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An increase in macrophage migration inhibitory factor release in patients with cardiopulmonary bypass surgery
S Gando1, J Nishihira, O Kemmotsu
1Department of Anesthesiology and Critical Care Medicine, Hokkaido University School of Medicine, Sapporo, Japan.
Abstract:
To determine the macrophage migration inhibitory factor (MIF) responses to cardiopulmonary bypass (CPB) surgery as well as to investigate their roles in predicting patient outcome, a prospective, observational, pilot study was performed. Thirty patients undergoing cardiovascular surgery with CPB received 10mg/kg betamethasone immediately before the CPB. Ten normal healthy volunteers served as control subjects. Blood samples were serially obtained for 24h and assayed for MIF, cortisol, and tumor necrosis factor alpha (TNF-alpha). TNF-alpha release could not be detected during the study period. Compared with both the control and baseline values, the MIF and cortisol levels were elevated before CPB and peaked at the end of CPB (57.5 +/- 4.8 ng/ml, P < 0.0001), and at the end of the surgery (507.7 +/- 44.1 nmol/l, P < 0.0001), respectively. Peak MIF levels correlated with aortic cross-clamp time (r2 = 0.183, P = 0.0182, n = 30), but did not show a significant correlation with peak cortisol levels. The levels of MIF tended to be 40%-50% higher during CPB in patients with longer intensive care unit (ICU) stays and in those with organ dysfunction than in those with short ICU stays and no organ dysfunction. All patients were discharged from the ICU. In conclusion, our findings demonstrate that MIF production occurs in patients with CPB surgery. When high-dose steroids are administered, high MIF levels were found to only slightly affect the patient morbidity and outcome after CPB surgery.
Insights
Macrophage migration inhibitory factor (MIF) is produced during cardiopulmonary bypass (CPB) surgery. Elevated MIF levels correlated with longer intensive care unit stays and organ dysfunction, but minimally impacted patient outcomes despite steroid administration.
Area of Science:
- Immunology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Macrophage migration inhibitory factor (MIF) is a key inflammatory mediator.
- Cardiopulmonary bypass (CPB) surgery is associated with significant inflammatory responses.
- The role of MIF in predicting outcomes after CPB surgery requires further investigation.
Purpose of the Study:
- To determine macrophage migration inhibitory factor (MIF) responses during cardiopulmonary bypass (CPB) surgery.
- To investigate the predictive role of MIF in patient outcomes following CPB surgery.
- To assess the impact of betamethasone administration on MIF levels and patient outcomes.
Main Methods:
- Prospective, observational pilot study involving 30 cardiovascular surgery patients undergoing CPB.
- Administration of 10mg/kg betamethasone prior to CPB.
- Serial blood sampling for 24 hours to assay MIF, cortisol, and TNF-alpha levels.
- Comparison with 10 healthy control subjects.
Main Results:
- MIF and cortisol levels were elevated before CPB and peaked post-surgery (MIF: 57.5 ng/ml, Cortisol: 507.7 nmol/l).
- Peak MIF levels correlated with aortic cross-clamp time but not with peak cortisol levels.
- MIF levels were 40-50% higher in patients with longer ICU stays and organ dysfunction.
Conclusions:
- MIF production is confirmed in patients undergoing CPB surgery.
- Elevated MIF levels show a trend towards association with increased morbidity (longer ICU stay, organ dysfunction).
- High-dose steroid administration minimally affected patient morbidity and outcome despite high MIF levels.