-52
references.pmid: 15037270
references.citation: Respir Physiol Neurobiol. 2011 Sep 15;178(2):256-60
references.pmid: 21736957
references.citation: J Heart Lung Transplant. 2007 Jul;26(7):675-80
references.pmid: 17613396
references.citation: Eur J Heart Fail. 2011 Apr;13(4):440-9
references.pmid: 21266376
references.citation: Thromb Haemost. 2001 Apr;85(4):634-8
references.pmid: 11341497
references.citation: Crit Care Med. 1999 Aug;27(8):1454-60
references.pmid: 10470749
references.citation: J Surg Res. 2008 Jun 1;147(1):79-83
references.pmid: 17981300
references.citation: Crit Care Med. 2008 Aug;36(8):2322-7
references.pmid: 18596623
references.citation: Am J Transplant. 2010 Apr;10(4):900-907
references.pmid: 20121754
references.citation: J Card Surg. 2010 Jan-Feb;25(1):47-55
references.pmid: 19549041
references.citation: Atherosclerosis. 2008 Jan;196(1):9-21
references.pmid: 17826783
references.citation: Eur J Heart Fail. 2010 Oct;12(10):1092-100
references.pmid: 20685687
references.citation: Genes Cells. 2004 Feb;9(2):165-74
references.pmid: 15009093
references.citation: Chest. 2000 Dec;118(6):1724-31
references.pmid: 11115465
references.citation: Ann Thorac Surg. 2003 Mar;75(3):853-7; discussion 857-8
references.pmid: 12645706
references.citation: Crit Care Med. 2011 Mar;39(3):480-8
references.pmid: 21220996
references.citation: Eur Respir J. 2011 Apr;37(4):841-7
references.pmid: 20650982
references.citation: Chest. 2008 Mar;133(3):713-21
references.pmid: 18263692
references.citation: Acta Paediatr. 2007 May;96(5):644-7
references.pmid: 17376185
references.citation: Am Rev Respir Dis. 1988 Sep;138(3):720-3
references.pmid: 3202424
references.citation: Intensive Care Med. 2012 Oct;38(10):1588-98
references.pmid: 22777515
references.citation: Eur J Cardiothorac Surg. 2007 Dec;32(6):882-7
references.pmid: 17904857
references.citation: Transfusion. 2009 Jan;49(1):13-20
references.pmid: 18954397
references.citation: Chest. 2005 Aug;128(2):595-601
references.pmid: 16100143
references.citation: Biom J. 2005 Aug;47(4):458-72
references.pmid: 16161804
references.citation: Chest. 1996 May;109(5):1222-30
references.pmid: 8625671
references.citation: Chest. 2009 Feb;135(2):269-275
references.pmid: 19017890
references.citation: Am J Respir Crit Care Med. 2006 May 1;173(9):1008-15
references.pmid: 16456142
references.citation: Am J Physiol Lung Cell Mol Physiol. 2007 Jul;293(1):L52-9
references.pmid: 17351061
references.citation: Am J Physiol Lung Cell Mol Physiol. 2011 Apr;300(4):L516-25
references.pmid: 21257730
references.citation: Eur J Cardiothorac Surg. 2002 Feb;21(2):232-44
references.pmid: 11825729
references.citation: Am J Respir Crit Care Med. 2009 Nov 15;180(10):1010-5
references.pmid: 19661249
references.citation: Ann Thorac Surg. 2007 Aug;84(2):528-36
references.pmid: 17643630
references.citation: Am J Pathol. 1993 Dec;143(6):1699-712
references.pmid: 8256857
references.citation: Thorax. 2008 Dec;63(12):1083-9
references.pmid: 18566109
references.citation: Acta Physiol (Oxf). 2009 Sep;197(1):47-53
references.pmid: 19302259
references.citation: J Biol Chem. 2004 Nov 26;279(48):50019-24
references.pmid: 15381690
references.citation: J Trauma. 2010 May;68(5):1121-7
references.pmid: 20038857