{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:33:56Z","timestamp":1788878036386,"version":"build-2803163510"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T00:00:00Z","timestamp":1704240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Acute kidney injury (AKI) is a frequent perioperative complication. The underlying mechanisms of cardiac surgery-associated AKI are still not completely elucidated. Cold-induced RNA-binding protein (CIRP) has been subsequently found to be regulated by various stress conditions. During cardiac surgery and cardiopulmonary bypass (CPB), the host is subjected to hypothermia and inadequate organ perfusion, resulting in an upregulation of CIRP secretion. The aim of this study is to evaluate the role of elevated extracellular CIRP level as a contributing factor in the development of AKI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 292 patients who underwent cardiac surgery were retrospectively enrolled and their serum samples were collected preoperative and postoperative. Demographic data, intraoperative data, in-hospital outcomes, and the occurrence of AKI were also collected for the patients. The correlation between CIRP and intraoperative procedures, as well as its association with postoperative outcomes were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In multivariable analysis, higher \u0394CIRP (<jats:italic>p<\/jats:italic>\u2009=\u20090.036) and body mass index (<jats:italic>p<\/jats:italic>\u2009=\u20090.015) were independent risk factors for postoperative AKI. Meanwhile, patients with postoperative AKI exhibited lower survival rate in 2-year follow-up (<jats:italic>p<\/jats:italic>\u2009=\u20090.008). Compared to off-pump coronary artery bypass grafting surgery, patients who underwent on-pump coronary artery bypass grafting, valve surgery, aortic dissection and other surgery showed higher \u0394CIRP, measuring 1,093, 666, 914 and 258\u2009pg\/mL, respectively (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). The levels of \u0394CIRP were significantly higher in patients who underwent CPB compared to those who did not (793.0\u2009\u00b1\u2009648.7 vs. 149.5\u2009\u00b1\u2009289.1\u2009pg\/mL, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). Correlation analysis revealed a positive correlation between \u0394CIRP levels and the duration of CPB (<jats:italic>r<\/jats:italic>\u2009=\u20090.502, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). Patients with higher CIRP levels are at greater risk of postoperative AKI (OR: 1.67, <jats:italic>p<\/jats:italic>\u2009=\u20090.032), especially the stage 2\u20133 AKI (OR: 2.11, <jats:italic>p<\/jats:italic>\u2009=\u20090.037).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>CIRP secretion increases with prolonged CPB time after cardiac surgery, and CIRP secretion is positively correlated with the duration of CPB. Cardiac surgeries with CPB exhibited significantly higher levels of CIRP compared to non-CPB surgeries. Elevation of CIRP level is an independent risk factor for the incidence of AKI, especially the severe AKI, and were associated with adverse in-hospital outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2023.1258622","type":"journal-article","created":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T04:20:46Z","timestamp":1704255646000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Serum CIRP increases the risk of acute kidney injury after cardiac surgery"],"prefix":"10.3389","volume":"10","author":[{"given":"Zhe","family":"Feng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiantong","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changying","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jialan","family":"Niu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjun","family":"Hao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinglong","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,1,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1097\/01.aco.0000192773.86656.bf","article-title":"Cellular inflammatory response and clinical outcome in cardiac surgery","volume":"19","author":"Rinder","year":"2006","journal-title":"Curr Opin Anesthesiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"II195","DOI":"10.1161\/01.cir.0000087441.48566.0d","article-title":"The -174G\/C interleukin-6 polymorphism influences postoperative interleukin-6 levels and postoperative atrial fibrillation. Is atrial fibrillation an inflammatory complication?","volume":"108","author":"Gaudino","year":"2003","journal-title":"Circulation"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1186\/s13054-016-1208-6","article-title":"36th international symposium on intensive care and emergency medicine Brussels, Belgium. 15-18 March 2016","volume":"20","author":"Bateman","year":"2016","journal-title":"Crit Care"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1046\/j.1460-9592.2003.01069.x","article-title":"Chemokines and the inflammatory response following cardiopulmonary bypass--a new target for therapeutic intervention?--a review","volume":"13","author":"Ben-Abraham","year":"2003","journal-title":"Paediatr Anaesth"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2799","DOI":"10.1002\/cphy.c210019","article-title":"Renal and cerebral hypoxia and inflammation during cardiopulmonary 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