The balance of pro- and anti-inflammatory cytokines in cardiac surgery

Profile of Urinary Cytokines in Kawasaki Disease: Non-Invasive Markers

This cohort study aimed to investigate urinary cytokines expression to help identify a less invasive method of cytokine detection for Kawasaki disease (KD). Patients with confirmed KD were recruited. Patients with fever or urinary tract infection (UTI) were enrolled as control groups. Urinary samples were collected before and 3 days after intravenous immunoglobulin (IVIG) treatment. The levels of cytokines were detected by MILLPLEX^® MAP human multiplex assay. All cytokines, i.e., epidermal growth factor (EGF), interferon (IFN)-γ, interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-9, IL-10, IL-13, IL-17A, IL-33, interferon-gamma-induced protein (IP)-10, macrophage inflammatory protein (MIP)-1β, tumor necrosis factor (TNF)-α, and vascular endothelial growth factor (VEGF) except monocyte chemoattractant protein (MCP)-1 were significantly higher in the KD group, compared with the fever-control (FC) group, whereas the expressions of IFN-γ, IL-1β, IL-6, IL-8, IL-17A, IL-33, MCP-1, MIP-1β, and TNF-α were significantly lower in the urine of KD patients, as compared with the UTI group. The expressions of EGF, IFN-γ, IL-8, IL-13, and IL-17A were higher in the urine of KD patients than in the FC group, whereas the level of IL-1β was lower in KD than in the UTI group after age adjustment by logistic regression. Levels of IL-6, IL-8, IL-13, IP-10, and MCP-1 were significantly higher in the pre-IVIG urine of KD patients than in the post-IVIG treatment group. Additionally, urine IL-4 and blood C-reactive protein were higher in the KD group with coronary artery lesion (CAL) than in the non-CAL group. Results of this study provide a new view of urinary cytokine expression in the disease progress of KD, which may help clinicians to predict and prevent morbidity early and non-invasively.

The Relationship Between Serum Concentration of Interleukin-35 and FoxP3 Polymorphism in Patients Undergoing Coronary Artery Bypass Graft Surgery

Objective

To investigate the association between interleukin-35 (IL-35) levels and single nucleotide polymorphisms (rs3761548, rs3761547) of the FoxP3 gene in coronary artery bypass grafting (CABG) patients.

Methods

We conducted a prospective study including 140 patients, who were scheduled for elective isolated on-pump CABG with cardiopulmonary bypass (CPB) from January 2017 to September 2018 in the Jorjani heart center. Blood samples were collected before and 12 hours after the operation. Serum levels of IL-35 were measured by enzyme-linked immunosorbent assay and the pattern of genetic variations was assessed using single specific primer-polymerase chain reaction.

Results

The serum concentrations of IL-35 after surgery were significantly higher than pre-surgery levels (18.4±8.3 vs. 9.89±3.2, respectively, P=0.002). There was no significant association between genotype frequencies of rs3761548 and rs3761547 and elevated IL-35 levels (P>0.05). There were significant associations between IL-35 levels and preoperative variables, including age (r=-0.34, P=0.047) and body mass index (r=-0.41, P=0.045), and intraoperative variables, including CPB time (r=0.4, P=0.02) and mean arterial pressure (r=-0.38, P=0.046), in carriers of the rs3761548 AA genotype.

Conclusion

Serum IL-35 concentrations were significantly increased in CPB patients, which may contribute to the post-CPB compensatory anti-inflammatory response syndrome. IL-35 increased levels were not influenced by FoxP3 promoter polymorphisms (rs3761548, rs3761547).

