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Volume 2 Supplement 1

ESICM LIVES 2014

  • Poster presentation
  • Open Access

0714. Interaction between adipokines and the metabolic stress response: angpt l2 cxcl5 and visfatin in patients undergoing cardiac surgery

  • 1,
  • 2,
  • 3,
  • 1,
  • 1,
  • 2,
  • 1 and
  • 1
Intensive Care Medicine Experimental20142 (Suppl 1) :P46

https://doi.org/10.1186/2197-425X-2-S1-P46

  • Published:

Keywords

  • Insulin Resistance
  • Metabolic Stress
  • Anesthesia Induction
  • CXCL5 Level
  • Aortocoronary Bypass

Introduction

Adipose tissue plays an intriguing role in the endocrine system by producing adipokines [1]. In patients with obesity, metabolic syndrome, and type 2 diabetes (DM2), insulin resistance is influenced by adipokines [1].

From a metabolic point of view, the stress response caused by surgical injury imitates the diabetic state. Stereotypical endocrine-metabolic and inflammatory reactions result in catabolism and pronounced insulin resistance, which is related to outcome [2].

Objectives

Three adipokines including angiopoietin-like protein 2 (ANGPTL2), CXC-chemokine ligand 5 (CXCL5), and Visfatin that are known to interact with insulin resistance [1] were evaluated in patients undergoing cardiac surgery.

Methods

Sixty-six patients scheduled for elective aortocoronary bypass surgery and/or valve repair were consecutively enrolled receiving standardized perioperative care. Serum adipokine concentrations were assessed before anesthesia induction as baseline values, upon arrival on the intensive care unit, on the first (POD1) and third (POD3) day postoperatively.

Results

Patients' baseline characteristics are shown in table 1. ANGPTL2 increased from baseline until POD1 and remained elevated on POD3 (table 2). In contrast, CXCL5 levels decreased during surgery and returned to baseline by POD3. Visfatin levels increased during surgery, showed a decrease by POD1 only to increase again by POD3. DM2 patients appear to exhibit a marked Visfatin increase during surgery, as well as a pronounced increase in CXCL5 from POD1 to POD3.

Table 1

Variable

All Patients (66)

Non-Diabetics (46)

Diabetics (20)

Sex (M/F)

45/21

33/13

12/8

Age (yrs)

65.5 ± 13

64 ± 14

68.7 ± 9.8

ASA (2/3/4)

13/46/7

9/35/2

4/11/5

BMI (kg/m2)

27.5 ± 4.4

26.4 ± 4.2

30.1 ± 3.9

HbA1c (%)

6.3 ± 0.9

5.9 ± 0.4

7.3 ± 1.1

EuroSCORE

4.8 ± 4.6

4.0 ± 2.6

6.5 ± 7.1

SAPS II Score

28.3 ± 8.3

27.7 ± 8.7

29.9 ± 7.1

Type of surgery AKB/valve/multiple

23/22/21

16/17/14

7/5/7

Duration of surgery (min)

212.5 ± 47.2

206.2 ± 46.2

226.8 ± 47.5

Table 2

Variable

 

Preop

Arrival ICU

POD 1

POD 3

ANGPTL2 (ng/ml)

All

66 ± 36

86 ± 30

96 ± 35

90 ± 35

 

Non-DM2

71 ± 38

85 ± 32

97 ± 36

90 ± 38

 

DM2

56 ± 29

87 ± 26

93 ± 31

90 ± 30

CXCL5 (pg/ml)

All

1022 ± 503

662 ± 357

742 ± 456

936 ± 595

 

Non-DM2

1009 ± 479

620 ± 331

695 ± 380

890 ± 532

 

DM2

1051 ± 563

756 ± 402

855 ± 598

1043 ± 723

Visfatin (ng/ml)

All

4.9 ± 2.5

13.2 ± 7.1

7.7 ± 3.4

12.6 ± 5.8

 

Non-DM2

4.6 ± 2.4

12.5 ± 7.2

7.6 ± 3.6

12.6 ± 6.2

 

DM2

5.3 ± 3.2

14.6 ± 6.9

7.8 ± 2.9

12.5 ± 4.9

Conclusions

This exploratory study assessed for the first time the perioperative levels of ANGPTL2, CXCL5, and Visfatin. Further studies are warranted to correlate adipokine concentrations with insulin resistance and surgical outcomes and to investigate the potential role of adipokines as biomarkers or therapeutic targets.

Declarations

Grant acknowledgment

Research Fond, Department of Anesthesia and Surgical Intensive Care, University Hospital Basel, Switzerland.

Authors’ Affiliations

(1)
Department of Anesthesia & Surgical Intensive Care, University Hospital Basel, Basel, Switzerland
(2)
School of Dietetics and Human Nutrition, McGill University, Montreal, Canada
(3)
Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland

References

  1. Ouchi N, et al.: Adipokines in inflammation and metabolic disease. Nat Rev Immunol 2011, 11: 85–97. 10.1038/nri2921PubMed CentralPubMedView ArticleGoogle Scholar
  2. Coursin DB, et al.: Perioperative diabetic and hyperglycemic management issues. Crit Care Med 2004, 32: S116–25. 10.1097/01.CCM.0000115623.52021.C0PubMedView ArticleGoogle Scholar

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