Evidence map›Paper›PMID 37552379›Full record

ArticleAnnals of intensive care2023

Angiopoietin-2 is associated with capillary leak and predicts complications after cardiac surgery.

Jakob Wollborn, Zilu Zhang, Julie Gaa, Moritz Gentner, Christian Hausmann, Felix Saenger, Karina Weise, Samuel Justice, Jean-Luca Funk, Hans Felix Staehle and 11 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of intensive care, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed, 1 pooled it
3.6field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

15 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Review
  6. Article
  7. Review
  8. Article
  9. Article
  10. Review
  11. Systemic capillary leak syndrome.Nature reviews. Disease primers · 2024
    Review
  12. Review
  13. Angiopoietin-2 associates with poor prognosis in Moyamoya angiopathy.Annals of clinical and translational neurology · 2024
    Article
  14. Review
  15. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors at 5 institutions in 2 countries.

Jakob WollbornDepartment of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. jwollborn@bwh.harvard.edu.ORCID http://orcid.org/0000-0002-6767-7978
Zilu ZhangDepartment of Biomedical Engineering, Duke University, Durham, NC, USA.
Julie GaaDepartment of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany.
Moritz GentnerDepartment of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany.
Christian HausmannDepartment of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany.
Felix SaengerDepartment of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany.
Karina WeiseDepartment of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany.
Samuel JusticeDepartment of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Jean-Luca FunkDepartment of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany.
Hans Felix StaehleDepartment of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany.
Marie ThomasDepartment of Cardiovascular Surgery, Medical Center, University of Freiburg, Freiburg, Germany.
Raphael R BrunoDepartment of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Hospital Duesseldorf, Duesseldorf, Germany.
Babak SaraviDepartment of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Jan O FriessDepartment of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA.
Markus MarxDepartment of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany.
Hartmut BuerkleDepartment of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany.
Georg TrummerDepartment of Cardiovascular Surgery, Medical Center, University of Freiburg, Freiburg, Germany.
Jochen D MuehlschlegelDepartment of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Daniel RekerDepartment of Biomedical Engineering, Duke University, Durham, NC, USA.
Ulrich Goebel *Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany.
Felix Ulbrich *Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany.
University of Freiburg · DEBrigham and Women's Hospital · USDuke University · USBoston Children's Hospital · USDüsseldorf University Hospital · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPatients undergoing cardiac surgery are prone to numerous complications. Increased vascular permeability may be associated with morbidity and mortality due to hemodynamic instability, fluid overload, and edema formation. We hypothesized that markers of endothelial injury and inflammation are associated with capillary leak, ultimately increasing the risk of postoperative complications.

methodsIn this prospective, observational, multidisciplinary cohort study at our tertiary academic medical center, we recruited 405 cardiac surgery patients. Patients were assessed daily using body impedance electrical analysis, ultrasound, sublingual intravital microscopy, and analysis of serum biomarkers. Multivariable models, as well as machine learning, were used to study the association of angiopoietin-2 with extracellular water as well as common complications after cardiac surgery.

resultsThe majority of patients underwent coronary artery bypass grafting, valvular, or aortic surgeries. Across the groups, extracellular water increased postoperatively (20 ± 6 preoperatively to 29 ± 7L on postoperative day 2; P < 0.001). Concomitantly, the levels of the biomarker angiopoietin-2 rose, showing a strong correlation based on the time points of measurements (r = 0.959, P = 0.041). Inflammatory (IL-6, IL-8, CRP) and endothelial biomarkers (VE-Cadherin, syndecan-1, ICAM-1) suggestive of capillary leak were increased. After controlling for common risk factors of edema formation, we found that an increase of 1 ng/mL in angiopoietin-2 was associated with a 0.24L increase in extracellular water (P < 0.001). Angiopoietin-2 showed increased odds for the development of acute kidney injury (OR 1.095 [95% CI 1.032, 1.169]; P = 0.004) and was furthermore associated with delayed extubation, longer time in the ICU, and a higher chance of prolonged dependence on vasoactive medication. Machine learning predicted postoperative complications when capillary leak was added to standard risk factors.

conclusionsCapillary leak and subsequent edema formation are relevant problems after cardiac surgery. Levels of angiopoietin-2 in combination with extracellular water show promising potential to predict postoperative complications after cardiac surgery. TRIAL REGISTRATION NUMBER: German Clinical Trials Registry (DRKS No. 00017057), Date of registration 05/04/2019, www.drks.de.

Indexed as

Acute kidney injuryAngiopoietin-2Capillary leak syndromeCardiac surgeryCritical careEndothelial permeabilityFluid balance

Identifiers

PMID37552379
PMCPMC10409979
OpenAlexW4385664583

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.