Background: Acute lung injury (ALI) induced by cardiopulmonary bypass (CPB, CPB-ALI) is a common and serious\ncomplication after cardiac surgery. And infants and young children are more prone to CPB-ALI. The purpose of this\nstudy was to investigate the perioperative changes of plasma gelsolin (pGSN) in patients below 3years of age with\ncardiac surgeries and CPB, and determine whether pGSN are associated with the occurrence and severity of\nCPB-ALI.\nMethods: Seventy-seven consecutive patients ?3 years of age with congenital heart diseases (CHD) performed on\nopen heart surgery with CPB were finally enrolled, and assigned to ALI and non-ALI groups according to the\nAmerican-European Consensus Criteria. Plasma concentrations of gelsolin and total protein were measured at\nfollowing 8 time points: before CPB (a), after CPB (b), 2 hours after CPB (c), 6 hours after CPB (d), 12 hours after\nCPB (e), 24 hours after CPB (f), 48 hours after CPB (g) and 72 hours after CPB (h).\nResults: Twenty-seven (35.1%) patients developed CPB-ALI in the study, including eleven (14.3%) patients with\nARDS. The earliest significant drop of pGSN and normalized pGSN (pGSNN) of ALI group both occurred at 6 hours\nafter CPB (p = 0.04 and p < 0.01), which was much earlier than those of non-ALI group (48 hours, p = 0.03 and\n24 hours, p < 0.01); PGSN of ALI group before CPB and 6 hours after CPB were both significantly lower than those\nof non-ALI group (p < 0.01); PGSNN of ALI group before CPB and 6 hours after CPB were both significantly lower\nthan those of non-ALI group (p < 0.01, p = 0.04); PGSN before CPB was the only independent risk factor predicting\nthe occurrence of CPB-ALI (OR, 1.023; 95% CI, 1.007-1.039; p < 0.01) with an AUC of 0.753 (95% CI, 0.626-0.880); The\noptimal cutoff value of pGSN before CPB was 264.2 mg/L, with a sensitivity of 58.3% and a specificity 94.7%. And\nlower pGSN before CPB was significantly associated with the severity of CS-AKI (r = ?0.45, p < 0.01).\nConclusions: Patients developing CPB-ALI had lower plasma gelsolin reservoir and a much more amount and rapid\nconsumption of plasma gelsolin early after operation. PGSN before CPB was an early and sensitive predictor of\nCPB-ALI in infants and young children undergoing cardiac surgery, and was negatively correlated with the\nseverity of CPB-ALI.
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