Serum levels of interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α, renal function biochemical parameters and clinical outcomes in pediatric cardiopulmonary bypass surgery

BACKGROUND

Cardiopulmonary bypass causes detrimental effects on remote organs due to inflammatory response. One of these organs is kidney that is frequently affected by cardiac surgery. Acute kidney injury is a post-cardiopulmonary bypass complication, which may result in increased post-operative morbidity and mortality. Post-cardiopulmonary bypass inflammatory response may contribute to remote organ dysfunction. In the present study, we investigated the relation between cytokines including interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α, and renal function tests such as creatinine and blood urea nitrogen (BUN).

METHODS

In total, 91 patients between the ages of 4 and 60 months were enrolled for elective cardiac surgery with cardiopulmonary bypass after informed consent. Data regarding renal function tests and clinical outcomes were carefully recorded until 24 hours after admission to intensive care unit and analyzed.

RESULTS

Our findings support that there is a direct correlation between cytokines including interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α and cardiopulmonary bypass time, duration of operation, and intensive care unit stay. Longer cardiopulmonary bypass time was associated with higher interleukin-8 at cross-clamp removal and 24 hours post- intensive care unit as well as higher interleukin-10 at declamp time. Higher interleukin-6 at declamp time was directly correlated with higher post-operative BUN. Interleukin-8 level after anesthesia induction was directly correlated with intensive care unit stay duration. Higher blood interleukin-6 and tumor necrosis factor-α levels following 24 hours of admission to intensive care unit were associated with longer mechanical ventilation time.

CONCLUSION

Higher circulatory pro-inflammatory cytokine level is associated with adverse outcomes such as increased intensive care unit stay and longer mechanical ventilation time in pediatric patients. It is also correlated with unfavorable biochemical parameter of renal function, BUN. Findings hint that proper control of the inflammatory response is vital for the control of unfavorable clinical and pathological outcomes.

Neurocognitive Function after Cardiac Surgery: From Phenotypes to Mechanisms

For half a century, it has been known that some patients experience neurocognitive dysfunction after cardiac surgery; however, defining its incidence, course, and causes remains challenging and controversial. Various terms have been used to describe neurocognitive dysfunction at different times after cardiac surgery, ranging from "postoperative delirium" to "postoperative cognitive dysfunction or decline." Delirium is a clinical diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Postoperative cognitive dysfunction is not included in the DSM-5 and has been heterogeneously defined, though a recent international nomenclature effort has proposed standardized definitions for it. Here, the authors discuss pathophysiologic mechanisms that may underlie these complications, review the literature on methods to prevent them, and discuss novel approaches to understand their etiology that may lead to novel treatment strategies. Future studies should measure both delirium and postoperative cognitive dysfunction to help clarify the relationship between these important postoperative complications.

Extracorporeal membrane oxygenation and cytokine adsorption

Extracorporeal membrane oxygenation (ECMO) is an increasingly used technology for mechanical support of respiratory and cardio-circulatory failure. Excessive systemic inflammatory response is observed during sepsis and after cardiopulmonary bypass (CPB) with similar clinical features. The overwhelming inflammatory response is characterized by highly elevated pro- and anti-inflammatory cytokine levels. The excessive cytokine release during the overwhelming inflammatory response may result in multiple organ damage and failure. During ECMO therapy activation of complement and contact systems occur which may be followed by cytokine release. Controlling excessively increased cytokines may be considered as a valuable treatment option. Hemoadsorption therapy may be used to decrease cytokine levels in case of excessive inflammatory response and due to its unspecific adsorptive characteristics also substances like myoglobin, free hemoglobin or bilirubin. Controlling pro-inflammatory response with hemoadsorption may have positive impact on the endothelial glycocalix and also may be advantageous for maintenance of the vascular barrier function which plays a pivotal role in the development of tissue edema and oxygen mismatch. Hemoadsorption therapy seems to offer a promising new option for the treatment of patients with overwhelming inflammatory response leading to faster hemodynamic and metabolic stabilization finally resulting in preserved organ functions.

