Pulmonary injury follows systemic inflammatory reaction in infrarenal aortic surgery

Chiara Adembri, Eleni Kastamoniti, Iacopo Bertolozzi, Simone Vanni, Walter Dorigo, Mirella Coppo, Carlo Pratesi, A. Raffaele De Gaudio, Gian F. Gensini, Pietro A. Modesti

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

Objective: To investigate whether an inflammatory response occurs in patients undergoing infrarenal aortic abdominal aneurysm repair, the localization and timing (ischemia and/or reperfusion) of this activation, and finally whether it affects postoperative pulmonary function. Design: Prospective, observational study. Setting: Academic referral center in Italy. Patients: We included 12 patients undergoing infrarenal aortic abdominal aneurysm repair and 12 patients undergoing major abdominal surgery. Interventions: Timed measurement of gene activation (angiotensinogen, angiotensin type 1 receptor, angiotensin-converting enzyme, and interleukin-6 genes) in muscle biopsies by reverse transcriptase-polymerase chain reaction (RT-PCR), and prospective assessment of interleukin-6 plasma concentration and pulmonary function (Pao2/Fio2 and Pao2/PAo 2 ratios). Measurements and Main Results: After 30 mins of aortic clamping, angiotensinogen, angiotensin type 1 receptor, angiotensin-converting enzyme, and interleukin-6 genes were all overexpressed at RT-PCR studies in quadriceps muscle of patients undergoing aortic abdominal aneurysm repair, and the overexpression persisted after reperfusion. In situ hybridization and immunohistochemistry revealed that the inflammatory response was localized in endothelial cells. A significant increase in plasma interleukin-6 concentrations was then detectable at 6 and 12 hrs after reperfusion in aortic abdominal aneurysm surgery compared with patients undergoing abdominal surgery (p <.05). The increase in interleukin-6 plasma concentration was then followed (12 and 24 hrs after surgery) by a significant reduction of Pao 2/Fio2 and Pao2/PAo2 ratios (p <.05 vs. abdominal surgery). Conclusions: The present study shows that a) during aortic surgery, the genes for interleukin-6 and for the components of the local renin-angiotensin system (angiotensinogen, angiotensin-converting enzyme, and angiotensin type 1 receptor subtype) are activated early in the ischemic muscle, and activation persists during reperfusion; b) interleukin-6 plasma concentration increases only in patients with tissue ischemia (aortic abdominal aneurysm), whereas no changes are detectable in patients with abdominal surgery; and finally c) the occurrence of systemic inflammatory reaction with increased interleukin-6 plasma concentrations is followed by impaired pulmonary function.

Original languageEnglish
Pages (from-to)1170-1177
Number of pages8
JournalCritical Care Medicine
Volume32
Issue number5
DOIs
Publication statusPublished - May 2004

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Lung Injury
Interleukin-6
Abdominal Aortic Aneurysm
Angiotensinogen
Angiotensin Type 1 Receptor
Reperfusion
Peptidyl-Dipeptidase A
Reverse Transcriptase Polymerase Chain Reaction
Lung
Ischemia
Genes
Muscles
Quadriceps Muscle
Renin-Angiotensin System
Constriction
Italy
Transcriptional Activation
In Situ Hybridization
Observational Studies
Referral and Consultation

Keywords

  • Aortic surgery
  • Interleukin-6
  • Ischemia reperfusion
  • Renin-angiotensin system

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Adembri, C., Kastamoniti, E., Bertolozzi, I., Vanni, S., Dorigo, W., Coppo, M., ... Modesti, P. A. (2004). Pulmonary injury follows systemic inflammatory reaction in infrarenal aortic surgery. Critical Care Medicine, 32(5), 1170-1177. https://doi.org/10.1097/01.CCM.0000124875.98492.11

Pulmonary injury follows systemic inflammatory reaction in infrarenal aortic surgery. / Adembri, Chiara; Kastamoniti, Eleni; Bertolozzi, Iacopo; Vanni, Simone; Dorigo, Walter; Coppo, Mirella; Pratesi, Carlo; De Gaudio, A. Raffaele; Gensini, Gian F.; Modesti, Pietro A.

