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Leukocyte activation and phagocytotic activity in cardiac surgery and infection
Markus Rothenburger1, Frank Trösch, Andreas Markewitz
1Department of Thoracic and Cardiovascular Surgery, University Hospital of Muenster, Albert-Schweitzer Str. 33, Germany. markus.rothenburger@thgms.uni-muenster.de
Insights
Cardiac surgery (CS) with cardiopulmonary bypass (CPB) triggers leukocyte activation and systemic inflammatory response. Immune response remains adequate, but caution is advised for leukocyte depletion therapies.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Critical Care Medicine
Background:
- Cardiac surgery (CS) utilizing cardiopulmonary bypass (CPB) can induce a systemic inflammatory response syndrome.
- Leukocyte activation is a key mechanism contributing to this inflammatory response, potentially exacerbated by concurrent infections.
Purpose of the Study:
- To investigate leukocyte activation and reticuloendothelial system (RES) function in patients undergoing CS with CPB.
- To compare immune markers between patients with uneventful recovery and those who develop systemic infections.
Main Methods:
- Prospective study of 85 patients undergoing CS with CPB.
- Measurement of leukocyte counts, elastase levels, and phagocytotic activity preoperatively and up to 7 days postoperatively.
- Categorization of patients into uneventful course (n=79) and systemic infection (n=6) groups.
Main Results:
- Leukocyte and elastase levels increased postoperatively, with significantly higher levels in the infection group (p<0.01).
- A decrease in the leukocyte/elastase ratio was observed in all patients (p<0.002), with no intergroup differences.
- Phagocytotic activity initially dropped on day 1 (p<0.05) but increased above baseline (p<0.001), with no significant differences between groups.
Conclusions:
- Leukocyte activation is a common finding after CS with CPB, associated with normal RES function and adequate immune response.
- Therapeutic strategies aimed at leukocyte depletion to mitigate reperfusion injury require caution, as they may compromise immune response in infected patients.
- Leukocyte depletion might benefit patients requiring prolonged CPB, warranting further investigation.
Background:
Cardiac surgery (CS) using cardiopulmonary bypass (CPB) is associated with cellular and humoral defense reactions termed the systemic inflammatory response syndrome. Leukocyte activation is one of its causative mechanisms which may be aggravated by additional infection.
Methods And Results:
Eighty-five patients undergoing CS with CPB were prospectively investigated. Leukocyte counts, elastase, and phagocytotic activity were measured from 24 h preoperatively up to 7 days postoperatively. Seventy-nine patients had an uneventful course (group 1) while six patients developed a systemic infection (group 2). Leukocytes and elastase levels increased postoperatively (p<0.01) and were significantly higher in group 2 (p<0.01). In both groups a decrease of leukocyte/elastase ratio occurred (p<0.002), no differences between groups were observed. The phagocytotic activity, representing the circulating cells of the reticuloendothelial system (RES), dropped on day 1 (p<0.05), and increased thereafter above baseline levels (p<0.001). No differences of RES function between groups was observed, the initial drop on day 1 in both groups was compensated by the quality of phagocytotic ability of each cells.
Conclusion:
Leukocyte activation after CS with CPB occurs. It is associated with a regular RES function and similarly leukocyte/elastase ratios in both groups, suggesting an adequate immune response. Therapeutic interventions resulting in depletion of leukocytes to alleviate reperfusion injury might impair the immune response of those patients acquiring perioperative infection and should be approached with caution. Leukocyte depletion maybe effective in patients for whom an extended period of CPB was required. Further investigations to prove this hypothesis awaits confirmation.