title: Plasma IL-6 and IL-10 Concentrations Predict AKI and Long-Term Mortality in Adults after Cardiac Surgery.
abstract: Inflammation has an integral role in the pathophysiology of AKI. We investigated the associations of two biomarkers of inflammation, plasma IL-6 and IL-10, with AKI and mortality in adults undergoing cardiac surgery. Patients were enrolled at six academic centers (n = 960). AKI was defined as a ≥ 50% or ≥ 0.3-mg/dl increase in serum creatinine from baseline. Pre- and postoperative IL-6 and IL-10 concentrations were categorized into tertiles and evaluated for associations with outcomes of in-hospital AKI or postdischarge all-cause mortality at a median of 3 years after surgery. Preoperative concentrations of IL-6 and IL-10 were not significantly associated with AKI or mortality. Elevated first postoperative IL-6 concentration was significantly associated with higher risk of AKI, and the risk increased in a dose-dependent manner (second tertile adjusted odds ratio [OR], 1.61 [95% confidence interval (95% CI), 1.10 to 2.36]; third tertile adjusted OR, 2.13 [95% CI, 1.45 to 3.13]). First postoperative IL-6 concentration was not associated with risk of mortality; however, the second tertile of peak IL-6 concentration was significantly associated with lower risk of mortality (adjusted hazard ratio, 0.75 [95% CI, 0.57 to 0.99]). Elevated first postoperative IL-10 concentration was significantly associated with higher risk of AKI (adjusted OR, 1.57 [95% CI, 1.04 to 2.38]) and lower risk of mortality (adjusted HR, 0.72 [95% CI, 0.56 to 0.93]). There was a significant interaction between the concentration of neutrophil gelatinase-associated lipocalin, an established AKI biomarker, and the association of IL-10 concentration with mortality (P = 0.01). These findings suggest plasma IL-6 and IL-10 may serve as biomarkers for perioperative outcomes.
authors: Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut;
authors: William R
authors: WR
authors: Zhang
authors: Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;
authors: Amit X
authors: AX
authors: Garg
authors: Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Section of Nephrology, Veterans Affairs CT Healthcare System, West Haven, Connecticut;
authors: Steven G
authors: SG
authors: Coca
authors: Department of Clinical Epidemiology and Biostatistics.
authors: Philip J
authors: PJ
authors: Devereaux
authors: Division of Cardiac Surgery, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada;
authors: John
authors: J
authors: Eikelboom
authors: Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; and.
authors: Peter
authors: P
authors: Kavsak
authors: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;
authors: Eric
authors: E
authors: McArthur
authors: Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada;
authors: Heather
authors: H
authors: Thiessen-Philbrook
authors: Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; and.
authors: Colleen
authors: C
authors: Shortt
authors: Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, University of California, San Francisco.
authors: Michael
authors: M
authors: Shlipak
authors: Division of Cardiac Surgery, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada;
authors: Richard
authors: R
authors: Whitlock
authors: Program of Applied Translational Research, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Section of Nephrology, Veterans Affairs CT Healthcare System, West Haven, Connecticut; chirag.parikh@yale.edu.
authors: Chirag R
authors: CR
authors: Parikh
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000401:mortality / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002170:Canada / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016753:Interleukin-10 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000652:urine; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D015850:Interleukin-6; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D016753:Interleukin-10; D003404:Creatinine
keywords: Epidemiology and outcomes; clinical epidemiology; cytokines; mortality