Contribution of damage-associated molecular patterns to transfusion-related acute lung injury in cardiac surgery.

Abstract

BACKGROUND:

The incidence of transfusion-related acute lung injury (TRALI) in cardiac surgery patients is high and this condition contributes to an adverse outcome. Damage-associated molecular pattern (DAMP) molecules, HMGB1 and S100A12, are thought to mediate inflammatory changes in acute respiratory distress syndrome. We aimed to determine whether DAMP are involved in the pathogenesis of TRALI in cardiac surgery patients.

MATERIALS AND METHODS:

This was a secondary analysis of a prospective observational trial in cardiac surgery patients admitted to the Intensive Care Unit of a university hospital in the Netherlands. Fourteen TRALI cases were randomly matched with 32 transfused and non-transfused controls. Pulmonary levels of HMGB1, S100A12 and inflammatory cytokines (interleukins-1β, -6, and -8 and tumour necrosis factor-α) were determined when TRALI evolved. In addition, systemic and pulmonary levels of soluble receptor for advanced glycation end products (sRAGE) were determined.

RESULTS:

HMGB1 expression and levels of sRAGE in TRALI patients did not differ from those in controls. There was a trend towards higher S100A12 levels in TRALI patients compared to the controls. Furthermore, S100A12 levels were associated with increased levels of markers of pulmonary inflammation, prolonged cardiopulmonary bypass, hypoxemia and duration of mechanical ventilation.

CONCLUSION:

No evidence was found that HMGB1 and sRAGE contribute to the development of TRALI. S100A12 is associated with duration of cardiopulmonary bypass, pulmonary inflammation, hypoxia and prolonged mechanical ventilation and may contribute to acute lung injury in cardiac surgery patients.

• Authors: Marcella C A Müller, Pieter R Tuinman, Alexander P Vlaar, Anita M Tuip, Kelly Maijoor, Achmed Achouiti, Cornelis Van t Veer, Margreeth B Vroom, Nicole P Juffermans
• Journal: Blood transfusion = Trasfusione del sangue (Blood Transfus) Vol. 12 Issue 3 Pg. 368-75 (Jul 2014) ISSN: 2385-2070 [Electronic] Italy
• PMID: 24887223 (Publication Type: Comparative Study, Journal Article, Observational Study, Randomized Controlled Trial)

Chemical References

• Cytokines
• HMGB1 Protein
• HMGB1 protein, human
• Receptor for Advanced Glycation End Products
• Receptors, Immunologic
• S100 Proteins
• S100A12 Protein
• S100A12 protein, human

Topics

• Acute Lung Injury (blood, etiology)
• Aged
• Aged, 80 and over
• Cardiac Surgical Procedures
• Cardiopulmonary Bypass (adverse effects)
• Cytokines (blood)
• Female
• HMGB1 Protein (blood)
• Humans
• Male
• Middle Aged
• Pneumonia, Ventilator-Associated (blood)
• Prospective Studies
• Receptor for Advanced Glycation End Products
• Receptors, Immunologic (blood)
• Respiratory Distress Syndrome (blood, etiology)
• S100 Proteins (blood)
• S100A12 Protein
• Transfusion Reaction