OBJECTIVE Micro-albuminuria (MA) is associated with a generalized increase in systemic vascular permeability and a sensitive marker of endothelial dysfunction. Several studies documented its rapid increase and its adverse prognostic significance after trauma, pancreatitis, ischemia reperfusion injury, and surgery. However, little is known about MA and its potential implication after thoracic surgery. We performed a prospective study to serially assess MA after thoracic surgery. METHODS Design: short-term prospective observational pathophysiology driven study. Setting: thoracic surgery unit. Patients: 80 consecutive patients. Outcome measures: MA in first-void urine samples before thoracic surgery and in postoperative day 1, 3 and 7. RESULTS Mean age was 63 years [60 to 65], 67% were male, and the most common comorbidities were COPD (55), hypertension (38), and diabetes (9). Sixty-four patients underwent standard thoracic surgery (55 lobectomies, 4 pneumonectomies and 5 thymectomies) and 16 VATS resections. Preoperative MAU level was normal, mean 0.61 mg/dl ([0.48 to 0.79]) while on postoperative day 1 we observed a seven fold increase (4.45 mg/dl [3.50 to 5.65] p<0.001). An even larger increase was observed in patients with diabetes and hypertension (8.95 mg/dl [1.54 to 52.09]; p<0.001 and 5.852 mg/dl [4.04 to 8.46]; p<0.001 respectively). On postoperative day 1 we did not find significant MAU differences between categories defined by type of surgery. Average MAU was normal and close to baseline level on postoperative day 7, however 45% of patients submitted to open procedures still had MAU greater than baseline level. CONCLUSIONS Our study showed that MAU might be and early marker of increased vascular permeability in thoracic surgery patients. As expected a larger increase was observed in diabetics and hypertensives. A wider proportion of patients undergoing VATS compared to open thoracic surgery recovered baseline MAU within 7 days. Persistence of MAU seems associated with the severity of surgical stress.
Short term prospective evaluation of microalbuminuria after thoracic surgery
CAGINI, Lucio;PECORIELLO, ROBERTA;CAPOZZI, ROSANNA;MONACELLI, Massimo;REBOLDI, Gianpaolo;PUMA, Francesco
2011
Abstract
OBJECTIVE Micro-albuminuria (MA) is associated with a generalized increase in systemic vascular permeability and a sensitive marker of endothelial dysfunction. Several studies documented its rapid increase and its adverse prognostic significance after trauma, pancreatitis, ischemia reperfusion injury, and surgery. However, little is known about MA and its potential implication after thoracic surgery. We performed a prospective study to serially assess MA after thoracic surgery. METHODS Design: short-term prospective observational pathophysiology driven study. Setting: thoracic surgery unit. Patients: 80 consecutive patients. Outcome measures: MA in first-void urine samples before thoracic surgery and in postoperative day 1, 3 and 7. RESULTS Mean age was 63 years [60 to 65], 67% were male, and the most common comorbidities were COPD (55), hypertension (38), and diabetes (9). Sixty-four patients underwent standard thoracic surgery (55 lobectomies, 4 pneumonectomies and 5 thymectomies) and 16 VATS resections. Preoperative MAU level was normal, mean 0.61 mg/dl ([0.48 to 0.79]) while on postoperative day 1 we observed a seven fold increase (4.45 mg/dl [3.50 to 5.65] p<0.001). An even larger increase was observed in patients with diabetes and hypertension (8.95 mg/dl [1.54 to 52.09]; p<0.001 and 5.852 mg/dl [4.04 to 8.46]; p<0.001 respectively). On postoperative day 1 we did not find significant MAU differences between categories defined by type of surgery. Average MAU was normal and close to baseline level on postoperative day 7, however 45% of patients submitted to open procedures still had MAU greater than baseline level. CONCLUSIONS Our study showed that MAU might be and early marker of increased vascular permeability in thoracic surgery patients. As expected a larger increase was observed in diabetics and hypertensives. A wider proportion of patients undergoing VATS compared to open thoracic surgery recovered baseline MAU within 7 days. Persistence of MAU seems associated with the severity of surgical stress.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
