Daily Anesthesiology Research Analysis
Three impactful studies in anesthesiology and perioperative/critical care emerged today: a single-cell atlas of immune-cell states in PICS after sepsis, a timely retrospective cohort linking GLP-1 receptor agonist use to increased retained gastric contents at upper endoscopy without more anesthesia adverse events, and a very large perioperative cohort showing unexpected eGFR improvement in CKD patients unless postoperative AKI occurs. Together, these works refine perioperative risk stratificatio
Summary
Three impactful studies in anesthesiology and perioperative/critical care emerged today: a single-cell atlas of immune-cell states in PICS after sepsis, a timely retrospective cohort linking GLP-1 receptor agonist use to increased retained gastric contents at upper endoscopy without more anesthesia adverse events, and a very large perioperative cohort showing unexpected eGFR improvement in CKD patients unless postoperative AKI occurs. Together, these works refine perioperative risk stratification, anesthetic planning, and mechanistic understanding of post-sepsis trajectories.
Research Themes
- Post-sepsis immune dysregulation and PICS mechanisms
- Periprocedural management with GLP-1 receptor agonists and aspiration risk
- Perioperative kidney outcomes and AKI-modified trajectories in CKD
Selected Articles
1. Immune-cell signatures of persistent inflammation, immunosuppression, and catabolism syndrome after sepsis.
Single-cell profiling reveals that specific monocyte subsets (Mono1/Mono4) in PICS exhibit immunosuppressive and pro-apoptotic interactions with B and CD8 T cells. PICS features reduced naive/memory B cells, expanded plasma cells, prognostically favorable active memory B/IGHA1 plasma cell signatures, dysfunctional proliferative CD8TEMRA in deaths, and proliferative megakaryocytes; key findings were validated in murine models.
Impact: Provides a mechanistically rich, single-cell atlas of PICS that identifies prognostic immune-cell states and potential therapeutic targets, bridging ICU clinical phenotypes with cellular programs.
Clinical Implications: Immune-cell signatures (e.g., active memory B/IGHA1 plasma cells vs. dysfunctional CD8TEMRA) may enable risk stratification and inform targeted immunomodulatory strategies in post-sepsis patients.
Key Findings
- Monocyte subsets Mono1/Mono4 show immunosuppressive and pro-apoptotic effects on B and CD8 T cells in PICS.
- PICS exhibits reduced naive/memory B cells, expanded plasma cells, and a more active antigen-processing signature in B cells than sepsis.
- Better PICS prognosis associates with active memory B cells and IGHA1 plasma cells; deaths show proliferative, dysfunctional CD8TEMRA.
- Megakaryocyte proliferation and immunomodulatory changes are prominent in PICS and validated in murine models.
Methodological Strengths
- Single-cell resolution profiling with detailed immune subset characterization
- Cross-validation in murine CLP PICS models supports translational relevance
Limitations
- Observational design limits causal inference
- Sample size and external generalizability are not detailed in the abstract
Future Directions: Prospective validation of prognostic immune signatures, interventional trials targeting identified pathways (e.g., CD8TEMRA dysfunction, B-cell programs), and integration with clinical risk scores.