Glucose regulates the intrinsic inflammatory response of the heart to surgically induced hypothermic ischemic arrest and reperfusion

We investigated the isolated working rat heart as a model to study early transcriptional remodeling induced in the setting of open heart surgery and stress hyperglycemia. Hearts of male Sprague Dawley rats were cold-arrested in Krebs-Henseleit buffer and subjected to 60 min normothermic reperfusion in the working mode with buffer supplemented with noncarbohydrate substrates plus glucose (25 mM) or mannitol (25 mM; osmotic control). Gene expression profiles were determined by microarray analysis and compared with those of nonperfused hearts. Perfused hearts displayed a transcriptional signature independent from the presence of glucose showing a more than twofold increase in expression of 71 genes connected to inflammation, cell proliferation, and apoptosis. These transcriptional alterations were very similar to the ones taking place in the hearts of open heart surgery patients. Prominent among those alterations was the upregulation of the three master regulators of metabolic reprogramming, MYC, NR4A1, and NR4A2. Targeted pathway analysis revealed an upregulation of metabolic processes associated with the proliferation and activation of macrophages and fibroblasts. Glucose potentiated the upregulation of a subset of genes associated with polarization of tissue reparative M2-like macrophages, an effect that was lost in perfused hearts from rats rendered insulin resistant by high-sucrose feeding. The results expose the heart as a significant source of proinflammatory mediators released in response to stress associated with cardiac surgery with cardiopulmonary bypass, and suggest a major role for glucose as a signal in the determination of resident cardiac macrophage polarization.

Effects of conventional CPB and mini-CPB on neutrophils CD162, CD166 and CD195 expression

OBJECTIVE

Cardiac surgery is known to trigger a systemic inflammatory response. While the use of conventional cardiopulmonary bypass (CPB) results in profound inflammation, modified mini-CPB is considered less harmful. We evaluated the impact of cardiac surgery on the expression of CD162, CD166, CD195 molecules and their association with the type of CPB used.

METHODS AND RESULTS

Twenty-four patients were enrolled in our study. Twelve of them were operated using conventional CPB while the other twelve patients underwent surgery with mini-CPB. Blood samples were analysed by flow cytometry. We observed a significant increase in median fluorescence intensity of CD162 and CD195 that peaked instantly after surgery and normalized to the baseline value on the 1^st day post surgery, whereas CD166 was initially down-regulated and its median fluorescence intensity (MFI) value increased to the baseline in the next few days.

CONCLUSION

We observed immediate changes in the expression of CD162, CD166, and CD195 molecules on the neutrophils after surgery in both study groups of patients. The intensity of the observed changes was significantly greater in the group of patients who underwent conventional CPB compared to patients who underwent mini-CPB cardiac surgery.

Effect of modified ultrafiltration on the inflammatory response in paediatric open-heart surgery: a prospective, randomized study

Modified ultrafiltration (MUF) is often used in conjunction with paediatric cardiac surgery with cardiopulmonary bypass (CPB) and is thought to improve clinical outcome. It is unclear whether these improvements (if any) are due to the removal of inflammatory mediators. In this prospective study, 18 children aged 12-24 months undergoing uncomplicated cardiac surgery with methylprednisolone added in the pump prime were randomized to receive CPB with ( n= 10) and without ( n= 8) MUF. Cytokines (TNFα, IL-6, IL- 1β, IL-10, IL-1ra), complement split products (C3d, C4d) and coagulation system activation (F1+ 2, ATIII) were measured pre-, peri- and up to 48 h postoperatively. For clinical outcome, the alveolar-arterial oxygen (A-a) gradient, transfusion requirement, drain loss, mean blood pressure and requirement for inotropic support were registered up to 24 h postoperatively. Our results show an improvement in postoperative oxygenation as well as a tendency towards decreased drain loss and improved haemodynamics in the MUF group. There were no intergroup differences detectable for TNFα, IL-1β, IL-1ra, complement and coagulation markers. We conclude that MUF in itself does not significantly influence TNFα, IL-1β, IL-1ra and the complement and coagulation profiles in children undergoing cardiac surgerywith CPB. Despite this, there was some evidence for improved clinical outcome. Our results do not support that MUF improves postoperative organ function by modulation of the measured markers of inflammation.

