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Soluble P-selectin and the postoperative course following cardiopulmonary bypass in children
1Department of Pediatric Intensive Care, The Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel.
Insights
Postoperative soluble P-selectin (sP-selectin) levels in children undergoing cardiopulmonary bypass (CPB) correlate with surgical factors and clinical outcomes. Monitoring sP-selectin may help manage the inflammatory response after CPB.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Immunology
Background:
- Cardiopulmonary bypass (CPB) triggers inflammatory responses.
- Cytokine-inducible adhesion molecules, like soluble P-selectin (sP-selectin), are implicated.
- The role of sP-selectin in pediatric CPB outcomes requires further investigation.
Purpose of the Study:
- To investigate the correlation between plasma sP-selectin levels and the intraoperative and postoperative course in children undergoing CPB.
- To explore the relationship between sP-selectin and clinical outcomes following pediatric CPB.
- To understand the inflammatory mediators' impact on clinical effects.
Main Methods:
- Serial blood samples collected from 13 pediatric patients undergoing CPB.
- Plasma sP-selectin levels measured using a sandwich enzyme-linked immunoabsorbent assay.
- Measurements taken preoperatively and seven times postoperatively.
Main Results:
- Significant post-CPB changes in plasma sP-selectin levels were observed.
- sP-selectin levels correlated with surgery time, aortic cross-clamping time, and inotropic support.
- Elevated sP-selectin associated with higher Pediatric Risk of Mortality scores, hypotension, and tachycardia.
Conclusions:
- CPB-induced mediators are linked to early and late clinical effects.
- Up-regulation of sP-selectin suggests neutrophil activation as a mechanism.
- Inhibiting sP-selectin may mitigate the inflammatory response associated with CPB.
Background:
Cytokine-inducible leucocyte-endothelial adhesion molecules were shown to affect the postoperative inflammatory response following cardiopulmonary bypass (CPB). Soluble P-selectin (sP-selectin) is one of these molecules. We investigated the correlation between plasma sP-selectin levels and the intra- and postoperative course in children undergoing CPB.
Methods:
Serial blood samples of 13 patients were collected preoperatively upon initiation of CPB and seven times postoperatively. Plasma was recovered immediately and frozen at - 70 degrees C until use. Circulating soluble selectin molecules were measured with a sandwich enzyme-linked immunoabsorbent assay technique.
Results:
The significant post-CPB changes in sP-selectins plasma levels were associated with patient characteristics, operative variables and postoperative course. sP-selectin levels correlated significantly with surgery time, aortic cross-clamping time and inotropic support, as well as with the postoperative Pediatric Risk of Mortality score, hypotension and tachycardia.
Conclusions:
A relation between CPB-induced mediators and both early and late clinical effects is suggested. The up-regulation and expression of sP-selectin indicate neutrophil activation as a possible mechanism for the increase, and inhibiting it may reduce the inflammatory response associated with CPB.