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The relationship between inflammatory activation and clinical outcome after infant cardiopulmonary bypass
Catherine K Allan1, Jane W Newburger, Ellen McGrath
1Department of Cardiology, Children's Hospital, Boston, MA 02115, USA. catherine.allan@cardio.chboston.org
Insights
Cardiopulmonary bypass (CPB) in infants triggers inflammation, but higher preoperative inflammatory markers in younger babies did not predict outcomes. Postoperative inflammation showed modest links to clinical course, suggesting limited impact on morbidity in this group.
Area of Science:
- Pediatric Cardiac Surgery
- Inflammatory Response
- Biomarkers
Background:
- Cardiopulmonary bypass (CPB) is known to induce a systemic inflammatory response.
- The extent and clinical impact of this response in infants undergoing cardiac surgery are not fully understood.
Purpose of the Study:
- To assess the relationship between the inflammatory state and clinical outcomes in infants undergoing CPB.
- To investigate the correlation between preoperative and postoperative inflammatory mediator concentrations and clinical outcomes.
Main Methods:
- Plasma concentrations of interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor α, IL-1β, and C-reactive protein (CRP) were measured in infants ≤9 months old.
- Measurements were taken pre-CPB, immediately post-CPB, and at 6, 12, and 24 hours post-CPB.
- Perioperative clinical data, including diagnoses and outcomes, were collected prospectively.
Main Results:
- While younger infants had higher pre-CPB IL-6 and CRP, these did not correlate with postoperative inflammatory mediator levels or clinical outcomes.
- Postoperative levels of IL-6, CRP, IL-10, and IL-8 significantly increased compared to pre-CPB levels.
- Postoperative IL-6 and IL-8 correlated with longer intensive care unit (ICU) stays, increased blood product administration, and, for IL-8, higher 24-hour lactate levels.
Conclusions:
- Preoperative inflammatory marker levels in younger infants do not predict postoperative outcomes.
- Postoperative inflammatory mediator production shows a statistically significant but clinically modest correlation with the clinical course.
- In infants undergoing low-to-moderate complexity cardiac surgery, the contribution of inflammatory mediator production to postoperative morbidity appears relatively limited.
Background:
Cardiopulmonary bypass (CPB) induces a systemic inflammatory response. The magnitude and consequences in infants remain unclear. We assessed the relationship between inflammatory state and clinical outcomes in infants undergoing CPB.
Methods:
Plasma concentrations of interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor α, IL-1β, and C-reactive protein (CRP) were measured pre-CPB and immediately post-CPB, and at 6, 12, and 24 hours post-CPB in infants ≤9 months old. Perioperative clinical data were collected prospectively.
Results:
Diagnoses of 93 patients included transposition of the great arteries (40), tetralogy of Fallot (28), ventricular septal defect (21), truncus arteriosus (2), and complete atrioventricular canal (2). The median age was 37 days (range = 2 to 264). Pre-CPB IL-6 and CRP were higher in younger infants but were not associated with postoperative inflammatory mediator concentrations or measured clinical outcomes. IL-6 increased post-CPB (median 3.2 pg/mL pre-CPB, 24.2 post-CPB, 95.4 at 6 hours, and 90.3 at 24 hours; all P < 0.001). CRP increased post-CPB, peaking at 24 hours (median 27.5 at 24 hours, 0.3 pre-CPB; P < 0.001). IL-10 and IL-8 increased immediately post-CPB. After adjusting for age and diagnosis, postoperative IL-6 and IL-8 correlated with intensive care unit length of stay and postoperative blood product administration and, for IL-8, 24-hour lactate.
Conclusions:
Greater preoperative cytokine and CRP production in younger infants did not correlate with postoperative outcomes; correlation between postoperative inflammatory mediator production and clinical course was statistically significant but clinically modest. We conclude that in infants undergoing low-to-moderate-complexity cardiac surgery in a single high-volume center, the contribution of inflammatory mediator production to postoperative morbidity is relatively limited.