BACKGROUND: Management of persistent inflammation, immunosuppression, and catabolism syndrome (PICS) after sepsis remains challenging for patients in the intensive care unit, experiencing poor quality of life and death. However, immune-cell signatures in patients with PICS after sepsis remain unclear. METHODS: We determined immune-cell signatures of PICS after sepsis at single-cell resolution. Murine cecal ligation and puncture models of PICS were applied for validation. FINDINGS: Immune functions of two enriched monocyte subpopulations, Mono1 and Mono4, were suppressed substantially in patients with sepsis and were partially restored in patients with PICS after sepsis and exhibited immunosuppressive and pro-apoptotic effects on B and CD8T cells. Patients with PICS and sepsis had reduced naive and memory B cells and proliferated plasma cells. Besides, naive and memory B cells in patients with PICS showed an active antigen processing and presentation gene signature compared to those with sepsis. PICS patients with better prognoses exhibited more active memory B cells and IGHA1-plasma cells. CD8TEMRA displayed signs of proliferation and immune dysfunction in the PICS-death group in contrast with the PICS-alive group. Megakaryocytes proliferation was more pronounced in patients with PICS and sepsis than in healthy controls, with notable changes in the anti-inflammatory and immunomodulatory effects observed in patients with PICS and verified in mice models. CONCLUSIONS: Our study evaluated PICS after sepsis at the single-cell level, identifying the heterogeneity present within immune-cell subsets, facilitating the prediction of disease progression and the development of effective intervention. FUNDING: This work was supported by the National Natural Science Foundation of China, Shanghai Municipal Health Commission "Yiyuan New Star" Youth Medical Talent Cultivating Program, and Shanghai Clinical Research Center for Anesthesiology.
2. Endoscopy and anesthesia outcomes associated with glucagon-like peptide-1 receptor agonist use in patients undergoing outpatient upper endoscopy.
Among 598 outpatients, GLP-1RA exposure (≥6 weeks) was associated with markedly higher odds of solid retained gastric contents and more aborted upper endoscopic procedures, without increased hypoxia or aspiration. No excess risk was observed when colonoscopy was performed concurrently.
Impact: Addresses a high-visibility, practice-changing question about GLP-1RA peri-procedural management, informing fasting policies and anesthesia planning for endoscopy.
Clinical Implications: Consider pre-procedural risk mitigation (e.g., modified fasting, gastric ultrasound, temporary GLP-1RA hold, or scheduling adjustments) for upper endoscopy; anesthesia teams should anticipate RGC and plan airway/aspiration precautions while balancing glycemic control.
Key Findings
- GLP-1RA use increased the odds of solid retained gastric contents during upper endoscopy (adjusted OR 3.80, 95% CI 1.57–9.21).
- Higher rate of aborted procedures in GLP-1RA users (1.3% vs 0%).
- No increase in anesthesia adverse events (similar hypoxia rates) and no pulmonary aspiration observed.
- No increased risk when colonoscopy was performed concurrently.
Methodological Strengths
- Pharmacy-documented exposure window (≥6 weeks) reduces misclassification
- Multivariable analysis adjusting for key confounders and procedure characteristics
Limitations
- Single-center retrospective design with potential residual confounding (e.g., diabetes imbalance)
- Low event rates for anesthesia complications limit precision for rare outcomes like aspiration
Future Directions: Prospective multicenter studies and randomized peri-procedural management strategies (e.g., gastric ultrasound-guided pathways) to quantify aspiration risk and optimize fasting/medication protocols.
BACKGROUND AND AIMS: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) can cause delayed gastric emptying, raising concern for retained gastric contents (RGC) during endoscopy and adverse anesthesia events. The aim of this study was to determine associations between GLP-1RA and endoscopy and anesthesia outcomes. METHODS: This single-center, retrospective cohort study examined patients prescribed GLP-1RAs who underwent outpatient endoscopy stratified according to exposure at the time of endoscopy. The GLP-1RA group had ≥6 weeks of exposure as confirmed by pharmacy dispensation reports. The control group were patients not taking GLP-1RAs at the time of endoscopy (prescription never filled, discontinued ≥6 weeks prior, or started postendoscopy). The outcomes were the presence of solid RGC, aborted procedures, or any adverse anesthesia events. RESULTS: A total of 598 patients were included in the study; 360 were taking GLP-1RAs, and 298 were control subjects. Baseline characteristics, including age, sex, chronic opiate use, gastroparesis, and prior gastric surgery, were similar, but diabetes mellitus was more prevalent in the GLP-1RA group (68% vs 57%; P = .005). The odds of solid RGC was significantly higher in the GLP-1RA group in multivariate analysis (odds ratio, 3.80; 95% confidence interval, 1.57-9.21; P = .003), but odds were not increased in patients undergoing concurrent colonoscopy. More patients in the GLP-1RA group had procedures aborted (1.3% vs 0%; P = .021), but rates of hypoxia were similar (.2% vs .3%; P = .341). There were no cases of pulmonary aspiration. CONCLUSIONS: Patients taking GLP-1RAs have increased rates of solid RGC during upper endoscopy (but not with concurrent colonoscopy) and higher rates of aborted procedures but similar rates of adverse anesthesia events.
