Association of Preoperative Basal Inflammatory State, Measured by Plasma suPAR Levels, with Intraoperative Sublingual Microvascular Perfusion in Patients Undergoing Major Non-Cardiac Surgery

It remains unknown whether chronic systemic inflammation is associated with impaired microvascular perfusion during surgery. We evaluated the association between the preoperative basal inflammatory state, measured by plasma soluble urokinase-type plasminogen activator receptor (suPAR) levels, and intraoperative sublingual microcirculatory variables in patients undergoing major non-cardiac surgery. Plasma suPAR levels were determined in 100 non-cardiac surgery patients using the suPARnostic (R) quick triage lateral flow assay. We assessed sublingual microcirculation before surgical incision and every 30 min during surgery using Sidestream Darkfield (SDF+) imaging and determined the De Backer score, the Consensus Proportion of Perfused Vessels (Consensus PPV), and the Consensus PPV (small). Elevated suPAR levels were associated with lower intraoperative De Backer score, Consensus PPV, and Consensus PPV (small). For each ng mL(-1) increase in suPAR, De Backer score, Consensus PPV, and Consensus PPV (small) decreased by 0.7 mm(-1), 2.5%, and 2.8%, respectively, compared to baseline. In contrast, CRP was not significantly correlated with De Backer score (r = -0.034, p = 0.36), Consensus PPV (r = -0.014, p = 0.72) or Consensus PPV Small (r = -0.037, p = 0.32). Postoperative De Backer score did not change significantly from baseline (5.95 +/- 3.21 vs. 5.89 +/- 3.36, p = 0.404), while postoperative Consensus PPV (83.49 +/- 11.5 vs. 81.15 +/- 11.8, p < 0.001) and Consensus PPV (small) (80.87 +/- 13.4 vs. 78.72 +/- 13, p < 0.001) decreased significantly from baseline. In conclusion, elevated preoperative suPAR levels were associated with intraoperative impairment of sublingual microvascular perfusion in patients undergoing elective major non-cardiac surgery.

Automated summary

This study found that elevated preoperative plasma suPAR levels were associated with intraoperative impairment of sublingual microvascular perfusion in patients undergoing major non-cardiac surgery. Specifically, higher suPAR levels were correlated with lower De Backer score, Consensus PPV, and Consensus PPV (small) during surgery.