Leukocyte depletion during CPB: effects on inflammation and lung function

Cardiopulmonary bypass (CPB) is related to inflammatory response and pulmonary dysfunction. The aim of this study was to evaluate the effects of CPB leukocyte filtration on inflammation and lung function after coronary artery bypass grafting (CABG). A prospective randomized study was performed to compare CABG patients undergoing CPB leukocyte filtration (n = 9) or standard CPB (n = 11). Computed tomography, oxygenation, leukocyte count, hemodynamic data, PaO2/FiO2, shunt fraction, interleukins, elastase, and myeloperoxidase were evaluated. Data were analyzed using two-factor ANOVA for repeated measurements. The filtered group showed lower neutrophil counts up to 50 min of CPB, lower shunt fraction up to 6 h after surgery, and lower levels of IL-10 at the end of surgery (p < 0.05). There was no statistically significant difference between groups related to other parameters. Leukodepletion during CPB results in neutrophil sequestration by a short time, decreased IL-10 serum levels, and lower worsening of lung function only temporarily.

[Role of antithrombin iii in cardiac surgery]

Coagulation of blood is of multidisciplinary interest. Cardiac surgery produces major changes in the delicate balance between pro-and anti-coagulant serum factors. The role of antithrombin iii has been analysed after finding evidence that associated decreased levels of protein activity to postoperative morbidity and mortality. Supplementing exogenous antithrombin is considered with the aim of optimising outcomes. Its intrinsic anticoagulant and anti-inflammatory properties have stimulated a growing interest, and suggests new lines of research.

Impact of blood product transfusion on short and long-term survival after cardiac surgery: more evidence

BACKGROUND

Despite the proven benefits in hemorrhagic shock, blood transfusions have been linked to increased morbidity and mortality. The short-term adverse effects of blood transfusion in cardiac surgical patients are well documented but there are very few studies that adequately assess the long-term survival. This study was undertaken to evaluate the effects of transfusion on both short-term and long-term survival after cardiac surgery.

METHODS

Data from 5,342 patients who underwent a cardiac surgical procedure from January 2002 to December 2005 at our institution were reviewed. The effect of transfusion of packed red blood cells (PRBC) and other blood products was tested in a 2-level approach of transfusion (any) versus no transfusion, and also a 4-level approach of transfusion (PRBC, other blood products, and both blood and blood products) versus no transfusion. Long-term survival data of these patients were obtained. Cox proportional hazard models, Kaplan-Meier survival plots, and hazard functions were used to compare the groups.

RESULTS

A total of 3,013 of the 5,342 study patients (56.4%) received transfusion during or within 72 hours of their cardiac surgery. Median time to death was significantly lower for patients who received transfusions; 1.15 years for PRC and 0.83 years for any transfusion, compared with 4.68 years in the non-transfused group. The overall 30-day mortality was 1.7%, but in patients who received transfusions (3.6%) was significantly higher than the non-transfused group (0.3%, p<0.001). The 1-year mortality (overall 3.9%) in the transfused group (7.3%, p<0.001) was also significantly higher than that in the non-transfused group (1.3%). The 5-year mortality rate in the transfused group was more than double that in the non-transfused group (16% vs 7%). After correction for comorbidities and other factors, transfusion was still associated with a 66% increase in mortality.

CONCLUSIONS

This study suggests that blood or blood product transfusion during or after cardiac surgery is associated with increased short-term and long-term mortality. It reinforces the need for prospective randomized controlled studies for evaluation of restrictive transfusion triggers and objective clinical indicators for transfusion in the cardiac surgical patient population.

