心脏手术后经常发生术后肺部并发症（PPC）。炎症生物标志物（白细胞介素 [IL]-6、IL-8 和肿瘤坏死因子-α [TNF-α]）和肺泡上皮损伤（晚期糖基化终末产物可溶性受体 [sRAGE]）的绝对术后值与缺氧和长时间通气有关。然而，这些生物标志物与 PPC 之间的关系（与术前炎症和围手术期肺损伤危险因素相关）尚不确定。我们的目的是确定成人心脏手术患者围手术期炎症生物标志物的增加与肺泡上皮损伤之间的关联，并采用以患者为中心的 PPC 定义，解释术中危险因素对肺损伤的影响。接受择期心脏手术的成人有资格参与此项研究。观察性队列研究。麻醉诱导后（基线）和术后第 1 天（POD 1）收集 IL-6、IL-8、TNF-α 和 sRAGE 的血液浓度。主要结局是中度或重度 PPC 的发生率，使用经过验证的量表进行分级，POD 0 至 7。我们估计了 POD 1 IL-6、IL-8、TNF-α 和 sRAGE 浓度与中度/重度之间的关联PPC 的存在对每个生物标志物使用单独的逻辑回归模型，并根据基线生物标志物值和术后肺损伤的危险因素（年龄、基线 PaO2/FiO2、左心室射血分数 [LVEF]、手术类型、体外循环持续时间和输血）进行调整。根据与肺损伤的相关性以及患有和不患有 PPC 的患者之间未经调整的组间差异来选择协变量。次要结局是术后通气持续时间，对其进行对数转换并使用线性回归进行分析，并使用与主要结局相同的变量进行调整。我们从 2016 年至 2018 年招募了 204 名患者。2023 年对 175 名具有完整数据的患者进行了生物标志物分析。在调整后的分析中，POD 1 IL-8 和 IL-6 与中度/重度 PPC 显着相关。 POD 1 IL-8 每增加 50 pg/mL，开发 PPC 的比值比 (OR) 为 7.19（95% 置信区间 [CI]，2.13-28.53，P = .003）和 1.42（95% CI， 1.13-1.93，P = .01) POD 1 IL-6 每增加 50 pg/mL。在调整分析中，术后通气持续时间与 POD 1 sRAGE 显着相关； sRAGE 每增加 50 pg/mL，通气时间就会增加 25%（95% CI，2%-52%，P = .03）。 TNF-α 与 PPC 或通气持续时间没有显着相关性。考虑到术前炎症负担和可能影响术后肺损伤的围手术期因素，急性全身炎症与成人择期心脏手术后的 PPC 显着相关。版权所有 © 2024 International Anesthesia Research社会。

Postoperative pulmonary complications (PPCs) occur frequently after cardiac surgery. Absolute postoperative values of biomarkers of inflammation (interleukin [IL]-6, IL-8, and tumor necrosis factor-alpha [TNF-α]) and alveolar epithelial injury (soluble receptor for advanced glycation end-products [sRAGE]) have been associated with hypoxia and prolonged ventilation. However, relationships between these biomarkers and PPCs, contextualized to preoperative inflammation and perioperative lung injury risk factors, are uncertain. We aimed to determine associations between perioperative increases in biomarkers of inflammation and alveolar epithelial injury with a patient-centric PPC definition in adult cardiac surgical patients, accounting for the influence of intraoperative risk factors for lung injury.Adults undergoing elective cardiac surgery were eligible for this observational cohort study. Blood concentrations of IL-6, IL-8, TNF-α, and sRAGE were collected after anesthesia induction (baseline) and on postoperative day 1 (POD 1). The primary outcome was the occurrence of moderate or severe PPCs, graded using a validated scale, in POD 0 to 7. We estimated the association between POD 1 IL-6, IL-8, TNF-α, and sRAGE concentrations and moderate/severe PPC presence using separate logistic regression models for each biomarker, adjusted for baseline biomarker values and risk factors for postoperative lung injury (age, baseline PaO2/FiO2, left ventricle ejection fraction [LVEF], procedural type, cardiopulmonary bypass duration, and transfusions). Covariables were chosen based on relevance to lung injury and unadjusted between-group differences among patients with versus without PPCs. The secondary outcome was postoperative ventilation duration, which was log-transformed and analyzed using linear regression, adjusted using the same variables as the primary outcome.We enrolled 204 patients from 2016 to 2018. Biomarkers were analyzed in 2023 among 175 patients with complete data. In adjusted analyses, POD 1 IL-8 and IL-6 were significantly associated with moderate/severe PPCs. The odds ratio (OR) for developing a PPC for every 50 pg/mL increase in POD 1 IL-8 was 7.19 (95% confidence interval [CI], 2.13-28.53, P = .003) and 1.42 (95% CI, 1.13-1.93, P = .01) for every 50 pg/mL increase in POD 1 IL-6. In adjusted analyses, postoperative ventilation duration was significantly associated with POD 1 sRAGE; each 50 pg/mL increase in sRAGE was associated with a 25% (95% CI, 2%-52%, P = .03) multiplicative increase in hours of ventilation. TNF-α was not significantly associated with PPCs or ventilation duration.Acute systemic inflammation is significantly associated with PPCs after elective cardiac surgery in adults when taking into consideration preoperative inflammatory burden and perioperative factors that may influence postoperative lung injury.Copyright © 2024 International Anesthesia Research Society.