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Title: An investigation into the balance of pro- and anti-inflammatory cytokines in cardiac surgery and hip fracture surgery
Author: McLean, Gavin W.
ISNI:       0000 0004 6494 377X
Awarding Body: Queen's University Belfast
Current Institution: Queen's University Belfast
Date of Award: 2017
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The aim of this study was to investigate the balance of pro- and anti-inflammatory cytokines in patients undergoing cardiac and hip fracture surgery in relation to the development of postoperative acute kidney injury (AKI). 400 patients undergoing elective cardiac surgery and 237 patients undergoing emergency hip fracture surgery were recruited. For each patient blood and urine samples were analysed preoperatively and postoperatively to determine how cytokine balance alters in those patients who develop postoperative AKI. In both patients groups, the balance of pro- and anti-inflammatory cytokines in the blood was maintained, regardless of whether or not the patient developed postoperative AKI. This demonstrates that the underlying process responsible for AKI in these patients was not located within the systemic circulation. In the cardiac surgery patients who developed postoperative AKI, it was found that there was a local imbalance of pro- and anti-inflammatory cytokines in the urine, indicating that the pathological cause of AKI is located within the kidney. What was observed was an inadequate anti-inflammatory response to the pro-inflammatory insult of surgery, thus, leaving the kidney vulnerable to the pro- inflammatory onslaught and, subsequently renal injury. A different picture was seen in the hip fracture patients, where elevated pro- and anti-inflammatory mediators were observed preoperatively due to the trauma that occurred in sustaining the hip fracture. This showed an important finding that the hip fracture patients had been undergone cytokine preconditioning as a result of trauma, prior to surgery. In this group the cytokines behaved quite differently to the cardiac surgery group. In the absence of preconditioning, postoperative AKI is associated with an inadequate anti- inflammatory cytokine response to the pro-inflammatory rise associated with surgery. However, when preconditioning is present, the cytokine levels must be analysed more carefully with the clinical context in mind.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available