Transfusion associated in-hospital mortality and morbidity in isolated Coronary Artery Bypass Graft surgery

Transfusion after cardiac surgery is very common. This rate varies between institutions and has remained high despite established transfusion guidelines. We analyzed our database of patients who underwent isolated CABG (Coronary Artery Bypass Graft) to determine the predictive factors of homologous transfusion and associated postoperative morbidity, mortality and resource utilization. All 14,152 patients who underwent first-time isolated CABG, with or without cardiopulmonary bypass (CPB) who had postoperative homologous transfusion between February 2002 and March 2008 in Tehran Heart Center, were evaluated retrospectively. Overall, 16.5% of patients received transfusion. Transfused patients demonstrated a significantly higher incidence of postoperative complications (cardiac, infectious, ischemic, reoperation) and mortality (p<0.001). Homologous blood transfusion effect on mortality, morbidity and resource utilization. By Multivariable logistic regression analysis adjusted for confounders: Homologous blood transfusion effect on Mortality (30-days) (OR=3.976, p<0.0001), Prolonged ventilation hours (OR=4.755, p<0.0001), Total ICU hours (β =14.599, p<0.0001), Hospital length of stay (β =1.141, p<0.0001), Post surgery length of stay (β =0.955, p<0.0001). We conclude that the isolated CABG patients receiving blood transfusion have significantly higher mortality, morbidity and resource utilization. Homologous blood transfusion is an independent factor of increased resource utilization, morbidity and mortality.

Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting

OBJECTIVE

Our objective was to quantify incremental risk associated with transfusion of packed red blood cells and other blood components on morbidity after coronary artery bypass grafting.

DESIGN

The study design was an observational cohort study.

SETTING

This investigation took place at a large tertiary care referral center.

PATIENTS

A total of 11,963 patients who underwent isolated coronary artery bypass from January 1, 1995, through July 1, 2002.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Among the 11,963 patients who underwent isolated coronary artery bypass grafting, 5,814 (48.6%) were transfused. Risk-adjusted probability of developing in-hospital mortality and morbidity as a function of red blood cell and blood-component transfusion was modeled using logistic regression. Transfusion of red blood cells was associated with a risk-adjusted increased risk for every postoperative morbid event: mortality (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.67-1.87; p<.0001), renal failure (OR, 2.06; 95% CI, 1.87-2.27; p<.0001), prolonged ventilatory support (OR, 1.79; 95% CI, 1.72-1.86; p<.0001), serious infection (OR, 1.76; 95% CI, 1.68-1.84; p<.0001), cardiac complications (OR, 1.55; 95% CI, 1.47-1.63; p<.0001), and neurologic events (OR, 1.37; 95% CI, 1.30-1.44; p<.0001).

CONCLUSIONS

Perioperative red blood cell transfusion is the single factor most reliably associated with increased risk of postoperative morbid events after isolated coronary artery bypass grafting. Each unit of red cells transfused is associated with incrementally increased risk for adverse outcome.

Transfusion in Coronary Artery Bypass Grafting is Associated with Reduced Long-Term Survival

BACKGROUND

Perioperative red blood cell (PRBC) transfusion has been associated with early risk for morbid outcomes, but risk related to long-term survival has not been thoroughly explored. Therefore, we examined the influence of PRBC transfusion and component therapy on long-term survival after isolated coronary artery bypass grafting after controlling for the effect of demographics, comorbidities, operative factors, and the early hazard for death.

METHODS

The US Social Security Death Index was used to ascertain survival status for 10,289 patients who underwent isolated coronary artery bypass grafting from January 1, 1995 through June 28, 2002. The outcome measure was all-cause mortality during the follow-up period. Unadjusted survival estimates were performed using the Kaplan-Meier techniques. Survival curves for transfusion status were compared with the log-rank test. The parametric decomposition model was used for risk-adjusted survival. A balancing score was calculated for each patient and forced into the final model.

