Serum level of growth-related oncogene alpha during abdominal aortic aneurysm repair in humans

Introduction

High postoperative mortality in patients after open elective aortic abdominal aneurysm (AAA) repair is thought to be the effect of ischemia-reperfusion organ injury followed by Multiple Organ Dysfunction Score. Neutrophils appear to be predominant leukocytes that are important in mediating ischemia-reperfusion injury and organ damage. Growth-related oncogene alpha (GROα) (CXCL1) is the chemokine with potent chemotactic activity for neutrophils. The aim of this study was to determine changes in serum GROα concentrations in the course of ischemia-reperfusion during AAA repair.

Methods

Blood samples were taken before surgery (Preop), before unclamping of the aorta (Pre-Xoff), 90 minutes after unclamping (90 min-Xoff) and 24 hours after surgery. GROα serum concentrations were measured with the ELISA technique.

Results

Seventeen patients, all men, with median age 65 (range 44–76) years undergoing AAA repair and a control group comprised of 11 volunteers, all men, were included in the study. Nine patients made an uncomplicated recovery, eight (47%) developed complications and four of them (24% of all) died. During AAA repair the GROα level decreased from 79 pg/ml at Preop and 76 pg/ml at Pre-Xoff to the lowest value of 61 pg/ml at 90 min-Xoff (P = 0.308 vs Preop), followed by an increase to 100 pg/ml 24 hours after operation (P = 0.055 vs 90 min-Xoff). Contrary to the uncomplicated group, in death and complicated cases there was no depletion of GROα levels during surgery, but the rise of its level to 137 pg/ml (P = 0.144 vs Preop) and 133 pg/ml (P = 0.86 vs Preop), respectively, was observed 24 hours after surgery. There was significant positive correlation between GROα level and Multiple Organ Dysfunction Score (r = 0.417), calculated on the second day after AAA repair.

Conclusion

Serum GROα concentrations decreased in the course of ischemia-reperfusion during AAA repair in uncomplicated patients. The lack of depletion of the chemokine level during surgery and its high value after AAA repair were associated with the development of postoperative organ dysfunction and death.