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The following is a summary of “High-density lipoprotein anti-inflammatory capacity and acute kidney injury after cardiac and vascular surgery: A prospective observational study,” published in the October 2024 issue of Critical Care by Perkins et al. 

Acute kidney injury (AKI) was found to predict mortality after cardiac and vascular surgery, while higher preoperative high-density lipoprotein (HDL) levels were linked with a reduced risk of postoperative AKI.  

Researchers conducted a retrospective study to assess the statistical relationship between HDL anti-inflammatory capacity and AKI following major cardiac and vascular surgery.  

They collected apolipoprotein B-depleted serum at anesthetic induction and incubated it with human endothelial cells stimulated by tumor necrosis factor alpha. A reverse transcriptase-polymerase chain reaction was performed to quantify intercellular adhesion molecule-1 (ICAM-1) messenger RNA. Enzyme-linked immunosorbent assays measured apolipoprotein A-I and postoperative soluble ICAM-1 concentrations in plasma samples from patients.  

The results showed that HDL concentration did not correlate with its ability to suppress ICAM-1 expression (Spearman R = 0.05; P = 0.64), and 12 participants (12%) had dysfunctional, pro-inflammatory HDL. Those with pro-inflammatory HDL had a higher incidence of postoperative AKI compared to those with anti-inflammatory HDL (P = 0.046). After adjusting for AKI risk factors, greater preoperative HDL capacity to suppress ICAM-1 was independently linked to lower odds of AKI (odds ratio, 0.88; 95% CI, 0.80–0.98; P = 0.016). This association was independent of HDL concentration (P = 0.018), and a higher long-term statin dose correlated with increased HDL capacity to suppress ICAM-1 (P = 0.045).  

They concluded that individuals with chronic kidney disease undergoing cardiac and vascular surgery with pro-inflammatory HDL faced a higher risk of postoperative AKI, while those with greater HDL anti-inflammatory capacity had a lower risk of AKI, regardless of HDL concentration. 

Source: journals.lww.com/ccmjournal/abstract/9900/high_density_lipoprotein_anti_inflammatory.391.aspx