In: Critical Care Medicine, Vol. 32, No. 5, 05.2004, p. 1170-1177.

Research output: Contribution to journalArticle

Adembri, C, Kastamoniti, E, Bertolozzi, I, Vanni, S, Dorigo, W, Coppo, M, Pratesi, C, De Gaudio, AR, Gensini, GF & Modesti, PA 2004, 'Pulmonary injury follows systemic inflammatory reaction in infrarenal aortic surgery', Critical Care Medicine, vol. 32, no. 5, pp. 1170-1177. https://doi.org/10.1097/01.CCM.0000124875.98492.11
Adembri C, Kastamoniti E, Bertolozzi I, Vanni S, Dorigo W, Coppo M et al. Pulmonary injury follows systemic inflammatory reaction in infrarenal aortic surgery. Critical Care Medicine. 2004 May;32(5):1170-1177. https://doi.org/10.1097/01.CCM.0000124875.98492.11
Adembri, Chiara ; Kastamoniti, Eleni ; Bertolozzi, Iacopo ; Vanni, Simone ; Dorigo, Walter ; Coppo, Mirella ; Pratesi, Carlo ; De Gaudio, A. Raffaele ; Gensini, Gian F. ; Modesti, Pietro A. / Pulmonary injury follows systemic inflammatory reaction in infrarenal aortic surgery. In: Critical Care Medicine. 2004 ; Vol. 32, No. 5. pp. 1170-1177.
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AU - Bertolozzi, Iacopo

AU - Vanni, Simone

AU - Dorigo, Walter

AU - Coppo, Mirella

AU - Pratesi, Carlo

AU - De Gaudio, A. Raffaele

AU - Gensini, Gian F.

AU - Modesti, Pietro A.

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N2 - Objective: To investigate whether an inflammatory response occurs in patients undergoing infrarenal aortic abdominal aneurysm repair, the localization and timing (ischemia and/or reperfusion) of this activation, and finally whether it affects postoperative pulmonary function. Design: Prospective, observational study. Setting: Academic referral center in Italy. Patients: We included 12 patients undergoing infrarenal aortic abdominal aneurysm repair and 12 patients undergoing major abdominal surgery. Interventions: Timed measurement of gene activation (angiotensinogen, angiotensin type 1 receptor, angiotensin-converting enzyme, and interleukin-6 genes) in muscle biopsies by reverse transcriptase-polymerase chain reaction (RT-PCR), and prospective assessment of interleukin-6 plasma concentration and pulmonary function (Pao2/Fio2 and Pao2/PAo 2 ratios). Measurements and Main Results: After 30 mins of aortic clamping, angiotensinogen, angiotensin type 1 receptor, angiotensin-converting enzyme, and interleukin-6 genes were all overexpressed at RT-PCR studies in quadriceps muscle of patients undergoing aortic abdominal aneurysm repair, and the overexpression persisted after reperfusion. In situ hybridization and immunohistochemistry revealed that the inflammatory response was localized in endothelial cells. A significant increase in plasma interleukin-6 concentrations was then detectable at 6 and 12 hrs after reperfusion in aortic abdominal aneurysm surgery compared with patients undergoing abdominal surgery (p <.05). The increase in interleukin-6 plasma concentration was then followed (12 and 24 hrs after surgery) by a significant reduction of Pao 2/Fio2 and Pao2/PAo2 ratios (p <.05 vs. abdominal surgery). Conclusions: The present study shows that a) during aortic surgery, the genes for interleukin-6 and for the components of the local renin-angiotensin system (angiotensinogen, angiotensin-converting enzyme, and angiotensin type 1 receptor subtype) are activated early in the ischemic muscle, and activation persists during reperfusion; b) interleukin-6 plasma concentration increases only in patients with tissue ischemia (aortic abdominal aneurysm), whereas no changes are detectable in patients with abdominal surgery; and finally c) the occurrence of systemic inflammatory reaction with increased interleukin-6 plasma concentrations is followed by impaired pulmonary function.

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