title: Elevated free fatty acid level is a risk factor for early postoperative hypoxemia after on-pump coronary artery bypass grafting: association with endothelial activation.
abstract: BACKGROUND
  We aimed to investigate the relationship between increased free fatty acid (FFA) level and early postoperative hypoxemia after coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).
  
  
  METHODS
  Ninety-eight consecutive patients undergoing CABG were enrolled. Early postoperative hypoxemia was defined as the lowest of the ratio of arterial oxygen tension (PaO2) to inspired oxygen fraction (FiO2) ≤ 200 mm Hg within 24 h without pleural effusion and pneumothorax. The 26 perioperative factors, serum levels of FFA and inflammatory cytokines between the hypoxemia and non-hypoxemia groups were recorded or detected using autoanalyzer and enzyme-linked immunosorbent assay, respectively. Additionally, the risk factors for early postoperative hypoxemia were evaluated using multiple logistic regression analysis.
  
  
  RESULTS
  The incidence rate of early postoperative hypoxemia was 37.8 %. Serum FFA levels were significantly higher in the hypoxemia group than in the non-hypoxemia group (P<0.001). Further, postoperative serum FFA levels were inversely related to the lowest of the ratio of PaO2/FiO2 at 24 h after CABG (r= - 0.367, P<0.001). Multiple logistic regression analysis confirmed that age, body mass index and postoperative serum FFA concentrations were independently associated with early postoperative hypoxemia. Notably, patients with hypoxemia had markedly higher serum intercellular adhesion molecule-1 (ICAM-1) levels than those without (P<0.001). Moreover, serum FFA levels at 2 h after CABG correlated positively with ICAM-1 concentrations (r=0.492, P<0.001).
  
  
  CONCLUSIONS
  Elevated FFA concentration is a risk factor for early postoperative hypoxemia after on-pump CABG, which may be closely associated with endothelial activation.
authors.affiliation: Department of Cardiovascular Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, P.R. China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Shi
authors.affiliation: Department of Cardiovascular Surgery, Taian City Central Hospital, 29 Longtan Road, Taian, Shandong Province, 271000, P.R. China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Cardiovascular Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, P.R. China.
authors.forename: Limin
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, P.R. China.
authors.forename: Jian
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Cardiovascular Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, P.R. China. yuanzx828@163.com.
authors.forename: Zhongxiang
authors.initials: Z
authors.lastname: Yuan
authors.affiliation: Department of Cardiovascular Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, P.R. China. minyudr@163.com.
authors.forename: Min
authors.initials: M
authors.lastname: Yu
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001784:Blood Gas Analysis; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D016207:Cytokines / Q000378:metabolism; D004797:Enzyme-Linked Immunosorbent Assay; D005230:Fatty Acids, Nonesterified / Q000097:blood*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000097:blood* / Q000209:etiology; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D016207:Cytokines; D005230:Fatty Acids, Nonesterified