RESULTS

Survival among transfused patients was significantly reduced as compared with nontransfused patients. The instantaneous risk of death displayed a biphasic pattern: a declining hazard phase from the time of the operation (early hazard) up until 6 months postoperatively and then a late hazard that continued out until about 10 years. Transfusion of red cells was associated with a risk-adjusted reduction in survival for both the early (0.34 +/- 0.02, p < 0.0001) and late phases (0.074 +/- 0.016, p < 0.0001).

CONCLUSIONS

Perioperative PRBC transfusion is associated with adverse long-term sequela in isolated CABG. Attention should be directed toward blood conservation methods and a more judicious use of PRBC.

The activity of N-acetyl-beta-D-glucosaminidase and tumor necrosis factor-alpha at early stage of diabetic retinopathy development in type 1 diabetes mellitus children

OBJECTIVE

The assessment of the clinical significance of TNF-alpha, IL-10 and NAG with its A and B isoforms concentrations in children with DM type 1 for the detection of early stages of both diabetic retinopathy and nephropathy.

PATIENTS AND METHODS

One hundred and two children with DM type 1 and 35 healthy controls were analyzed. Levels of TNF-alpha, IL10 and total NAG enzyme activity with its A and B isoforms were measured in serum and urine of all participants.

RESULTS

Children with diabetic retinopathy had a significantly higher levels of TNFalpha in serum (P=0.01) in comparison to those without retinopathy. The activity of NAG (P=0.002) and its isoform A (P=0.006) and isoform B (P=0.001) were significantly higher in children with diabetic retinopathy in comparison to those without this complication. Conversely, within the group with retinopathy, more children had detectable concentrations of IL10 in serum as compared to those without retinopathy (P=0.01).

CONCLUSIONS

These results suggest that NAG activity and TNF-alpha concentration in diabetic retinopathy patients might show a relationship with a degree of renal glomeruli epithelial cells and renal proximal tubules damage.

Acute lung injury and acute respiratory distress syndrome after pulmonary resection

The occurrence of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) after thoracic surgery are perplexing and persistent problems. Variously described as postpneumonectomy pulmonary edema, noncardiogenic pulmonary edema, and postlung resection pulmonary edema, ALI and ARDS may be considered a single entity, with ALI being the less severe form of ARDS. It is characterized by the acute onset of hypoxemia with radiographic infiltrates consistent with pulmonary edema, without elevations in the pulmonary capillary wedge pressure. Although this syndrome does not occur frequently and is usually without identifiable cause, the mortality is high. However, the phenomenon has not been rigorously studied owing to the low incidence, with primarily retrospective case series reported. Thus, the nomenclature, risks, and pathogenesis are not well defined. Interest in this syndrome has recently been renewed as the rate of other perioperative complications has declined. ALI/ARDS is reviewed with a focus on potential etiologies and the spectrum of available interventions.

The effect of intravenous quinaprilat on plasma cytokines and hemodynamic variables during cardiac surgery

OBJECTIVES

Perioperative treatment with angiotensin-converting enzyme (ACE) inhibitors in cardiac surgery with cardiopulmonary bypass is still controversial. Using ACE inhibitors during cardiac surgery might be associated with an increased risk of critical hypotensive episodes. On the other hand, ACE inhibitors could have beneficial effects with respect to the development of the systemic inflammatory response syndrome.

DESIGN

The effect of acute administration of quinaprilat on hemodynamic variables and plasma cytokines was assessed under double-blind, randomized, and placebo-controlled conditions.

SETTING

Department of anesthesiology and cardiovascular surgery clinic in a university hospital.

PARTICIPANTS

Forty patients without preexisting cardiac failure, undergoing coronary artery bypass grafting.

INTERVENTIONS

Patients received 0.08 mg/kg of intravenous quinaprilat or intravenous isotonic saline solution after induction of anesthesia.

