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Elevated endothelin-1 level is a risk factor for nonocclusive mesenteric ischemia.

Heinrich V Groesdonk1, Miriam Raffel2, Thimoteus Speer3

  • 1Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany; Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany.

The Journal of Thoracic and Cardiovascular Surgery
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Summary

Elevated endothelin-1 serum levels may predispose patients to nonocclusive mesenteric ischemia after cardiac surgery. This peptide may serve as a valuable predictive marker for identifying at-risk individuals.

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Area of Science:

  • Cardiovascular Surgery
  • Gastroenterology
  • Vascular Biology

Background:

  • Nonocclusive mesenteric ischemia (NOMI) is a serious complication following cardiac surgery, often associated with cardiopulmonary bypass.
  • Elevated serum levels of endothelin-1 (ET-1) have been observed in patients with general mesenteric ischemia.
  • The specific association between ET-1 and NOMI after cardiac surgery has not been previously investigated.

Purpose of the Study:

  • To investigate the potential association between elevated endothelin-1 serum levels and the development of nonocclusive mesenteric ischemia in patients undergoing cardiac surgery.
  • To determine if ET-1 can serve as a predictive biomarker for NOMI in this patient population.

Main Methods:

  • An observational cohort study included 865 patients undergoing elective cardiac surgery, with 78 developing NOMI.
  • Control patients were selected using 1:1 propensity score matching.
  • Preoperative and postoperative serum ET-1 levels were measured using enzyme-linked immunosorbent assay (ELISA).
  • Logistic regression analysis was employed to calculate odds ratios (OR) and confidence intervals (CI) for the association between ET-1 levels and NOMI risk.

Main Results:

  • Patients with NOMI exhibited significantly higher preoperative (11.3 vs 9.3 pg/mL, P = .001) and postoperative (15.7 vs 11.1 pg/mL, P < .001) ET-1 levels compared to controls.
  • Increased preoperative ET-1 levels were associated with a higher probability of developing NOMI (OR, 1.29; 95% CI, 1.12-1.49 per pg/mL increase).
  • Postoperative ET-1 levels showed an even stronger association with NOMI risk (OR, 2.04; 95% CI, 1.54-2.72 per pg/mL increase).
  • Receiver operating characteristic (ROC) analysis indicated that elevated ET-1 levels accurately predicted NOMI, with an optimal cutoff of 14.5 pg/mL (Area Under Curve = 0.77, sensitivity = 51%, specificity = 94%).

Conclusions:

  • Endothelin-1 appears to be a predisposing factor for the development of nonocclusive mesenteric ischemia in patients undergoing cardiac surgery.
  • Elevated serum endothelin-1 levels demonstrate potential as a valuable biomarker for identifying patients at risk of NOMI post-cardiac surgery.