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Relationship Between Antiinflammatory Cytokine Interleukin-10 and Lactate Concentrations in Neonates Undergoing the
Kyrylo Chasovskyi1, Volodymyr Zhovnir2, Ganna Vorobiova3
1Department of Perfusiology, Ukrainian Children's Cardiac Center, Kyiv, Ukraine; Department of Intensive Care, Ukrainian Children's Cardiac Center, Kyiv, Ukraine.
Background:
The aim of this study was to evaluate the relationship between antiinflammatory cytokine interleukin (IL)-10 production and perioperative lactate concentrations and their impact on postoperative outcomes in neonates undergoing the arterial switch operation (ASO).
Methods:
Between August 2010 and August 2012, 80 neonates with transposition of the great arteries (TGA) were enrolled. Serum IL-10 levels were measured immediately before and after cardiopulmonary bypass (CPB) on the first, third, and seventh days. Perioperative clinical data were collected prospectively.
Results:
Patients underwent the ASO at a median age of 72 hours (4-144 hours). We found that serum IL-10 levels significantly correlated with a prolonged intensive care unit (ICU) length of stay (r = 0.3; p = 0.020) and duration of ventilation (r = 0.3; p = 0.017). Serum IL-10 levels on the first day after the surgical procedure had predictive value for a prolonged ICU stay (defined as an ICU stay >6 days postoperatively) by receiver operator curve analysis, with an area under the receiver operating characteristic (ROC) curve of 0.65 (p = 0.045). Logistic regression modeling indicated that serum lactate level (β = 2.7; p = 0.027), age at operation (β = -4.0; p = 0.007), and the nature (autologous or allogeneic) of blood products (β = -3.5; p = 0.030) used during CPB affected serum IL-10 levels. The strongest predictor of increased IL-10 on the first day after operation was a serum lactate level greater than 3 mmol/L measured after the surgical procedure on admission to the ICU, recording an odds ratio of 15.31. Serum lactate levels after operation and at admission to the ICU positively correlated with a prolonged ICU stay (r = 0.4; p = 0.007).
Conclusions:
Elevated lactate levels are associated with increased IL-10 production on the first postoperative day. Excessive production of IL-10 on the first day after the surgical procedure is associated with a prolonged ICU stay.
