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Cytokine balance in infants undergoing cardiac operation
Hedwig H Hövels-Gürich1, Kathrin Schumacher, Jaime F Vazquez-Jimenez
1Department of Pediatric Cardiology, Aachen University of Technology, Germany. hhoevels-guerich@ukaachen.de
Insights
Infants with hypoxemia exhibit a preoperative inflammatory state and lower anti-inflammatory cytokine balance compared to those with heart failure. This imbalance may worsen outcomes following pediatric cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Immunology
- Critical Care Medicine
Background:
- Systemic inflammatory response during cardiac operations requires adequate anti-inflammatory mechanisms.
- Preoperative clinical condition, specifically hypoxemia or heart failure, may influence cytokine balance in pediatric cardiac surgery patients.
Purpose of the Study:
- To test the hypothesis that cytokine balance during pediatric cardiac surgical procedures is influenced by preoperative hypoxemia or heart failure.
Main Methods:
- Prospective study of 20 infants undergoing corrective cardiac surgery.
- Measurement of plasma interleukin-6 (IL-6), interleukin-10 (IL-10), C-reactive protein, and procalcitonin.
- Assessment of the IL-10 to IL-6 ratio as a marker of anti-inflammatory cytokine balance.
Main Results:
- Infants with hypoxemia (Group 1) had higher preoperative IL-6, lower IL-10, and a lower IL-10/IL-6 ratio than those with heart failure (Group 2).
- Preoperative IL-6 levels in hypoxemic infants correlated inversely with oxygen saturation.
- Perioperative IL-6 levels were higher, and IL-10 and the IL-10/IL-6 ratio were lower in Group 1 compared to Group 2.
Conclusions:
- Infants with hypoxemia present with a preoperative inflammatory state and diminished anti-inflammatory cytokine balance.
- This preoperative imbalance is associated with a lower perioperative anti-inflammatory cytokine balance, potentially contributing to postoperative morbidity in pediatric cardiac surgery patients.
Background:
The control of the systemic inflammatory response taking place during cardiac operations depends on adequate antiinflammatory reaction. In this prospective study we tested the hypothesis that cytokine balance during pediatric cardiac surgical procedures would be influenced by the patients' preoperative clinical condition, defined as hypoxemia or heart failure.
Methods:
Twenty infants (median age, 8 months) with hypoxemia owing to intracardiac right-to-left shunt (group 1, n = 10) or with heart failure because of intracardiac left-to-right shunt (group 2, n = 10), scheduled for elective primary corrective operation, were enrolled. Plasma levels of the proinflammatory cytokine interleukin (IL) 6, the natural antiinflammatory cytokine IL-10, and the markers of the acute-phase response, C-reactive protein and procalcitonin, were sequentially measured before, during, and after cardiac operation up to the 10th postoperative day. The ratio of IL-10 to IL-6 levels served as a marker for the individual's antiinflammatory cytokine balance.
Results:
Group 1 showed higher preoperative IL-6 (p < 0.001), lower IL-10 levels (p < 0.02), and lower ratio of IL-10 to IL-6 levels (p < 0.001) than group 2. Preoperative C-reactive protein and procalcitonin were not detectable. In group 1, preoperative IL-6 levels inversely correlated with preoperative oxygen saturation (Spearman correlation coefficient, -0.74, p < 0.02). During cardiopulmonary bypass, IL-6 levels were higher, whereas IL-10 and ratio of IL-10 to IL-6 levels were lower in group 1 than in group 2. In all patients, postoperative IL-6 levels were positively correlated with duration of inotropic support and serum creatinine value and inversely correlated with oxygenation index and diuresis.
Conclusions:
Infants with hypoxemia show a preoperative inflammatory state with low antiinflammatory cytokine balance in contrast to those with heart failure. This in turn is associated with lower perioperative antiinflammatory cytokine balance and might contribute to postoperative morbidity.