3. Progression of chronic kidney disease after non-cardiac surgery: A retrospective cohort study.
In 58,175 noncardiac surgical cases, preoperative CKD patients showed significant eGFR improvement at 1–2 years, while non-CKD patients showed minimal change. Postoperative AKI negated gains in CKD and worsened long-term kidney function in non-CKD, highlighting AKI as a key modifier of postoperative renal trajectory.
Impact: Challenges prevailing assumptions about inevitable CKD decline after surgery and quantifies how AKI shapes long-term renal outcomes, informing perioperative risk discussions and follow-up strategies.
Clinical Implications: Focus perioperative protocols on AKI prevention (hemodynamic optimization, nephrotoxin avoidance) and arrange targeted follow-up, especially for CKD patients, recognizing potential for renal recovery absent AKI.
Key Findings
- Among 58,175 cases, CKD patients’ mean eGFR improved from 45.6 to 55.6 mL/min/1.73m2 at 1–2 years.
- Non-CKD patients showed minimal mean eGFR change (90.1 to 92.0).
- Postoperative AKI significantly modified outcomes: in CKD, AKI reduced eGFR gains; in non-CKD, AKI led to eGFR declines proportional to AKI severity.
Methodological Strengths
- Very large sample size with standardized lab-based outcome (eGFR)
- Interaction analysis quantifying AKI’s modifying effect on long-term kidney function
Limitations
- Single-center retrospective design with potential residual confounding and selection bias
- eGFR changes may reflect perioperative care shifts (medications, hemodynamics) not fully captured
Future Directions: Multicenter prospective validation, mechanistic studies on renal recovery post-surgery, and interventional trials targeting AKI prevention to preserve long-term renal function.
BACKGROUND: Chronic-kidney-disease (CKD) is prevalent among adults undergoing noncardiac surgery, with surgery-related factors potentially worsening CKD or triggering acute kidney injury (AKI). We hypothesized that CKD patients experience more kidney function decline within one to two years post-surgery than those without CKD, particularly if they develop AKI. METHODS: We conducted a single-center retrospective cohort study, including noncardiac surgery patients with documented creatinine preoperative and between 1 and 2 years after surgery. The primary outcome was long-term course of kidney function, defined as the change in estimated glomerular filtration rate (eGFR) in mL/min/1.73m RESULTS: Of 58,175 included cases, 17 % had preoperative CKD. Mean eGFR changed from 90.1 ± 16.7 to 92.0 ± 18.8 in non-CKD patients and from 45.6 ± 11.9 to 55.6 ± 20.1 in patients with CKD, with an estimated difference in means of 8.9 (95 % CI: 8.5, 9.3; P < 0.0001). There was a significant interaction between CKD-dependent eGFR change from baseline to follow-up and postoperative AKI (P = 0.001). For cases with preoperative CKD, eGFR increase from baseline to follow-up was 11.7 ± 18.0 with no AKI, 7.7 ± 17.9 with AKI stage 1, 2.4 ± 15.0 with AKI stage 2, and 7.3 ± 25.8 with AKI stage 3. For non-CKD patients, eGFR increased from baseline by 2.3 ± 13.7 with no AKI but decreased by 5.5 ± 19.0 with AKI stage 1, 7.7 ± 21.8 with AKI stage 2, and 9.3 ± 21.3 with AKI stage 3. CONCLUSIONS: Contrary to expectations, patients with preoperative CKD experienced a significant improvement in eGFR postoperatively. Patients without CKD exhibited minimal change. Postoperative AKI negated the eGFR improvement in CKD patients and exacerbated the decline in non-CKD patients.