Plasma-soluble E-selectin after cardiopulmonary bypass in children: is it a marker of the postoperative course?
1Department of Pediatric Intensive Care, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Objective:
To investigate the relationship and possible role of soluble adhesion molecule E-selectin in the postoperative course in children undergoing cardiopulmonary bypass (CPB).
Design:
Prospective cohort study.
Setting:
Pediatric intensive care unit of a university hospital.
Participants:
Thirteen children who were candidates for cardiac surgery.
Interventions:
None.
Measurements And Main Results:
Serial blood samples of 13 CPB patients were collected from the arterial catheter or from the bypass circuits preoperatively; on initiation of CPB; on termination of CPB; and 1, 2, 4, 8, 12, 18, 24, and 48 hours postoperatively. Plasma was recovered immediately, aliquoted, and frozen at -70 degrees C until use. Circulating soluble selectin molecules were measured with a sandwich enzyme-linked immunosorbent assay technique. There were significant changes in plasma levels of soluble E-selectins in patients after CPB, and these levels were associated with patient characteristics, operative variables, and postoperative course. Soluble E-selectin correlated significantly with inotropic support and the use of anti-inflammatory drugs. There was a significant association between the development of postoperative sepsis and soluble E-selectin levels. No correlation was found between soluble E-selectins and duration of CPB, aortic cross-clamping, or hemodynamic variables, including heart rate and mean systemic arterial pressure.
Conclusion:
These results suggest a relationship between CPB-induced mediators and early and late clinical effects. Although the mechanism for the increase of soluble E-selectin remains to be elucidated, the upregulation of soluble E-selectin indicates neutrophil activation, and its inhibition may represent a target for reducing the inflammatory response associated with CPB.
