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ORIGINAL RESEARCH article

Front. Endocrinol.
Sec. Renal Endocrinology
Volume 15 - 2024 | doi: 10.3389/fendo.2024.1441632

Blood and urinary cytokine balance and renal outcomes at orthopaedic surgery

Provisionally accepted
William T McBride William T McBride 1Mary Jo Kurth Mary Jo Kurth 2Joanne Watt Joanne Watt 2Allister Irvine Allister Irvine 2Anna Domanska Anna Domanska 2Gavin McLean Gavin McLean 1John V Lamont John V Lamont 2Peter Fitzgerald Peter Fitzgerald 2Mark W Ruddock Mark W Ruddock 2*
  • 1 Department of Cardiac Anaesthesia, Belfast Health and Social Care Trust, Belfast, United Kingdom
  • 2 Randox Laboratories Limited, Crumlin, United Kingdom

The final, formatted version of the article will be published soon.

    Abstract Background: In patients undergoing orthopaedic trauma surgery, acute kidney injury (AKI) can develop post-operatively and is a major cause of increased mortality and hospital stay time. Development of AKI is associated with three main processes: inflammation, ischaemia-reperfusion injury (IRI) and hypoperfusion. In this study, we investigated whether ratios of urine and blood anti-inflammatory biomarkers and biomarkers of hypoperfusion, IRI and inflammation are elevated in patients who develop post-trauma orthopaedic surgery acute kidney injury (PTOS-AKI). Methods: Blood and urinary biomarkers of inflammation, hypoperfusion and IRI were analysed in 237 patients undergoing orthopaedic fracture surgery pre- and post-operatively. Biomarker ratios were compared between non-PTOS-AKI and PTOS-AKI patients. Results: Multiple inflammatory biomarkers were significantly elevated in PTOS-AKI patients compared to non-PTOS-AKI patients. When urine anti-inflammatory biomarkers were expressed as biomarker ratios with biomarkers of inflammation, hypoperfusion and IRI, multiple ratios were lower in PTOS-AKI patients. In contrast, blood anti-inflammatory biomarkers when expressed as ratios with blood proinflammatory biomarkers were elevated in PTOS-AKI patients. Discussion: Reductions in ratios of urine anti-inflammatory and proinflammatory biomarkers in PTOS-AKI patients suggest that the renal anti-inflammatory response is protective against the proinflammatory response in patients who do not develop PTOS-AKI. Detection of proinflammatory and anti-inflammatory biomarkers both pre- and post-operatively may be useful in detecting patients at risk of developing AKI after orthopaedic surgery.

    Keywords: Acute Kidney Injury, biomarkers, Cytokines, Orthopaedic surgery, STNFR1, sTNFR2, H-FABP, midkine

    Received: 31 May 2024; Accepted: 29 Nov 2024.

    Copyright: © 2024 McBride, Kurth, Watt, Irvine, Domanska, McLean, Lamont, Fitzgerald and Ruddock. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Mark W Ruddock, Randox Laboratories Limited, Crumlin, BT29 4QY, United Kingdom

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.