MEASUREMENTS AND RESULTS

Blood samples were taken after induction of anesthesia (T0), before cardiopulmonary bypass (T1), at the end of surgery (T2), and 4 hours after the end of surgery (T3). There was no difference between the 2 groups regarding mean arterial pressure and inotropic or vasopressor support. Systemic vascular resistance index was significantly lower in the quinaprilat group at T2 (p = 0.016) and T3 (p = 0.017). No difference in proinflammatory cytokine levels was observed between the 2 groups.

CONCLUSIONS

The present investigation shows that acute administration of an intravenous ACE inhibitor, quinaprilat, has no influence on proinflammatory cytokines during cardiac surgery with cardiopulmonary bypass. The patients treated with quinaprilat showed an improved systemic vascular resistance index with no increased risk of deleterious hemodynamic episodes.

Levels of inflammatory markers in the blood processed by autotransfusion devices during cardiac surgery associated with cardiopulmonary bypass circuit

Intraoperative blood salvage devices allowing a reinfusion of red blood cells (RBCs) after processing of shed blood and stagnant blood in the mediastinal cavity are more and more used to reduce homologous blood requirements in cardiac surgery with cardiopulmonary bypass (CPB). As the proinflammatory activity of the shed blood also contributes to morbidity during CPB, we conducted a prospective study in order to examine the quality of autologous blood before and after processing with five different devices [BRAT2, Sequestra, Compact Advanced, Cell Saver 5 (CS5), Continuous Autologous Transfusion System (CATS)]. All systems resulted in an excellent haemoconcentration, ranging from 53.7% (Compact) to 68.9% (CATS). The concentrations and elimination rates of several inflammatory markers [IL-1beta, IL-2, IL-8, TNFalpha, myeloperoxidase (MPO), elastase] were examined. Except for the Sequestra, an important increase in concentration of IL-1beta (between 30% and 220%) has been observed after processing with each device. In contrast, the attenuation rate of IL-6 and TNFalpha (95%) was optimal for all investigated blood salvages systems. Regarding IL-8, only the CATS and CS5 systems were able to attenuate this biological parameter with an excellent efficacy. The rate of attenuation in MPO and elastase, as markers of leukocyte activation, was higher than 80% for all devices. In conclusion, the different RBC washing systems tested in this study resulted in a significant attenuation of the inflammatory response. Increased levels of IL-1beta after processing remained, however, unclear. According to the type of protocol, based on inlet haematocrit, fill and wash speeds, and wash volumes, small variations in reducing the inflammatory response have been observed from one device to another.

Balance of proinflammatory and antiinflammatory cytokines at thoracic cancer operation

BACKGROUND

A homeostatic balance of proinflammatory and antiinflammatory cytokines is thought to be important for the maintenance of health. Cytokine baseline levels and response patterns to cardiac and nonmalignant abdominal operations have been investigated. The purpose of this study was to investigate the cytokine patterns at operation for thoracic cancer; the hypothesis tested was that cytokine baseline levels and response patterns would be unique for patients with malignant disease undergoing thoracic operation.

METHODS

Ten patients undergoing pulmonary tumor resections were studied. Blood samples were collected at six perioperative time points.

RESULTS

The cytokine response of these patients differed from patients undergoing cardiac operations: baseline tumor necrosis factor-alpha (39.1 pg/mL) and interleukin-10 (76.76 pg/mL) were elevated without significant changes. Interleukin-1 receptor antagonist became elevated postoperatively (871.6 pg/mL) compared with baseline (332.8 pg/mL) (p < 0.01). The level of tumor necrosis factor soluble receptor-2 was elevated at baseline (4,823.3 pg/mL) and remained elevated postoperatively (7,293.4 pg/mL) (p < 0.01).

CONCLUSIONS

Our hypothesis was supported; a separate pattern of proinflammatory and antiinflammatory cytokine levels and responses to thoracic operation was determined. This pattern may be indicative of tumor burden or detrimental to tumor surveillance; it merits further evaluation.