The following is a summary of “Angiopoietin-2 is associated with capillary leak and predicts complications after cardiac surgery,” published in the August 2023 issue of Critical Care by Wollborn et al.

Potential issues include unstable blood flow, excessive fluid, and swelling in cardiac surgery patients. Researchers performed a cohort study testing our hypothesis that endothelial injury and inflammation markers correlate with a capillary leak, heightening the chance of postoperative complications.

They enrolled 405 cardiac surgery patients at tertiary academic medical centers. Daily evaluations employed body impedance electrical analysis, ultrasound, sublingual intravital microscopy, and serum biomarker analysis. Multivariable models and machine learning explored the relationship between angiopoietin-2, extracellular water, and post-cardiac surgery complications.

The results showed the patient cohort predominantly underwent coronary artery bypass grafting and valvular or aortic surgeries. Post-surgery, extracellular water rose from 20 ± 6 to 29 ± 7L by postoperative day 2 (P<0.001). Angiopoietin-2 biomarker showed a substantial increase, strongly correlating with measurement time points (r = 0.959, P=0.041). Inflammatory (IL-6, IL-8, CRP) and endothelial (VE-Cadherin, syndecan-1, ICAM-1) capillary leak biomarkers exhibited elevated levels. Adjusted for common edema factors, 1 ng/mL higher angiopoietin-2 linked to 0.24L increased extracellular water (P<0.001).Angiopoietin-2 is linked to increased odds of acute kidney injury, delayed extubation, longer ICU stays, and prolonged need for vasoactive medication (OR 1.095 [95% CI 1.032, 1.169]; P=0.004). Machine learning integrated capillary leak and standard risk factors to predict postoperative complications.

They concluded capillary leak and edema formation are relevant problems after cardiac surgery, predicting complications.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-023-01165-2