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Serum Free Fatty Acid Concentration Predicts ARDS after Off-Pump CABG: A Prospective Observational Study

  • RESEARCH
  • ACUTE RESPIRATORY DISTRESS SYNDROME AFTER CARDIAC SURGERY
  • Published:
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Abstract

Background

Free fatty acids (FFAs) are established risk factors for various cardiovascular and metabolic disorders. Elevated FFAs can trigger inflammatory response, which may be associated with the occurrence of acute respiratory distress syndrome (ARDS) in cardiac surgery. In this prospective study, we aimed to investigate the association between circulating FFA and the incidence of ARDS, as well as the length of ICU stay, in patients undergoing off-pump coronary artery bypass grafting (CABG).

Methods

We conducted a single-center, prospective, observational study among patients undergoing off-pump CABG. The primary endpoint was the occurrence of ARDS within 6 days after off-pump CABG. Serum FFA were measured at baseline and 24 h post-procedure, and the difference (Δ-FFA) was calculated.

Results

A total of 180 patients were included in the primary analysis. The median FFA was 2.3 mmol/L (quartile 1 [Q1]–Q3, 1.4–3.2) at baseline and 1.5 mmol/L (Q1–Q3, 0.9–2.3) 24 h after CABG, with a Δ-FFA of 0.6 mmol/L (Q1–Q3, -0.1 to 1.6). Patients with elevated Δ-FFA levels had a significantly higher ARDS occurrence (55.6% vs. 22.2%; P < 0.001). Elevated Δ-FFA after off-pump CABG correlated with a significantly lower PaO2/FiO2 ratio, prolonged mechanical ventilation, and extended length of ICU stay. The area under the curve (AUC) of Δ-FFA for predicting ARDS (AUC, 0.758; 95% confidence interval, 0.686–0.831) significantly exceeded the AUC of postoperative FFA (AUC, 0.708; 95% CI 0.628–0.788; P < 0.001).

Conclusions

Elevated Δ-FFA levels correlated with ARDS following off-pump CABG. Monitoring FFA may assist in identifying high-risk patients for ARDS, facilitating timely interventions to improve clinical outcomes.

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Data Availability

All data generated from this study including supporting information and Raw data are available from the corresponding author on reasonable request.

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Acknowledgements

None.

Funding

This research was supported by National Natural Science Foundation of China (No. 81573234), National Natural Science Foundation of China (No. 81773445), Key Project of Taizhou School of Clinical Medicine (No. TZKY20220304), Key Project of Jiangsu Commission of Health (No. ZDA2020004), and Ili&Jiangsu Joint Institute of Health (No. YL2022MS04).

Author information

Author notes

  1. Peng Lu, Jidan Fan and Xiangyu Li authors contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiovascular Surgery, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taihu Road 366, Taizhou, Jiangsu, 225300, China

    Peng Lu, Jidan Fan & Xiaowei Wang

  2. Department of Cardiovascular Surgery, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China

    Peng Lu, Xiangyu Li, Zhaoyang Liu, Yuanpu Qi, Zihao Shen, Ziang Wen & Xiaowei Wang

  3. Department of Cardiovascular Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou, China

    Chenlong Yi

  4. Department of Geriatrics, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China

    Meijuan Song

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  1. Peng Lu
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Contributions

M.S. and X.W. conceived and designed the study. P.L., J.F., X.Y., Z.L., Y.Q., Z.S., and Z.W. gathered the data. P.L., C.Y., and M.S. performed statistical analyses. P.L., J.F., X.L., and X.W. wrote the first draft of the manuscript. P.L., M.S., and X.W. made critical revision of the manuscript for key intellectual components. All authors provided approval of the final version of the manuscript.

Corresponding authors

Correspondence to Meijuan Song or Xiaowei Wang.

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Competing interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Ethical Approval

Ethical approval for this study was obtained from The First Affiliated Hospital with Nanjing Medical University (protocol code 2023-SR-513, 2023-03-23).

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Informed consent was obtained for all participants in this study.

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Lu, P., Fan, J., Li, X. et al. Serum Free Fatty Acid Concentration Predicts ARDS after Off-Pump CABG: A Prospective Observational Study. Lung (2024). https://doi.org/10.1007/s00408-024-00704-3

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