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T-cell lymphopenia is associated with an increased infecting risk in children after cardiopulmonary bypass
Wen-Juan Li1, Yong-Xuan Peng1, Li-Qing Zhao1
1Department of Pediatric Cardiology, Xinhua Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
Insights
Children undergoing cardiopulmonary bypass (CPB) face higher infection risks. Post-CPB lymphopenia and elevated inflammatory cytokines are linked to increased early postoperative infections in pediatric patients.
Area of Science:
- Pediatric surgery
- Immunology
- Infectious disease
Background:
- Children undergoing cardiopulmonary bypass (CPB) are susceptible to infections due to immunosuppression.
- Early identification of infection risk post-CPB in pediatric patients with congenital heart disease (CHD) is challenging.
Purpose of the Study:
- To investigate the association between lymphopenia following CPB and early postoperative infection in children.
- To determine if monitoring lymphocyte subpopulations can predict infection risk after CPB.
Main Methods:
- Retrospective analysis of 41 children under 2 years old who underwent CPB.
- Measurement of inflammatory cytokines (IL-6, IL-8, IL-10, IL-1β, TNF-α), CRP, PCT, and lymphocyte subpopulations (CD3+, CD4+, CD8+).
- Comparison between 9 infected and 32 non-infected subjects.
Main Results:
- Infected subjects showed higher inflammatory cytokine levels and lower absolute lymphocyte counts (CD3+, CD4+, CD8+).
- T-cell impairment correlated with elevated IL-10 levels.
- Specific thresholds for CD3+, CD4+, and CD8+ T-cells predicted early postoperative infection.
Conclusions:
- Elevated inflammatory cytokines post-CPB contribute to T-cell lymphopenia, increasing infection risk in infants and young children.
- Monitoring T-cell lymphopenia may be a more effective predictor of early postoperative infection than CRP or PCT.
Background:
children who undergo CPB operations are at an elevated risk of infection due to immunosuppression. This study aims to investigate the association between lymphopenia following CPB and early postoperative infection in children.
Methods:
A retrospective analysis including 41 children under 2 years old underwent CPB. Among them, 9 subjects had an early postoperative infection, and 32 subjects were period-matched without infection. Inflammatory cytokines, serum CRP and PCT values were measured in plasma, additionally, circulating total leucocyte and lymphocyte subpopulations were counted.
Results:
Infected subjects exhibited significantly higher levels of inflammatory cytokines, including IL-6, IL-8, IL-10, IL-1β and TNF-α, than non-infected subjects after CPB. Additionally, lower absolute number of lymphocyte and their subpopulations CD3+ T cells, CD4+ T-helper cells and CD8+cytotoxic T-cells, were observed in infected subjects. The impairment of T-cells Immune was found to be associated with higher levels of inflammatory cytokines IL-10. The ROC demonstrated that the absolute number of CD3+ T-cells <1934/ul, CD4+ T helper cells <1203/ul and CD8+cytotoxic T-cells <327/ul were associated with early postoperative infection.
Conclusion:
Higher levels of inflammatory cytokines resulted in T-cells lymphopenia after CPB, which significantly increasing the risk of postoperative infection in infants and young children.
Impact:
Infection complications after cardiopulmonary bypass (CPB) in pediatric CHD patients are serious issues, identifing the infection from after CPB remains a challenging. CPB can release numerous inflammatory cytokines associated with T cells lymphopenia, which increases the risk of postoperative infection after surgery. Monitoring T cells lymphopenia maybe more beneficial to predict early postoperative infection than C-reactive protein and procalcitonin.
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