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Cytokine response in children undergoing surgery for congenital heart disease
Ashish B Madhok1, Kaie Ojamaa, Viraga Haridas
1Division of Pediatric Cardiology, Schneider Children's Hospital, NY 11040, USA.
Insights
Pediatric cardiac surgery using cardiopulmonary bypass (CPB) triggers inflammation, increasing interleukin-6 and -8. Higher levels correlate with greater medical intervention and poorer outcomes in children.
Area of Science:
- Pediatric Cardiology
- Immunology
- Surgical Inflammation
Background:
- Pediatric cardiac surgery with cardiopulmonary bypass (CPB) is known to induce a significant inflammatory response.
- This inflammatory cascade can lead to multiorgan dysfunction in pediatric patients.
Purpose of the Study:
- To quantify postoperative cytokine production in children undergoing cardiac surgery with CPB.
- To correlate the inflammatory response with intraoperative factors and postoperative outcomes.
Main Methods:
- Serum samples were collected from 20 pediatric patients preoperatively and on postoperative days 1-3.
- Levels of interleukin (IL)-6, IL-8, IL-10, IL-1beta, IL-12, and tumor necrosis factor-alpha were measured.
- Correlations were analyzed between cytokine levels, intraoperative variables, and clinical outcomes.
Main Results:
- Significant increases in IL-6, IL-8, and IL-10 were observed on postoperative day 1.
- Elevated IL-6 and IL-8 levels correlated with increased need for medical intervention (Therapeutic Interventional Scoring System) and inotropic support.
- A negative correlation between IL-6, IL-8, and mixed venous oxygen saturation indicated compromised cardiopulmonary function.
- Patients with single ventricle anatomy exhibited the highest IL-6 and IL-8 levels.
Conclusions:
- The proinflammatory response following pediatric cardiac surgery with CPB is associated with postoperative morbidity.
- Increased cytokine levels, particularly IL-6 and IL-8, are linked to a greater need for medical intervention and potential cardiopulmonary compromise.
- Cytokine profiling may aid in predicting patient outcomes after CPB.
Abstract:
Pediatric cardiac surgery with cardiopulmonary bypass (CPB) induces a complex inflammatory response that may cause multiorgan dysfunction. The objective of this study was to measure postoperative cytokine production and correlate the magnitude of this response with intraoperative variables and postoperative outcomes. Serum samples from 20 children (median age, 15 months) undergoing cardiac surgery with CPB were obtained preoperatively and on postoperative days (POD) 1-3. Serum levels of interleukin (IL)-6, IL-8, and IL-10 increased significantly on POD 1 (p < 0.01) vs pre-op values to 271 +/- 68, 44 +/- 9, 7.5 +/- 0.8 pg/ml, respectively, whereas serum IL-1beta, IL-12, and tumor neurosis factor -alpha were not significantly changed. The serum IL-6 and IL-8 levels correlated positively (p < 0.01) with the degree of postoperative medical intervention as measured by the Therapeutic Interventional Scoring System and indicated a greater need for inotropic support (p = 0.057). A negative correlation (p < 0.01) between IL-6, IL-8, and mixed venous oxygen saturation suggested compromised cardiopulmonary function. Patients with single ventricle anatomy had the highest levels of IL-6 and IL-8 (629 +/- 131 and 70 +/- 17 pg/ml, respectively), with a mean CPB time of 106 +/- 23 minutes. Thus, the proinflammatory response after surgery with CPB was associated with postoperative morbidity with increased need for medical intervention.
